Substance Use and Addictive Disorders

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 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.

  • 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.
  • 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