Substance Related Disorder

Clinical Picture

Substance Related Disorder are disorders of intoxication, dependence, abuse, and substance withdrawal caused by various substances, both legal and illegal. These Substance Related Disorder include: alcohol, amphetamines, caffeine, inhalants, nicotine, prescription medications that may be abused (such as sedatives), opioids (morphine, heroin), marijuana (cannabis), cocaine, hallucinogens, and phencyclidine (PCP).

A Substance Related Disorder is a condition (such as intoxication, harmful use/abuse, dependence, withdrawal, and psychoses or amnesia associated with the use of the substance) associated with substance abuse, often involving maladaptive behaviors over a long period of time. In order to be diagnosed with substance dependence an individual must display at least three of the following for a 12-month period: “development of tolerance to the substance, withdrawal symptoms, persistent desire/unsuccessful attempts to stop using the substance, ingestion of larger amounts of substance, declined life functioning, and persistent use of substance.”  

Substance abuse has been found to be most common among people 18 to 25 years of age and is also more common in males than females and in urban residents compared to those who live in rural areas. Over 50 percent of individuals with substance abuse issues have been found to have another psychiatric disorder, something that is termed Comorbid Psychiatric Diagnosis. Substance abuse is not the same in every person; it can differ in terms of the substance abused, the pattern of use and also the type of comorbid illness present, if any.

According to the mental health clinician’s handbook, Diagnostic and Statistical Manual of Mental Disorders (the DSM), 5th edition text revised (DSM 5), all of the substances listed above, with the exceptions of nicotine and caffeine, have disorders of two types: substance use disorders and substance-induced disorders. Substance use disorders include abuse and dependence. Substance-induced disorders include intoxication, withdrawal, and various mental states (dementia, psychosis, anxiety, mood disorder, etc.) that the substance induces when it is used.

Types of Substance Related Disorder

Substance Use: Intake of psychoactive materials 

Substance Intoxication: Altered cognition or behavior due to substance use 

Substance Abuse: Use that results in social/occupational/health problems 

Substance Dependence: Use marked by tolerance and/or withdrawal 

Substance Abuse is continued use of a substance in spite of school- or work-related or interpersonal problems, but the user has not gotten dependent on the substance. The individual who abuses a substance may experience legal problems and may have problems fulfilling responsibilities, such as caring for a child. Intoxication is the direct effect of the substance after an individual has used or has been exposed to the substance. Different substances affect individuals in various ways, but some of the effects seen in intoxication might include impaired judgment, emotional instability, increase or decrease in appetite, or changed sleep patterns.

Substance Dependence is characterized by continued use of a substance even after the user has experienced serious substance-related problems. The dependent user desires the substance (“craving”) and needs more of the substance to achieve the effect that a lesser amount of the substance induced in the past. This phenomenon is known as tolerance. The dependent user also experiences withdrawal symptoms when the substance is not used. Withdrawal symptoms vary with the substance, but some symptoms may include increased heart rate, shaking, insomnia, fatigue, and irritability.

Traditional Classes of Substances

1. Depressants – e.g. alcohol, narcotics 
2. Stimulants  – e.g. cocaine, amphetamines 
3. Hallucinogens – e.g. cannabis, psilocybin, Lysergic acid diethylamide(LSD)
4. Other Substances with Psychoactive Effects

The DSM 5 does not recognize caffeine abuse or dependence, but does recognize the caffeine-induced disorders caffeine intoxication (restlessness, nervousness, excitement, etc. after caffeine consumption), caffeine- induced anxiety disorder (feelings of anxiety or panic attacks after caffeine consumption), and caffeine induced sleep disorder (usually insomnia, but some may experience excessive sleepiness when caffeine is not consumed).As for nicotine, the DSM 5 recognizes nicotine dependence and nicotine withdrawal.

List of Disorder of Substance Related Disorder

The DSM-5 lists disorders in the following categories:

• alcohol-related disorders
• amphetamine-related disorders
• caffeine-related disorders
• cannabis-related disorders
• cocaine-related disorders
• hallucinogen-related disorders
• inhalant-related disorders
• nicotine-related disorders
• opioid-related disorders
• phencyclidine-related disorders
• sedative-, hypnotic-, or anxiolytic-related disorders
• polysubstance dependence