💊 Substance Use Disorder (SUD) is a chronic, relapsing medical condition in which alcohol, drugs, or other substances are used compulsively despite harmful consequences. ⚠️ It involves brain reward pathway changes, cravings, tolerance, withdrawal, and loss of control. 🌍 Affects ~5% of adults worldwide, major public health burden.

📖 Key Features of SUD

🔥 Cravings: Overwhelming urge to use.
⬆️ Tolerance: Needing higher doses for same effect.
🤒 Withdrawal: Symptoms if use reduced/stopped.
🚫 Loss of Control: Larger/longer use than intended.
💼 Social/occupational impairment: Missed work, school, or family duties.
💥 Continued use despite harm: Worsening physical or psychological damage.

📊 Common Substances & Their Management


Substance	🔎 Signs & Symptoms	🧪 Diagnosis	💊 Treatment
🍷 Alcohol	Slurred speech, ataxia, tremors, liver disease, withdrawal (seizures, DTs)	AUDIT-C, LFTs, MCV, history	Detox (chlordiazepoxide), relapse prevention (acamprosate, naltrexone, disulfiram), AA
💉 Opioids	Drowsiness, pinpoint pupils, constipation, withdrawal (yawning, sweating, cramps)	Urine screen, Hx	Methadone/buprenorphine substitution, naloxone for overdose, CBT, needle exchange
⚡ Cocaine	Euphoria, insomnia, paranoia, chest pain, nasal septum damage	Urine screen, ECG, troponin	CBT, contingency management, manage cardiac risk, no licensed substitute drug
🌿 Cannabis	Red eyes, ↑ appetite, poor concentration, anxiety, amotivation	History, urine screen	Counseling, psychoeducation, CBT, relapse prevention
💊 Benzodiazepines	Drowsiness, confusion, ataxia, withdrawal → seizures	History, urine/serum screen	Gradual taper, switch to diazepam equivalent, CBT for anxiety

📋 DSM-5 Diagnosis of SUD

Diagnosis requires ≥2 criteria in 12 months (mild = 2–3, moderate = 4–5, severe = ≥6):

➡️ Using more/longer than intended.
➡️ Unsuccessful attempts to cut down.
➡️ Excessive time obtaining/using/recovering.
➡️ Craving.
➡️ Recurrent failure in obligations.
➡️ Continued use despite social problems.
➡️ Important activities abandoned.
➡️ Use in hazardous situations.
➡️ Continued use despite medical/psychological harm.
➡️ Tolerance.
➡️ Withdrawal.

💊 Management Principles

SUD management is multidisciplinary: combine medical treatment, psychological therapies, and social support.

🧹 Detoxification: Medically supervised withdrawal (e.g. benzodiazepine taper for alcohol).
💊 Medications:
- Alcohol → acamprosate 666 mg TDS, disulfiram 200–400 mg OD, naltrexone 50 mg OD.
- Opioids → methadone (20–60 mg daily titrated), buprenorphine (4–16 mg daily).
- Nicotine → NRT, varenicline, bupropion.
🧠 Therapies: CBT, motivational interviewing, contingency management.
👥 Support groups: AA, NA, SMART Recovery.
🏥 Integrated care: GP, psychiatry, social services, housing and employment support.

🛡️ Prevention & Harm Reduction

📚 School & workplace education.
🧪 Early screening (AUDIT, ASSIST) in primary care.
💉 Needle exchange programs, opioid substitution therapy.
🚑 Take-home naloxone for opioid users & families.
🏠 Social support: housing, community rehab services.

🚨 Red Flags

💔 Suicidal ideation or self-harm.
🩸 Signs of overdose (respiratory depression, arrhythmia, coma).
🧠 Co-existing psychosis or severe depression.
👶 Pregnant women using alcohol/opiates → urgent referral.

📌 Exam Pearls

💡 Always assess for dual diagnosis (mental illness + SUD).
👀 Alcohol withdrawal → risk of seizures (12–48h) & delirium tremens (48–72h).
💊 Clozapine + alcohol/cannabis = increased seizure risk.
⚠️ Never stop benzodiazepines abruptly → taper slowly to avoid withdrawal seizures.

🔗 References

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Substance use disorder