Substance Use Disorder: Criteria, Types, Risks, and Treatment

Substance use disorder (SUD) is one of those topics that comes with a lot of baggage: stigma, shame, awkward family conversations,
and the occasional “I can quit anytime” pep talk that doesn’t quite pan out. But here’s the more helpful frame:
SUD is a medical condition that affects the brain, behavior, and decision-makingoften in very predictable ways.
And like other chronic conditions, it can improve with the right combination of support, treatment, and time.

This guide breaks down how SUD is diagnosed, the main types, the biggest risks,
and the evidence-based treatments that actually help. We’ll keep it practical, plain-English, and judgment-free
because recovery is hard enough without reading something that sounds like it was written by a fax machine.

What Is Substance Use Disorder?

Substance use disorder is a clinical term used when alcohol or drug use becomes more than “a bad habit” and starts causing
significant impairmenthealth issues, safety problems, relationship strain, work or school trouble, and loss of control.
SUD exists on a spectrum: some people meet criteria for a mild disorder, while others experience severe, life-threatening patterns.

A key idea: SUD is not defined by what someone uses, but by how it affects their life.
Two people can drink the same amount; one is fine, the other is in trouble. It’s the impact and loss of control that matter.

SUD Criteria: How Clinicians Diagnose It

Clinicians commonly use diagnostic criteria from the DSM-5-TR. Substance use disorder is diagnosed when a person meets
a certain number of criteria within a 12-month period. The criteria fall into four “buckets” that map pretty neatly onto real life:
impaired control, social impairment, risky use, and physical dependence changes.

The 11 DSM-5-TR Criteria (Plain-English Version)

• Using more than intended (more amounts or longer than planned).
• Wanting to cut down but not being able to.
• Spending a lot of time getting, using, or recovering.
• Cravings (strong urges that are hard to ignore).
• Missing responsibilities at work, school, or home because of use.
• Continuing despite relationship problems caused or worsened by use.
• Giving up activities you used to care about (social, work, hobbies).
• Using in risky situations (driving, operating machinery, unsafe settings).
• Continuing despite health or mental health harm linked to use.
• Tolerance (needing more to get the same effect).
• Withdrawal (feeling sick or off when the substance wears off, or using to avoid that feeling).

Severity Levels: Mild, Moderate, Severe

Severity is typically based on how many criteria are met:
mild (2–3), moderate (4–5), and severe (6 or more).
This helps guide treatment intensitykind of like how a small kitchen fire needs a different response than your whole house being on fire.

Important Note: Tolerance and Withdrawal Aren’t the Whole Story

People often assume “dependence” equals “addiction.” Not always. Some medications (like certain pain medicines) can cause
tolerance and withdrawal even when used as prescribed. SUD is about the pattern of harm and loss of control,
not just the body adapting.

Types of Substance Use Disorder

SUD can involve many substances. Clinically, the diagnosis is typically named for the substance involved (for example,
alcohol use disorder or opioid use disorder).

Common SUD Categories

• Alcohol use disorder (AUD)
• Opioid use disorder (OUD) (prescription opioids, heroin, illicit fentanyl)
• Stimulant use disorder (methamphetamine, cocaine)
• Cannabis use disorder
• Sedative/hypnotic/anxiolytic use disorder (benzodiazepines, certain sleep meds)
• Tobacco/nicotine use disorder
• Hallucinogen use disorder
• Inhalant use disorder

You may also hear people discuss “behavioral addictions” (like gambling disorder). Gambling disorder is recognized separately,
and while it doesn’t involve a substance, it can share similar brain-and-behavior patterns.

Risks of Substance Use Disorder

The risks depend on the substance, how it’s used, and a person’s overall healthbut there are common themes.
Think of SUD risks as a mix of immediate dangers (overdose, accidents) and long-term consequences (organ damage, mental health strain).

Short-Term and Safety Risks

• Overdose, especially with opioids and unexpected potency (including illicit fentanyl exposure).
• Accidents and injuries (falls, crashes, workplace incidents).
• Impaired judgment leading to risky sexual behavior, unsafe situations, or legal trouble.
• Dangerous withdrawal for certain substances (notably alcohol and benzodiazepines), which can require medical supervision.

Long-Term Health and Life Risks

• Heart, liver, lung, and brain effects (varies by substance and duration).
• Infectious diseases when drugs are injected and equipment is shared (risk includes HIV and hepatitis).
• Mental health complications, including anxiety, depression, and increased suicide risk.
• Relationship, parenting, and work impacts (trust erosion, instability, job loss).
• Financial strain and housing insecurity.

Who Is at Higher Risk for Developing SUD?

No single factor “causes” SUD. It’s more like a blender of biology + environment + timing.
Some common risk factors include:

• Genetics and family history
• Early exposure to alcohol or drugs (especially during adolescence)
• Trauma and chronic stress
• Co-occurring mental health conditions (like depression, PTSD, bipolar disorder, ADHD)
• Social environment (peer use, availability, unstable housing)
• Medical exposure in some cases (for example, opioid prescriptions after surgery)

How SUD Is Screened and Assessed

Many people don’t walk into a clinic saying, “Hello, I’d like one substance use disorder diagnosis, please.” SUD is often identified
through screening tools and supportive conversationssometimes in primary care, emergency settings, or mental health visits.

Screening Tools You Might Hear About

• SBIRT (Screening, Brief Intervention, and Referral to Treatment)
• AUDIT (Alcohol Use Disorders Identification Test)
• DAST (Drug Abuse Screening Test)

A good assessment doesn’t just ask “How much do you use?” It asks about cravings, safety, withdrawal risk, mental health,
medical conditions, social supports, and what someone actually wants out of treatment.

Treatment: What Actually Works

Here’s the encouraging part: SUD treatment is not one thing. It’s a menu. And people do best when the plan matches
their needsmedical, psychological, social, and practical. Evidence supports combining behavioral therapies with medications
when appropriate, and adjusting the plan as recovery evolves.

1) Starting With Safety: Withdrawal Management (Detox)

Some substances can cause dangerous withdrawal (especially alcohol and benzodiazepines). In those cases, a medically supervised
withdrawal plan can be life-saving. Detox is not the same as treatmentthink of it as stabilizing the body so real recovery work can begin.

2) Medications (When Available) Can Be Game-Changers

Medications are evidence-based toolsnot “cheating,” not “weakness,” and not “just swapping one drug for another.”
They can reduce cravings, prevent relapse, and lower overdose risk.

Medications for Opioid Use Disorder (OUD)

• Buprenorphine (often combined with naloxone in some formulations)
• Methadone
• Naltrexone (an opioid antagonist used after full detoxification)

Example: A person with OUD who keeps relapsing after “cold turkey” attempts may do better with buprenorphine
plus counseling, stable routines, and overdose prevention planning. The medication helps quiet cravings and stabilizes brain chemistry
so therapy and life changes can actually stick.

Medications for Alcohol Use Disorder (AUD)

• Naltrexone (helps reduce heavy drinking and cravings for some people)
• Acamprosate (often used to support abstinence after stopping alcohol)
• Disulfiram (causes unpleasant effects if alcohol is consumed; works best with strong support and adherence)

Example: Someone who wants to cut back but keeps sliding into binge drinking might benefit from naltrexone
alongside motivational interviewing and a plan for high-risk situations (like weekends, celebrations, or loneliness at 11 p.m.a very real time).

Medications for Nicotine/Tobacco Use Disorder

• Nicotine replacement therapy (patches, gum, lozenges)
• Varenicline
• Bupropion

What About Stimulants (Meth/Cocaine)?

There are currently no universally established FDA-approved medications specifically for stimulant use disorder the way there are for OUD and AUD.
But that does not mean “nothing works.” Behavioral approachesespecially contingency management and cognitive-behavioral strategiescan be effective,
and treatment often includes addressing sleep, mood, trauma, and triggers.

3) Behavioral Therapies and Counseling

Therapy helps people change patterns, cope with cravings, build distress tolerance, and repair relationships.
Common evidence-based approaches include:

• Cognitive Behavioral Therapy (CBT) (skills for thoughts, triggers, and behaviors)
• Motivational Interviewing (MI) (supports ambivalence: “part of me wants to quit, part of me doesn’t”)
• Contingency Management (uses incentives to reinforce recovery behaviors)
• Family-based therapies (especially for adolescents and for strengthening support systems)
• Trauma-informed therapy when trauma is part of the story (often, it is)

4) Levels of Care: From Outpatient to Residential

Treatment intensity can range from a weekly appointment to medically managed inpatient care. Many clinicians use
structured placement frameworks (such as ASAM’s continuum) to match level of care with a person’s needs and risks.

• Outpatient: therapy/medication visits while living at home
• Intensive outpatient / partial hospitalization: more hours per week, more structure
• Residential: live-in support and therapy
• Medically managed inpatient: for high medical/psychiatric complexity or severe withdrawal risk

A lot of people move between levels over time (step-up when things are unstable, step-down as recovery strengthens).
That’s not “failing”that’s adjusting the dosage of care.

5) Mutual Support and Recovery Communities

Many people benefit from peer support12-step groups (like AA or NA), SMART Recovery, recovery community organizations,
or faith-based supports. The “best” group is the one that helps you show up, stay honest, and keep going.

6) Harm Reduction: Keeping People Alive While Change Happens

Harm reduction means reducing danger even if someone isn’t ready or able to stop immediately. It includes practical tools like:

• Naloxone (Narcan) to reverse opioid overdose
• Not using alone, and having an emergency plan
• Safer-use education and access to health services

The principle is simple: you can’t recover if you’re not alive. Keeping people safer is not “enabling”it’s public health and basic humanity.

Relapse, Recovery, and What Progress Really Looks Like

Many people with SUD experience relapse. That doesn’t mean treatment is pointless; it means the condition is persistent and requires ongoing care,
like asthma or diabetes. A relapse can be a signal to adjust the plan: more support, different therapy, medication changes, or a higher level of care.

Real progress often looks like: fewer risky episodes, longer stretches of stability, better coping skills, improved sleep,
repaired relationships, and rebuilding trustespecially self-trust.

How to Help Someone You Care About

If someone you love is struggling, you don’t need the perfect speech. You need the next kind, clear step.

• Use nonjudgmental language (“I’m worried about you,” not “You’re ruining everything”).
• Offer specific support (ride to an appointment, help finding a clinic, childcare during therapy).
• Set boundaries that protect safety without turning into punishment.
• Encourage evidence-based care, including medications when appropriate.
• Consider naloxone if opioids are involved (for families, friends, and communities).

When to Seek Immediate Help

Get emergency help right away if someone has signs of overdose (unconsciousness, slow or stopped breathing, blue/gray lips or fingertips),
severe confusion, chest pain, seizures, or severe withdrawal symptoms.

If you or someone you know needs help finding treatment in the U.S., resources like FindTreatment.gov
and SAMHSA support lines can help connect people to care. If someone is in immediate danger, call emergency services.
If someone is in emotional crisis, the 988 lifeline can be a starting point.

Conclusion

Substance use disorder is not a character flawit’s a health condition that can affect anyone, and it often thrives in silence.
The good news is that effective treatment exists: careful assessment, the right level of care, evidence-based therapies,
and medications when appropriate. Add in social support, practical harm reduction, and a plan for relapse prevention, and you have
something powerful: a pathway forward.

If you’re reading this and thinking, “This is me,” or “This is someone I love,” let this be the moment you trade shame for strategy.
You don’t have to do it perfectly. You just have to start.

Experiences: What SUD Can Feel Like in Real Life (About )

People often talk about SUD like it’s one dramatic momentan “intervention episode” or a rock-bottom scene with sad background music.
In reality, it’s usually quieter and more repetitive. A lot of experiences share the same emotional rhythm: promises, bargaining,
short-term relief, and then consequences that show up like an unwanted subscription you forgot to cancel.

1) The “Tomorrow Me” Trap

A common experience is genuinely meaning to changejust not today. “Tomorrow I’ll cut back.” “After this stressful week.”
“Once the kids are sleeping better.” Tomorrow becomes a moving target, because the substance has become the brain’s fastest tool
for switching off discomfort. The intention is real; the brain’s reward system is just louder.

2) The Negotiation Phase (Yes, Your Brain Can Be a Lawyer)

Many people describe a constant internal debate: “I’m not as bad as that person,” “I only use on weekends,”
“I can still work,” “I’m fine as long as I don’t mix substances.” The goal isn’t to lieit’s to keep the relief while reducing guilt.
The tricky part is that SUD often improves your ability to make convincing arguments for choices that hurt you.

3) Losing Control in Small, Boring Ways

Loss of control isn’t always spectacular. It can look like finishing a bottle faster than planned, stopping at the store “just for one thing,”
or spending an hour thinking about using even while trying to focus on work. People often feel confused: “Why can’t I do the thing I want to do?”
That confusion is painfuland it’s also a clue that this is more than willpower.

4) Shame Spirals and Isolation

Many people pull away from friends and family, not because they don’t care, but because they’re exhausted from hiding.
The secrecy can be as stressful as the substance itself. Then shame increases, and the substance becomes the quick relief again.
It’s a loop that can feel impossible to exit alone.

5) Treatment as a “Relearning” Process

In recovery, people often describe a strange early phase: emotions return with the volume turned up.
Stress, boredom, anger, griefthings the substance used to muteare suddenly louder. Therapy and support groups can feel less like “talking”
and more like learning a new operating system: how to cope, how to ask for help, how to sit with discomfort without escaping.
Medications (when appropriate) can make this possible by lowering cravings so skills actually have room to grow.

6) The Win That No One Sees

Some of the biggest victories are invisible: deleting a dealer’s number, leaving a party early, calling a sponsor,
dumping alcohol down the sink, or choosing sleep over chaos. These moments don’t go viral. They also build the foundation
of long-term recovery.

7) Families: Love, Fear, and Exhaustion in One Room

Loved ones often describe living on high alertwatching moods, counting pills, checking bank accounts, listening for footsteps at night.
Support for families matters, too. When boundaries are clear and help is evidence-based, the whole system can start to heal.
Recovery is rarely a solo sport; it’s more like rebuilding a team after a rough season.

If any of these experiences feel familiar, it doesn’t mean you’re “broken.” It means you’re humanand you may need support that matches
the reality of what you’re facing. The most important message is simple: people recover every day, and asking for help is a strategy,
not a surrender.