Behaviors that Make up the Disorder
The behaviors that define substance use disorder are separated into 11 categories or criterion. The first four categories relate to impaired control. The first category is that the individual ingests the substance for longer and in greater quantities than they had planned. Next the person reports the desire to cease use but is unsuccessful in either stopping or cutting down. Third, the amount of time spent acquiring using and recovering from the substance is assessed, and fourth the individual craves the substance almost any time but specifically in concert with environmental queues that have been associated with previous use. This last criterion is measured by asking whether the person was unable to think of anything else when they had the obsession and it can be a yardstick as to the likelihood of relapse when measured during treatment (American Psychiatric Association, 2013).
The next set of markers in substance use disorder is that of pathological behaviors, numbers 5 through 7 are those that impair social functioning. First, the person is unable to satisfy commitments at work or school. Next the person, although experiencing major crises with relationships or in social situations, continues to use despite the problems. And last the sufferer chooses substance use over important activities that include work, social engagements or recreational undertakings (American Psychiatric Association, 2013).
In criterion 8 and 9 the identifier is risky use. The individual undertakes use in the face of persistent problems and at great risk especially when it is a hazard. Next there may be use even though there are physical or psychological problems that are exacerbated by the use. This is identified when the person fails to discontinue use despite knowledge of the problem (American Psychiatric Association, 2013).
The Last criterion for substance use disorder in (American Psychiatric Association, 2013), 10 and 11, fall under the parameter of pharmacology. First, the individual shows tolerance for the substance. This occurs when the dose of the substance must be increased to achieve the same effect. There are issues with tolerance determination that include a person’s sensitivity to the initial substance use. In some cases a person might be able to tolerate more than another. However, testing of the levels of a substance in the blood juxtaposed against the level of functionality while intoxicated can indicate the presence of tolerance.
Criterion 11 involves withdrawal. In this area, the subject discontinues use and concentrations of the substance decrease. This precipitates withdrawal symptoms. Not all substances cause withdrawal symptoms. In the case of those drugs that do cause symptoms of withdrawal, the symptoms may include an increase production of histamines, anxiety, nausea, cramps and even pain (MedlinePlus Medical Encyclopedia, 2017). It should be noted that due to the fact that some substances do not cause these symptoms, neither tolerance nor withdrawal have to be noted for a diagnosis of substance use disorder, but can be used to consider severity.
The final aspect of the definition for substance use disorder has to do with severity and specifications. The DSM 5 uses continuums to diagnose mental illness. In the case of substance use disorder the levels are from mild, moderate to severe. This corresponds with the number of criteria that are met during assessment. Mild diagnosis would be 2 or three symptoms. Moderate would be four or five symptoms and severe for a diagnosis would occur when the subject reports six or more of the earlier criteria. The severity can also change over time with regard to the number of symptoms.
The specifiers used in substance use disorder are as follows: “in early remission,” in most cases this would specify that the person has been free from the earlier symptoms for at least 3 months but less than 12 months; “in sustained remission,” This would occur if the symptoms have not been met for more than 12 months; “on maintenance therapy,” not all substances would include this specifier but it would appear if the individual were taking continuous maintenance medication such as an opiate agonist, partial agonist, agonist/antagonist or full antagonist with the requirement that none of the symptoms for substance use disorder have been met for that medication; and “in a controlled environment,” which is used to note that the individual is in an environment where the substance of abuse is not available. Each of these specifiers is dependent upon the type of substance and is explained within the criteria for that substance (American Psychiatric Association, 2013).