Substance Use Disorder: Understanding the Signs, Severity, and How to Get Help

Substance use disorder (SUD) isn’t just about using drugs or alcohol—it’s about losing control over that use. It’s a condition where a person keeps using substances despite the harm it causes to their health, relationships, and daily responsibilities.

So, what exactly happens in the brain that makes it so hard to stop? And how do doctors diagnose SUD? Let’s break it down in a way that’s easy to understand.

Why Do People Get Hooked on Substances?

At the core of substance use disorder is the brain’s reward system. When someone uses alcohol, drugs, or even certain prescription medications, they experience a rush of pleasure or relief. Over time, this feeling can become so powerful that the person starts to prioritize substance use over everything else—work, relationships, hobbies, and even basic self-care.

Addiction isn’t just about wanting a substance—it’s about the brain being rewired to need it.

How Do Professionals Diagnose SUD?

Decades of research have led to the development of the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision), the standard guide for diagnosing mental health conditions, including substance use disorders. Since its first publication in 2013 and revision in 2022, the DSM-5-TR has been used to diagnose over 70 different conditions, including addiction.

What Substances Can Lead to SUD?

According to the DSM-5-TR, there are ten categories of substances that can lead to substance use disorder:

1. Alcohol

2. Caffeine

3. Cannabis (marijuana, THC products)

4. Hallucinogens (LSD, psilocybin mushrooms, peyote)

5. Inhalants (glue, paint thinners, nitrous oxide)

6. Opioids (heroin, prescription painkillers like oxycodone and fentanyl)

7. Sedatives, hypnotics, and anxiolytics (Xanax, Valium, Ambien)

8. Stimulants (cocaine, methamphetamine, Adderall, Ritalin)

9. Tobacco (nicotine products like cigarettes and vapes)

10. Other unknown or designer drugs

Not everyone who uses these substances develops a disorder, but for some, the brain adapts to repeated use, making it harder and harder to stop.

The 11 Signs of Substance Use Disorder

Doctors diagnose SUD based on 11 criteria that fall into four key categories:

1. Impaired Control (Struggling to stop or cut back)

✔ Taking more of the substance or using it for longer than intended

✔ Trying to cut back but not being able to

✔ Spending a lot of time getting, using, or recovering from the substance

✔ Experiencing strong cravings or urges to use

2. Social Problems (Impacting relationships, work, or responsibilities)

✔ Failing to meet obligations at work, school, or home

✔ Continuing to use, even when it damages relationships

✔ Giving up important activities (social, recreational, or work-related)

3. Risky Use (Ignoring safety concerns)

✔ Using the substance in situations that put you in danger (e.g., driving under the influence)

✔ Continuing to use despite knowing it’s harming your health

4. Physical Dependence (The body adapts to the substance)

✔ Needing more of the substance to get the desired effect (tolerance)

✔ Experiencing withdrawal symptoms when not using (relieved by taking more)

If someone meets at least two of these criteria, they may have substance use disorder.

How Severe is the Problem?

SUD isn’t “all or nothing”—it exists on a spectrum:

• Mild SUD → 2–3 symptoms

• Moderate SUD → 4–5 symptoms

• Severe SUD → 6 or more symptoms

Even mild cases can worsen over time, making early intervention crucial.

What About Prescription Medications?

Not everyone who develops tolerance or withdrawal from a medication has a substance use disorder. Some people need medications like painkillers or anti-anxiety drugs for medical reasons, and their bodies naturally adapt. The key difference? People with SUD continue using even when it’s no longer needed or becomes harmful.

What to Do if You or a Loved One Needs Help

If you suspect that you or someone you care about has a substance use disorder, the most important step is to seek a professional diagnosis. Treatment can vary depending on the severity of the disorder, but common options include:

✔ Medical detox – To safely manage withdrawal symptoms

✔ Therapy & counseling – Cognitive-behavioral therapy (CBT), motivational interviewing, and group therapy

✔ Medication-assisted treatment (MAT) – Medications like buprenorphine (for opioids) or naltrexone (for alcohol) can help

✔ Support groups – 12-step programs like AA (Alcoholics Anonymous) or NA (Narcotics Anonymous)

You’re Not Alone—Help is Out There

Substance use disorder is a medical condition, not a moral failing. Recovery is possible, and millions of people have successfully overcome addiction. If you or a loved one is struggling, reaching out for help is the first step toward healing.

Click here for resources available to treat substance use disorder.