Understanding Substance Use Disorder

Understanding Substance Use Disorder

What is “Substance Use Disorder”?

Substance use disorder is defined as the continued use of a substance despite harmful consequence and is the recognized diagnostic term applied to substance use addiction disorders according to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013. This terminology represents a shift from the use of terms such as “abuse” and “dependence” and recognizes addiction as a complex chronic condition that may manifest as mild, moderate, or severe.  

What causes substance use disorder?

Long thought to be the consequence of a lack of willpower, substance use disorder is now understood to be a chronic relapsing disorder of the brain. Brain imaging studies have revealed similar changes in the brains of individuals afflicted with substance use disorder regardless of the substance being used. While the socio-psychological factors leading to substance use vary, the development of substance use disorder appears to hinge on progressive alterations in brain function that result in intense craving, loss of control over use, and the continued use despite adverse consequences.

What is the incidence of substance use disorder?

According to a 2018 report from the Substance Abuse and Mental Health Service Association (SAMHSA.gov) the incidence of substance use disorder among American adults is 8% with the most used substance being alcohol. According to a JAMA Psychiatry article published in 2016, the lifetime prevalence of substance use disorders is 9.9%.

Why is it important to destigmatize substance use disorder?

Substance use disorder, regardless of severity, is a chronic medical disease for which there are evidence-based treatments that support recovery. Unfortunately, it is estimated that 90% of individuals with substance use disorder do not receive treatment.  In some cases, the stigma associated with this condition—that it is shameful, one’s own fault, or due to a lack of willpower—inhibits individuals from seeking help.  In other cases, the fear of losing one’s livelihood is a barrier. This is particularly a concern in the context of professional licensure and one of the reasons that the GVMA has worked hard to make the Professional Health Program available to Georgia veterinarians.

What can we do to destigmatize substance use disorder?

According to NIH, we can begin by using non-stigmatizing language that reflects an accurate, science-based understanding of substance use disorder. We can also use language that differentiates the individual from the condition.  Rather than referring to someone as an “addict” or an “alcoholic”, we can choose the more neutral reference of  “someone with a substance use disorder”.

It is also recommended that “substance use” be used to describe all substances, including alcohol and other drugs and that the word “treatment” be used in place of “intervention”, consistent with the understanding that this is a treatable chronic medical condition.

For more information on guidance on how to talk about substance use disorder, visit NIH’s Words Matter: Preferred Language for Talking About Addiction.

Written by Laura Smallwood, DVM, DACVIM(SAIM), RYT-200