What is a Substance Use Disorder?

What is a Substance Use Disorder (SUD)? This seems like a really good place to start this little blogging adventure. Why? Because when we start talking about drug and alcohol usage the conversation can get really loaded really quickly. We'll talk more about that later, but first let's be very clear about what we're talking about.

So let's break it down. First, we have to talk about substances. People use substances all the time. I just had a delicious croissant breakfast sandwich and a glazed donut. Both of these are substances that I used. Some other substances include alcohol, cocaine, heroin, nicotine, green tea, coffee, sugar, Cadberry Eggs, and cupcakes. Calm down! Before you kick my butt for comparing cupcakes to heroin, let me finish. These are all substances. Everybody uses substances. So using cupcakes could be referred to as Cupcake Use. The thing about alcohol and illegal drugs is that using them often leads to serious problems in functioning in several areas of your life. For many people, this is true of food as well, but that's not my specialty, kids, so we'll leave that for another time.

So, people who use substances generally fall into two categories:

Substance Use: This means that you use a substance, but there are NO negative consequences associated with your use. This could include experimental use where you tried a substance once or twice, but decided you didn’t like it. Or, this person might like to use, but there is no distinct pattern. They may use on special occasions, or “once in a while”. Many people who have substance use disorders characterize their use in this way, but the people around them definitely wouldn't. This is what denial looks like, by the way. That's for another post as well. Theoretically, you could be a casual user of any drug, but it's safe to say some drugs are less likely to be "casual" than others. In my personal experience, people don't remain casual heroin or methamphetamine users for long.

Substance Use Disorder: This is a straight up diagnosis. This diagnosis is characterized by a pattern of behaviors related to substance use that is indicative of a disease process. The DSM 5 calls this a pathological pattern of behaviors. If you have a substance use disorder you're using in a way that causes noticeable problems in your life. We would say that those problems are mild, moderate, or severe based on how much they are screwing with your life. We look at four areas of how your dealing with stuff to determine this.

·       impaired control

·       social impairment

·       risky use

·       pharmacological criteria (tolerance and withdrawal)

We'll talk more about specific examples of these later. This is all a long-winded way of saying, if it ain't a problem, it ain't a problem. But figuring out if it is a problem requires a very hard look at your life. Preferably before you're sitting in county jail.

Fun fact about jail. In many county jails men can't wear underwear at all. Also, jails smell funny. You do not want to go to there.

So, next time we'll look at more specific examples of this stuff can screw up your life. It's like a Cosmo Quiz of Dysfunction, kids. Until then!