creation date: 2025-11-20 15:49
tags: Pathologies
Substance Use Disorder
Background
Definitions
Substance use disorder (SUD) is an umbrella term used to describe a problematic pattern of substance use, which includes alcohol, marijuana, opioids, and other illicit drugs.
The exact details of each substance is discussed separately.
Clinical Presentation
Signs & Symptoms
The presentation of SUD varies depending on the substance of abuse.
History & Physical Exam
History should include the type of substance which may include:
- Caffeine, tobacco/nicotine, alcohol
- Prescription medications (eg. opioids, sedatives/hypnotics, stimulants)
- Marijuana
- Illicit drugs (eg. cocaine, opioids, hallucinogens, inhalants)
For each substance determine:
- Pattern of use
- Last use
- Recent frequency
- Quantity per use
- Route of administration (oral, smoking, intranasal inhalation, subcutaneous injection, intramuscular injection, intravenous injection)
- History of overdose
Additionally, a comprehensive mental health history should be obtained in addition to a mental status examination.
Diagnosis
Criteria
The DSM-5-TR describes SUD as follows:
A problematic pattern of use leading to clinically significant impairment or distress is manifested by two or more of the following within a 12-month period:
- Often taken in larger amounts or over a longer period than was intended.
- A persistent desire or unsuccessful efforts to cut down or control use.
- A great deal of time is spent in activities necessary to obtain, use, or recover from the substance’s effects.
- Craving or a strong desire or urge to use the substance.
- Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by its effects.
- Important social, occupational, or recreational activities are given up or reduced because of use.
- Recurrent use in situations in which it is physically hazardous.
- Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance.
- Withdrawal.
The severity of the disorder is classified by the number of criteria met:
- Mild: 2-3 criteria
- Moderate: 4-5 criteria
- Severe: ≥6 criteria
Work-up
Laboratory tests are not useful for diagnosis but may aid assessment of recent drug use. Typical drug screens include:
- Amphetamine
- Cocaine
- Cannabis
- Opioids
- Phencyclidine
Management
Management generally vary based on substance used and are discussed separately.
In many cases, treatment may have to be adjusted based on assessment findings including:
- Social issues (eg. homelessness)
- Severity requiring multiple treatment modalities
- Disabling psychiatric disorder
- Comorbid medical conditions requiring integrated medical care