Substance Use Disorders (SUD)
Substance Use Disorder (SUD) is a chronic, relapsing brain disease characterized by compulsive substance seeking and use, despite harmful consequences. Diagnosis is based on DSM-5 criteria, reflecting a spectrum from mild to severe.
Key Diagnostic Criteria (DSM-5)
| Category | Key Indicators |
|---|---|
| Impaired Control | Larger amounts than intended, unsuccessful efforts to cut down, excessive time spent. |
| Social Impairment | Failure to fulfill roles (work/home), giving up important activities, continued use despite problems. |
| Risky Use | Physical/psychological danger, continued use despite physical/psychological exacerbation. |
| Pharmacological | Tolerance and withdrawal symptoms. |
Management Principles
- Assessment: Use validated screening tools like CAGE (for alcohol) or DAST (for drugs).
- Pharmacotherapy: Targeted treatments are available (e.g., Methadone/Buprenorphine for opioids, Naltrexone/Acamprosate for alcohol).
- Psychosocial: Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and 12-step facilitation are foundational.
High-Yield Clinical Notes:
- Harm Reduction: Focuses on minimizing the negative health and social impacts of substance use (e.g., needle exchange, supervised consumption) for those not ready for abstinence.
- Dual Diagnosis: Many patients with SUD have co-occurring psychiatric conditions (e.g., depression, PTSD). Effective treatment must address both concurrently.
- Relapse: Must be viewed as a clinical event rather than a moral failure; it typically requires adjustment to the treatment plan.