Substance Use Disorders



Substance Use Disorders







First you take a drink, then the drink takes a drink, then the drink takes you.

—F. Scott Fitzgerald


Clinical Description

Substance use disorders (SUDs) are among the most prevalent psychiatric disorders in young people. Although experimentation with alcohol and drugs is sometimes considered one of the rites of passage for American youth, there is a high risk for misuse, addiction, and serious negative consequences (legal, social, and safety). Additionally, the treatment of any other psychiatric disorders is complicated by concomitant substance use. See Table 18.1 for diagnostic criteria for substance abuse.

Compared to adults, adolescents with SUDs present with a greater number of drugs used at any time. While substance-dependent youth may present with symptoms of tolerance, they present less often with symptoms of withdrawal or other symptoms of dependence noted in Table 18.2.

In general, substance abuse is a disorder that starts in adolescence or early adulthood. In evaluating even a prepubertal child, however, you have a goal to understand if smoking or substance use is present, to understand the nature and severity, and to ensure that it is addressed in treatment. Minors tend to have a higher rate of risk-taking behaviors than adults. They may begin to steal, lie, and participate in criminal behavior to support a habit. SUD youth often have comorbid conduct disorders.










Table 18.1. DSM-IV-TR Criteria for Alcohol/Substance Abuse






A maladaptive pattern of alcohol/substance use leading to clinically significant impairment or distress, as manifested by at least one of the following:

  1. Failure to fulfill major role obligations at work, school, or home
  2. Recurrent alcohol use in situations in which it is physically hazardous
  3. Recurrent alcohol-related legal problems
  4. Continued alcohol use despite persistent problems caused by its use
Adapted from American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision. Washington, DC. American Psychiatric Association.









Table 18.2. DSM-IV-TR Criteria for Alcohol/Substance Dependence






Mnemonic: Tempted With Cognac. To be considered alcohol (or other substance) dependent, the patient must meet at least three of the following seven criteria:
Tolerance—a need for increasing amounts of alcohol to achieve intoxication
Withdrawal syndrome
Loss of Control of alcohol use (five criteria follow):
   More alcohol ingested than the patient intended
   Unsuccessful attempts to cut down
   Much time spent in activities related to obtaining or recovering from the effects of alcohol
   Important social, occupational, or recreational activities given up or reduced because of alcohol use
   Alcohol use continued despite the patient’s knowledge of significant physical or psychological problems caused by its use
Adapted from American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision. Washington, DC. American Psychiatric Association.

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Jul 5, 2016 | Posted by in PSYCHIATRY | Comments Off on Substance Use Disorders

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