Substance Use and Addictive Disorders

Primer

Substance Use Disorders and Addictive Disorders are mental disorders in the DSM-5 broadly divided into 10 classes of drugs for which substance-related disorders can apply: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, “sedatives, hypnotics, and anxiolytics,” stimulants, tobacco, and other (or unknown) substances.

Addiction Medicine

Addiction Medicine is a branch of medicine involved in the diagnosis, treatment, and prevention of substance use disorders. See the main article above for an introduction to the basic concepts and approach to addictions.

Substance and Addictive Disorders

  • Depressant use generally causes mood elevation, anxiety, sedation, behavioural disinhibition, and respiratory depression during intoxication. Withdrawal symptoms generally speaking cause anxiety, tremor, seizures, insomnia.
  • Stimulant use generally causes mood elevation, decreased appetite or anorexia, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, and anxiety. Withdrawal symptoms typically include a “post-use crash” that includes symptoms such as depression, fatigue/lethargy, increased appetite, insomnia, and vivid nightmares.
  • Hallucinogens are substances that can cause mind and body separation (“dissociative”) effects and visual and/or auditory hallucinations. Of note, hallucinogens such as PCP and LSD do not cause withdrawal symptoms, and hence do not have a DSM-5 diagnosis for withdrawal. Other hallucinogens however, like MDMA (which is officially designated as a hallucinogen in the DSM-5, but in fact has strong stimulant properties) and cannabis, can trigger withdrawal symptoms.
  • Finally, gambling disorder is the only non-substance DSM-5 addictive disorder.

Depressants

Stimulants

Hallucinogens

Other

Comparison of Substance Use and Substance-Induced Disorders

  • Different substances can induce various psychiatric symptoms (depression, psychosis, mania, sleep disturbances, sexual dysfunction, cognitive impairment, delirium, anxiety) during different phases of use (intoxication, withdrawal).
  • The table below summarizes DSM-5 recognized syndromes and diagnoses.[1]
  • Some of these disorders are temporary (i.e. - during the intoxication or withdrawal phase), while others can be persistent and have long-term sequalae.[2]

Substance-Induced Mental Disorders

Adapted from: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
Psychosis Bipolar Depression Anxiety OCD Sleep Sexual Delirium Cognition DSM-5 Use Disorder DSM-5 (I) DSM-5 (W)
Alcohol I/W I/W I/W I/W I/W I/W I/W I/W/P ✓ ✓ ✓
Caffeine I I/W ✓ ✓
Cannabis I I I/W I ✓ ✓ ✓
Phencyclidine I I I I I ✓ ✓
Other hallucinogens I I I I I ✓ ✓
Inhalants I I I I I/P ✓ ✓
Opioids I/W W I/W I/W I/W ✓ ✓ ✓
Sedatives, hypnotics, or anxiolytics I/W I/W I/W W I/W I/W I/W I/W/P ✓ ✓ ✓
Stimulants I I/W I/W I/W I/W I/W I I ✓ ✓ ✓
Tobacco W ✓ ✓
Other (or unknown) I/W I/W I/W I/W I/W I/W I/W I/W I/W/P ✓ ✓ ✓
I = The specifier 'with onset during intoxication' is used, W = The specifier 'with onset during withdrawal' is used, I/W = Either 'with onset during intoxication' or 'with onset during withdrawal' can be used, P = the disorder is persisting, ✓ = This diagnostic category is recognized in the DSM-5.