Is Substance Abuse a Type of Mental Disorder?

The simple answer to “Is substance abuse a type of mental disorder?” is “yes”. However, the way in which substance abuse fits into mental health classifications is complex and has been the subject of decades of research and discussion. The most current version of the American Psychiatric Association’s “bible” on the names, symptoms and diagnostic features of every recognized mental illness, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse or substance dependence. Instead, the currently recognized diagnosis is substance use disorder, which is further defined by severity and number of diagnostic criteria met by an individual.

A substance use disorder involves the repeated use of a substance, alcohol and/or drugs, that results in a failure to follow through and meet significant responsibilities. Addiction is known to make changes in the brain which can disrupt an individual’s normal hierarchy of needs and desires. The resulting compulsions redirect behaviors from what were once priorities to focus almost exclusively on obtaining and using the addictive substance, with little to no regard for consequences. According to the DSM-5, the diagnosis of substance use disorder is based on evidence of the following:

  • impaired control
  • social impairment
  • risky behavior with regard to substance use
  • other pharmacological criteria

Some of the most common substance use disorders in the United States include:

  • Alcohol Use Disorder (AUD) – the severity (mild, moderate, or severe) of an alcohol use disorder is determined by the number of criteria met, such as, problems controlling alcohol intake, continued use regardless of resulting problems, development of a tolerance leading to increased consumption and the associated health issues, drinking that leads to situations putting the individual at risk and the development of withdrawal symptoms.
  • Tobacco Use Disorder – according to the CDC, smoking is the leading cause of preventable death and damages nearly every organ in the human body, often leading to cancer, respiratory disorders, heart disease, stroke and other illnesses.
  • Cannabis Use Disorder – after alcohol and tobacco, marijuana is the most-used drug in the United States. The immediate effects include distorted perception, difficulty with concentration and focus and decreased motor skills. Long-term use of the drug is more troubling, including respiratory infections, impaired memory, exposure to carcinogens and an increased risk of developing mental illness and poor cognitive functioning in youth.
  • Stimulant Use Disorder – the most commonly abused stimulants are amphetamines, methamphetamine, and cocaine. Abuse of stimulants leads to cravings, inability to control use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance and spending increased amounts of time focused on obtaining and using stimulants.
  • Opioid Use Disorder – Opioids, like oxycodone and hydrocodone, reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation and can interfere with breathing. Highly addictive, prescription opiates can be expensive and hard to get, which leads to many users switching to the less costly heroin. Besides the ever-present risk of overdose, purchasing heroin on the street leads to an extremely high rate of deaths due to impurities and questionable drugs with the heroin.

Treatment for substance use disorders is available. While difficult, the combination of rehabilitation, medications, support groups and talk therapy can be effective.