Substance-related Disorder

Substance-related disorders, also known as substance use disorders, can lead to significant societal problems and are most prevalent among individuals aged 18–25. These disorders are more likely to occur in men than women and are more common in urban residents compared to rural residents.

General medical facilities often report that 22% of their patients have substance-related disorders, which may lead to psychiatric disorders later on. Over 50% of individuals with substance-related disorders will have a dual diagnosis, where they are diagnosed with both substance use and a psychiatric condition such as major depression, personality disorder, anxiety disorders, or dysthymia.

Substance use refers to the patterned consumption of a substance in amounts or methods harmful to oneself or others. The substances used often result in levels of intoxication that impair judgement, perception, attention, and physical control. While illegal drugs and alcohol are commonly associated with substance use, prescription drugs and tobacco are increasingly becoming prevalent problems.

Signs and Symptoms

Common symptoms of substance-related disorders include sudden changes in behaviour, mood swings, issues with work or school, changes in eating and sleeping habits, and shifts in social relationships. Individuals may exhibit secretive or suspicious behaviour, anger, paranoia, or a lack of concern for their future. They may also experience a sudden, unexplained need for money, leading to borrowing or stealing.

People who use substances often face unpleasant withdrawal symptoms if the drug is taken away. Even after prolonged periods of abstinence, individuals may experience strong cravings, a condition known as being "clean." Research on mice has helped explain these cravings and suggests that substance-related disorders may be classified as a subcategory of personality disorders according to the DSM-5.

Classification and Terminology

Substance-related disorders were initially categorised into "substance use disorders" (SUD) and "substance-induced disorders" (SID). Although DSM-IV makes a firm distinction between the two, SIDs often occur in the context of SUDs.

Substance-induced Disorders

Substance-induced disorders include medical conditions directly attributed to substance use, such as intoxication, withdrawal, substance-induced delirium, psychosis, and mood disorders.

Substance Use Disorders

Substance use disorders encompass substance use and dependence. In DSM-IV, these conditions are diagnosed separately, but DSM-V proposes combining them into a single condition called "Substance-use disorder."

Changes in Classification

The DSM-5 now combines substance abuse and substance dependence into a single continuum known as substance use disorder, which requires more symptoms for a diagnosis. Each substance is considered a separate disorder based on the same criteria. The DSM-5 also distinguishes between dependence and addiction as two separate disorders.

Complications

Substance use can lead to severe physiological, psychological, and social complications. Physiological damage may include alcohol-induced diseases such as alcoholic hepatitis, liver disease, and cardiomyopathy. Substance use is also associated with premature ageing, fertility issues, brain damage, and a higher risk of infectious diseases due to a weakened immune system.

Long-term substance use can result in personality changes, including depression, paranoia, and anxiety, which may be related to psychological disorders. Substance use often coincides with personality disorders such as borderline personality disorder and can lead to severe brain damage, impairing behaviour control and potentially leading to addiction.

Socially, substance use is often viewed negatively, leading to social discrimination. Many drugs can result in criminal convictions, either due to their illegal status or the unlawful methods used to obtain them. Substance use increases the likelihood of criminal or anti-social behaviour.

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Self-assessment MCQs (single best answer)

Which age group is most prevalent for substance-related disorders?

Which gender is more likely to exhibit substance-related disorders?

What percentage of patients in general medical facilities report substance-related disorders?

What percentage of individuals with substance-related disorders have a dual diagnosis?

Which of the following is NOT a common symptom of substance-related disorders?

Which condition is characterised by strong cravings even after prolonged periods of abstinence?

In DSM-5, which term is used to describe the combined condition of substance abuse and substance dependence?

Which of the following is NOT classified as a substance-induced disorder?

Which of the following is a physiological complication associated with substance use?

What social consequence is often associated with substance use?