Substance-related and addictive disorders
Substance Use Disorders
A substance use disorder is a problematic pattern involving a specific substance that causes clinically significant distress or impairment; it is a health condition, not a moral judgement.
A pattern, not a stereotype
The diagnosis is considered separately for alcohol, cannabis, opioids, stimulants, sedatives and other substance classes. It requires at least two of 11 criteria within the same 12-month period, with severity based on the number of criteria.
Possible signs include using more than intended, repeated unsuccessful attempts to cut down, craving, substantial time spent using or recovering, neglected obligations, hazardous use and continued use despite harm. Tolerance and withdrawal can occur but are not required.
Assessment and safety
- Frequency alone, use alone or a positive toxicology result does not establish the disorder; the clinician examines the full functional pattern.
- Physical health, mental health, pain, medicines, housing, work and legal or family pressures are assessed alongside the substance use.
- Abrupt withdrawal from heavy alcohol or sedative use can cause seizures or delirium and should be medically planned.
Treatment and harm reduction
Care may combine motivational interviewing, CBT, contingency management, family support and medication where evidence supports it. Methadone or buprenorphine are established treatments for opioid use disorder; naloxone access reduces the risk of death from opioid overdose.
Detoxification is only an initial step, not complete treatment. Harm reduction can include avoiding dangerous combinations, infection testing, sterile equipment where available and an overdose plan, while longer-term treatment supports recovery goals.
When urgent help is needed
Slow or stopped breathing, inability to wake, blue lips, seizures, severe confusion, hallucinations or loss of consciousness is an emergency. For suspected opioid overdose, administer naloxone if available and you know how, call emergency services and do not leave the person alone.