Substance Related Disorders: Everything You Need To Know

A Substance-Related Disorder is a category of conditions which involve any form of substance abuse, substance dependence, and disorders that specifically arise from drug abuse.

There are two distinct types of Substance-Related Disorders – Substance-Induced Disorders and Substance Use Disorders.

Substance-Induced Disorders refers to the immediate effects (e.g. intoxication) or discontinuation (e.g. withdrawal) of substance use. Substance Use Disorders meanwhile involve the negative consequences that arise from continued use of substances – typically involving addiction.

It is common for people to have mental health conditions comorbidly with a Substance-Related Disorder. Both types of disorder result in functional impairment, and can be significant burdens to live with. Fortunately though, treatment is available.

Types of Substance Related Disorders

The different disorders are grouped by two distinct areas – Substance-Induced Disorders and Substance Use Disorders.

Substance-Induced Disorder: A Substance-Induced disorder refers to the immediate effects of substance use, such as intoxication and delirium, along with the immediate effects of discontinuing a substance, namely withdrawal. This area is also concerned with the resulting symptoms of both use and discontinuation – especially in relation to the possible mood disorder or psychotic symptoms that may develop. Treatment for Substance-Induced Disorders will vary, dependent on the symptoms present. There are considered to be nine Substance-Induced Disorders.

• Substance-induced Depressive Disorders
• Substance-induced Bipolar and Related Disorders
• Substance-induced Anxiety Disorders
• Substance-induced Obsessive-Compulsive and Related Disorders
• Substance-induced Psychotic Disorder
• Substance-induced Sleep Disorders
• Substance-induced Sexual Dysfunction
• Substance-induced Neurocognitive Disorders
• Substance-induced Delirium

Substance Use Disorder: A Substance Use Disorder involves the negative effects caused by long-term or continued use of a substance. Disorders can become more severe as time progresses, with an individual typically become addicted. Substance Use Disorders are also associated with abuse and dependence. Substance Dependence concerns the state that develops following repeated administration of a drug. Substance Abuse refers to the use of a drug in a way that results in harm to the individual consuming it. Typically, an individual will use the drug either in excessive amounts, or through a method that results in harm to them. A Substance Use Disorder results in impairment in multiple areas – including both physical and psychological effects. Treatment will vary, dependent on circumstance and presenting symptoms. There are considered to be ten Substance Use Disorders.

• Alcohol Use Disorder
• Amphetamine Use Disorder
• Cannabis Use Disorder
• Cocaine Use Disorder
• Inhalants Use Disorder
• Opioid Use Disorder
• Phencyclidine Use Disorder
• Sedatives, Hypnotics or Anxiolytics Use Disorder
• Tobacco Use Disorder
• Other (or Unknown) Substance Use Disorder

A range of substances are involved in abuse. Benzodiazepines, barbiturates, opioids, alcohol, cannabis, inhalants, stimulants and amphetamines are just some of the classes of drugs that are abused regularly.

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Symptoms of Substance Related Disorders

There is such a huge array of possible symptoms of Substance-Related Disorders. Different substances have the potential to cause different symptoms. As seen with Substance-Induced Disorders, short-term damage can be severe. But symptoms can also cause harm in the long-term – with suicidal ideation and self-harm both common. Below, some of the symptoms are listed.

Substance-Induced Disorder:

• Intoxication – This refers to a state involving the altering of perception or euphoria, along with the cognitive, physical and social functioning, seen in reaction to the consumption of a drug, often in a higher than therapeutic dose, or while being abused. When an individual becomes intoxicated, they are at risk of behavioural changes. In the worst cases, an overdose, as well as death, is possible.
• Withdrawal – Withdrawal refers to the effects, symptoms and behavioural changes that take place when the consumption of a substance either stops abruptly, or reduces slightly. In order for the disorder to be classified within the substance-induced disorder class, distress, along with functional impairment, must be visible. Re-administering the substance will typically see withdrawal symptoms cease. For a disorder to be present in this context, only those abusing a substance should be considered to have a substance-induced disorder.
• Substance-Induced Delirium – Delirium is a state of general confusion. It is accompanied by poor awareness, abnormal thoughts, and altered perception. It is common for a state of delirium to appear as a result of substance abuse. It is particularly common during the withdrawal phase of abusing a substance. Opioids and Benzodiazepines are particularly renowned for causing delirium.
• Substance-Induced Mental Disorders – Substance abuse also has the potential to cause a range of mental disorders, due to changes in mental state. These are disorders that develop in those who haven’t encountered mental health problems prior to engaging in substance use.

Substance Use Disorders:

• Addiction – The compulsive use of a substance, despite the ongoing negative consequences brought about by use.
• Dependence – The state associated with withdrawal syndrome, when an individual becomes dependent, either physically or emotionally, on a drug. Upon withdrawal, physical symptoms like sweating, headaches, tremors and vomiting is normal.
• Tolerance – Needing to consume a higher dose of the substance in order to obtain the desired effects.
• Involves using one or more substances in a way that leads to impairment.
• Often involves attempting to cut down on use, though an inability to do so.
• Cravings are common.
• Specific symptoms depend on the type of Substance Use Disorder present.

These symptoms will typically lead to an individual’s behaviour changing. Typical changes include mood swings, impulsivity, and physical ailments.

There are many potential issues associated with substance-related disorders, especially when substance abuse takes place on a long-term basis.

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Causes of Substance Related Disorders

Substance-Related Disorders encompass a wide array of potential ailments and impairments that are generally involved with the misuse or abuse of a substance, both on a short-term and long-term level.

While the substance itself is the cause of these conditions, it is evident that not everyone who uses substances goes on to develop a disorder. Some risk factors appear to exist:

• Genetics: Children born to those who have pre-existing substance-related disorders have an increased risk of developing their own disorder. This appears to imply a genetic risk.
• Type of Drug: The type of drug that is consumed too is a crucial factor. Some drugs have more of an addiction liability. For instance, Ecstasy is a harmful drug, and long-term use can result in an increased chance of dependence. But the harm the drug does is very little in comparison to that of other drugs, like Heroin – which is renowned for being highly addictive, as well as causing physical ailments.
• Teenage Use: Use of substances in teenage years could be a key factor. Symptoms associated with teenage use of substances could easily continue into adulthood.
• Self-Medication: This is a key area. Many people choose to self-medicate when they feel low, or go through a traumatic time. Those with pre-existing mental health conditions like Depression or Anxiety may be more at risk of developing a substance-related disorder, due to the self-medicating aspect. They may quickly become reliant on the substance to give them some happiness, something that can quickly spiral out of control.
• Lack of Support: Similar to the above, individuals who have a lack of support from others may be more prone to developing a substance-related disorder. Not having support from anyone can lead to a lack of control in life. A lack of dependents too can lead an individual to neglecting life responsibilities – leading to more reckless behaviour.
• Abuse: Physical, sexual or emotional abuse are risks for any form of harmful behaviour to develop, including substance abuse. 
• Self-Control: Those that have lower levels of self-control may be unable to stop themselves from taking substances on a long-term basis. When exposed to harmful substances, they may not have the control to show restraint.
• Chronic Pain: Someone who has chronic pain issues will commonly develop a tolerance to a substance they use for pain relief. They may need to use substances with higher potency, and ultimately struggle to ever stop abusing.

It can be very difficult to pinpoint exactly what leads someone to suffering from a substance-related disorder.

It seems that many different factors are involved, though certain risk factors are present.

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Diagnosis of Substance Related Disorders

Substance-Related Disorders cannot be diagnosed through a medical examination. Instead, the first step is to visit a Doctor.

A doctor may ask a series of questions regarding the abuse of the substance. Anything discussed will remain confidential. The impact too of symptoms will be questioned.

Questions on a personal history of substance abuse may also be asked – so that the doctor can get a thorough picture of how the substance abuse is affecting an individual.

It is crucial that in order to receive an accurate diagnosis that the patient answers each question truthfully.

Substance-Induced Disorder

It can be difficult to diagnose a substance-induced disorder – mainly due to the similarity and overlap between symptoms of psychiatric disorders and those seen with intoxication and withdrawal.

For a Substance-Induced Disorder to be diagnosed, the following criteria will generally need to be satisfied:

• The disorder developed during or within a month of substance intoxication or withdrawal
• The symptoms of the disorder remain for at least a month following the substance not being taken anymore
• The symptoms result in distress for the individual
• No trace or symptoms of the disorder before substance use
• The substance that a person has misused should be known to potentially cause the disorder that the person is suffering from

If the above criteria have all been satisfied, then the individual will also need to satisfy the diagnostic criteria for the psychiatric disorder that has been caused by substance use.

For instance, someone with Substance-Induced Depressive Disorder will need to meet the diagnosis for Depression.

By adding the extra criteria above, it is possible to distinguish between substance-induced disorders and disorders that have arisen through a different cause. This has important implications for the treatment phase.

Substance Use Disorder

In terms of the actual symptoms, for a Substance Use Disorder to be diagnosed, a patient will generally show at least two of the following symptoms in any given year.

• There is evidence of the individual developing a tolerance to the substance – meaning they require a higher dose of a substance to obtain its anticipated effects.
• There is evidence of withdrawal symptoms – such as the effects on mood, behaviour and health – when consumption of the substance is stopped abruptly, or slightly reduced
• The person uses more of a substance than they had intended on when first trying the substance
• The person is unable to stop using the substance, despite exhibiting a desire to do so.
• The person continues to use the substance despite knowing the harm it does to them, either/both mentally and physically.
• Person has persistent cravings to use the substance.
• The use of the substance causes an individual impairment in multiple areas of their life e.g. work or socially

The more symptoms that are present, the more severe the Substance Use Disorder is considered to be.

As seen, there are different diagnostic criteria across the two different types of disorders. The sooner help is sought, the sooner recovery will be possible.

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Treatment of Substance Related Disorders

Substance-Related Disorders are difficult to live with. However, the good news is that with the right treatment and support, a full recovery is possible.

The exact treatment plan that an individual will receive depends on a range of factors.

Firstly, the type of substance-related disorder that is present will be important. Both types of Substance-Related Disorders have their own treatment plan.

Substance-Induced Disorders

The important consideration with substance-induced disorders is that the disorders should clear up on their own, once the effect of withdrawal and intoxication have worn off.

In instances when they don’t, and the disorder persists, medication is possible. Typically, medication would be prescribed in the short-term. In any case, therapy and detoxification should take place.

• Self-Help: Any recovery from substance-related disorders must involve the individual, who should enter treatment motivated to change their ways. Without the individual involved putting in substantial effort, the chances are treatment won’t work effectively. But with the right effort and motivation, treatment can certainly work.

• Detoxification: Generally, the first step involved is detoxification. This is the process where an individual gradually stops taking the substance. A nurse or doctor can help provide a detoxification plan, which hopefully will be supported by family members and friends. Detoxification will return the individual to a state pre-substance consumption. It therefore builds the foundation for a recovery. However, while detoxification deals with the dependence and addiction, it does not address the psychological element. This is where therapy can help.

• Talking Therapy: Some form of talking therapy can be very useful. Cognitive Behavioural Therapy and Family Therapy are two particular therapies that can provide help. Therapy can help an individual to learn more about their behaviour, and the effects it has on those around them. A key goal is to try and plan a method for avoiding addictive substances – therefore hopefully preventing this occasion from happening again, or worse, turning into a fully-blown Substance Use Disorder. Therapy also tries to teach healthier ways of living, and non-harmful ways of finding satisfaction. There are many different types of therapy that could help, including:

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Family Therapy: Family therapy is a form of therapy that is delivered with close family members. The therapy can focus on how a person’s actions have caused problems for their wider family. In many cases, the family will be told not to condone nor reward behaviour that is associated with their problematic behaviour. In theory, by seeing the damage their behaviour can cause, this can help the individual change their behaviour.

Therapeutic Communities: Therapeutic Communities are for people with long-standing and complex emotional problems. These communities host groups of people, where individuals will often attend for weeks, and even months in some cases – typically attending a large house. Most therapy is provided in small groups. Patients are taught about interacting with others, and by partaking in group activities, learn the importance of getting on with others. When disagreements arise, the patients in the treatment are entrusted with setting rules to prohibit conflict. The patients also improve social skills by engaging in common behaviour – such as meal preparation. Not everyone is allowed into a Therapeutic Community, with the patients already situated at the community deciding whether or not an individual can enter. Overall, these measures can lead to an improved chance of recovery.

• Medication: Substance-Induced Disorders shouldn’t need to be treated by a psychotropic medicine. But if agitation is present, or symptoms are difficult to deal with, an antidepressant or benzodiazepine could be prescribed. Antidepressants can help to improve low mood and poor motivation, while Benzodiazepines are useful for when an individual is agitated or highly anxious.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Benzodiazepines: Benzodiazepines are fast-acting sedatives, which can relax an individual and improve their mood. Any anxiety should fade rapidly upon consumption. The individual should therefore have an improved level of functioning. Benzodiazepines cannot be taken for more than a few weeks, due to acute risk of both physical and psychological dependence.

Substance-Use Disorders

Unlike Substance-Induced Disorders, Substance Use Disorders will very, very rarely clear up on their own. Therefore, a multiple-faceted approach to treatment should be taken. Therapy, detoxification, medication and self-help are all factors involved.

• Self-Help: Any recovery from substance-related disorders must involve the individual, who should enter treatment motivated to change their ways. Without the individual involved putting in substantial effort, the chances are treatment won’t work effectively. But with the right effort and motivation, treatment can certainly work.

• Detoxification: Generally, the first step involved is detoxification. This is the process where an individual gradually stops taking the substance. A nurse or doctor can help provide a detoxification plan, which hopefully will be supported by family members and friends. Detoxification will return the individual to a state pre-substance consumption. It therefore builds the foundation for a recovery. However, while detoxification deals with the dependence and addiction, it does not address the psychological element. This is where therapy can help.

• Talking Therapy: Some form of talking therapy can be very useful. Cognitive Behavioural Therapy and Family Therapy are two particular therapies that can provide help. Therapy help an individual to learn more about their behaviour, and the effects it has on those around them. A key goal is to try and plan a method for avoiding the addictive stimulus. Therapy also tries to teach healthier ways of living, and non-harmful ways of finding satisfaction. Long-term management is key.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Family Therapy: Family therapy is a form of therapy that is delivered with close family members. The therapy can focus on how a person’s actions have caused problems for their wider family. In many cases, the family will be told not to condone nor reward behaviour that is associated with their problematic behaviour. In theory, by seeing the damage their behaviour can cause, this can help the individual change their behaviour.

Therapeutic Communities: Therapeutic Communities are for people with long-standing and complex emotional problems. These communities host groups of people, where individuals will often attend for weeks, and even months in some cases – typically attending a large house. Most therapy is provided in small groups. Patients are taught about interacting with others, and by partaking in group activities, learn the importance of getting on with others. When disagreements arise, the patients in the treatment are entrusted with setting rules to prohibit conflict. The patients also improve social skills by engaging in common behaviour – such as meal preparation. Not everyone is allowed into a Therapeutic Community, with the patients already situated at the community deciding whether or not an individual can enter. Overall, these measures can lead to an improved chance of recovery.

• Medication: While this may seem counter-productive, medications actually have the potential to play an important role in the treatment of Substance Misuse. Many medications actually have a license for substance abuse treatment. Medications like Methadone, Buprenorphine, Naltrexone and even the antidepressant Bupropion all can be useful. The medication that is used will depend upon the substance that is being abused. For instance, a medication named Disulfiram is particularly useful for treating alcohol-related disorders.

It is common for people with a Substance Use Disorder to have a comorbid mental health condition like Depression or Anxiety. Treatment should also involve help for these areas too, which can result in all relevant symptoms being treated.

Substance-Related Disorders are difficult conditions to live with. Fortunately, treatment is available, and it should lead to an improvement in quality of life. In many cases, a full recovery can be made, leading to a better and healthier life being lived. 

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Living with Substance Related Disorders

Substance Abuse is an area which continues to take its toll on the entire world. There are epidemics gripping numerous countries.

For those who live with a substance-related disorder, it can be difficult to cope from day-to-day. Many people will have turned to substances in an effort to cope with intense emotional pain.

But it isn’t just the individual with the disorder that is affected, it is their family, friends and dependents too. There are ways to cope better, check out the article below for more.

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Prognosis

The prognosis of Substance-Related Disorders are contingent on a huge number of factors. Substance-induced Disorders are typically easier to recover from compared to Substance Use Disorders.

Areas like adherence to therapy, the substance involved, the personality of the individual, and anything else relevant is key.There is also the risk of health problems, legal problems, and even death.

Recovery is certainly a possibility, but it can be difficult to achieve this, with high relapse rates evident. But, with the right motivation, treatment plan and support system, a person should be able to see a marked improvement in the quality of their life – hopefully free of illicit substances.

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See Also

• Substance Related Disorders Homepage
• A-Z of Mental Health Conditions
• Therapy Home
• Mental Health General Homepage