Substance Use Disorder


Substance use:

Substance disorders 4 Criteria for diagnosing:

  1. Impaired control

  2. social impairment

  3. risky use

  4. pharmacological criteria 

  • Irreversible damage 

  • alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, gambling.


Substance-induced disorders: Include cluster of substance related symptoms: intoxication, med-induced mental disorders, sleep problems, sexual dysfunction, delirium, dementia.

  • usually reversible

  • Usually consists of changes in perception, wakefulness, attention, thinking, judgement, psychomotor behavior and interpersonal behavior.

Cause = genetics, biological, childhood trauma, age cohorts

Protective factors: supportive family, child’s temperament, positive family rituals

  • Impacts neurological pathways involved in the dopamine reward pathway and the prefrontal cortex

Brain Centers and Addiction: 

Intoxication stage = basal ganglia

Withdrawal stage = amygdala

Anticipation stage = prefrontal cortex


  • variety of genes make an individual vulnerable to this disease

  • Onset as an adult primary related to ACE score and trauma

  • Greater risk if you grew up in household with substance use disorder


Incidence and prevalence:

  • 51% adults 12 and older drink alcohol

  • 24% reported binge drinkers

  • 6.1% defined as heavy drinkers

  • 5.4% adults 12 and older have substance use disorder

  • most common illicit drug is marijana and prescription pain relievers

  • alcohol dependency is 2 times more in males than females


Drinking Risk 

High risk Males = 5 or more drinks per day, 15 or more drinks per week

High risk Females = 4 or more drinks per day, 8 or more drinks per week



Signs and symptoms:

  • Poor academic performance - money problems

  • violent outbursts - trouble with the law

  • excessive or lack sleeping - withdraw from friends and family

  • drastic weight changes


Medical management

  • medications with counseling

  • self-help groups

  • detox

  • Opioids: methadone, Sub Oxone

  • CBT, Dialectical behavior therapy


OT interventions

  • Assessment (cognitive, perception, community skills)

  • Stress management strategies

  • Coping skills