Assessing and Treating Substance Abuse

This article explores what substance abuse is, how to identify its symptoms and diagnose it in your clients, and what some of the common treatment approaches are.

Overview of substance abuse

Substance abuse is a pattern of using drugs or alcohol in a way that causes significant harm to an individual’s physical, mental, and social wellbeing. Substance use disorder (SUD) is a clinically diagnosed condition characterised by a problematic pattern of using a substance leading to clinically significant impairment or distress. It can manifest in various forms such as abuse, dependence, and addiction.

The risk factors for substance abuse include genetic predisposition, psychological and emotional factors, social and cultural influences, and availability of the substance. Commonly abused substances include alcohol, opioids, marijuana, stimulants, and sedatives.

Individuals with substance abuse problems may experience a range of negative consequences, including physical health problems, mental health issues, problems at work or school, legal or financial troubles, and social and relationship problems.

What is substance abuse?

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) defines substance abuse as a pattern of using a substance that leads to significant problems or distress. The substance use can be in the form of alcohol, drugs, or other chemicals. The DSM-5-TR criteria for substance abuse include:

1. Recurrent substance use leading to failure to fulfil major role obligations at work, school, or home.
2. Recurrent substance use in situations in which it is physically hazardous.
3. Recurrent substance-related legal problems.
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.

Note that the DSM-5-TR, as the DSM-5 iteration before the text revision (related reading: The DSM-5-TR: What Changes Should You Know About?),  uses the term “substance use disorder” (SUD) instead of “substance abuse”. SUD is a clinically diagnosed condition characterised by a problematic pattern of using a substance leading to clinically significant impairment or distress and is classified as mild, moderate or severe based on the number of criteria met.

A diagnosis of substance use disorder is made when an individual experiences significant problems related to substance use and meets two or more criteria within a 12-month period.

What are the symptoms of substance abuse?

Symptoms of substance abuse may include:

• Neglecting responsibilities at work, school, or home
• Using the substance in hazardous or risky situations
• Legal problems related to substance use
• Continued use despite interpersonal problems
• Tolerance, or the need to use more of the substance to achieve the desired effect
• Withdrawal symptoms when not using the substance
• Using the substance in larger amounts or for longer periods of time than intended
• Difficulty cutting down or controlling substance use
• Spending a significant amount of time using the substance or recovering from its effects
• Giving up important activities in favour of substance use
• Using the substance despite knowledge of having a physical or psychological problem that is likely to have been caused or exacerbated by the substance.

Not all individuals with substance use disorder will experience all of these symptoms and the severity of symptoms may vary. A mental health clinician will consider how these symptoms combine and use their clinical judgement to make the diagnosis of substance use disorder.

How to diagnose substance abuse

The diagnosis of substance abuse, also known as substance use disorder, is made by a mental health clinician through a combination of a thorough clinical assessment, an interview, and observation of the patient.

First, the clinician should take a detailed history of the patient’s substance use, including the type of substance(s) used, the frequency and duration of use, and any associated symptoms or problems. The clinician should also ask about the patient’s medical and psychiatric history, family history of substance use, and any past treatment for substance abuse.

Next, the clinician should perform a physical examination to look for any signs of substance use or related medical problems. This may include measurement of vital signs, a general examination of the patient’s appearance and behaviour, and specific tests such as a urine or blood test to detect the presence of the substance.

The clinician should also use a standardised assessment tool, such as the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) or the International Classification of Diseases (ICD-11) to help determine the severity of the disorder.

Lastly, the clinician should make a diagnosis based on the patient’s history, physical examination, and assessment results, as well as the clinician’s judgement. Substance abuse diagnosis is a complex process, and it should also consider cultural and social factors that may influence the patient’s behaviour and experiences. Because substance use disorder may have an underlying mental health disorder that should be treated as well as the SUD, only a mental health professional should make the diagnosis and organise a treatment plan.

Common treatment approaches for substance abuse

Treatment for substance use disorder typically involves a combination of pharmacological and behavioural therapies. The most common treatment approaches for a mental health clinician include:

• Medications. Medications such as methadone, buprenorphine, and naltrexone can be used to help individuals reduce or stop their use of opioids, alcohol, and other substances.
• Antidepressants, anti-anxiety medication, and other psychotropics. Antidepressants, anti-anxiety medication, and other psychotropics may also be used to address underlying mental health disorders.
• Behavioural therapies. These therapies aim to change the patient’s behaviour and attitudes related to substance use. Common examples include cognitive-behavioural therapy, motivational interviewing, and contingency management.
• Psychotherapy. This type of therapy can help individuals understand and work through underlying emotional or psychological issues that may be driving their substance use.
• Support groups. Support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can provide individuals with a sense of community and accountability, as well as practical advice for maintaining sobriety.
• Residential or inpatient treatment. This type of treatment is typically used for individuals with severe substance use disorder or those who have not been successful with other forms of treatment. It typically involves living at a treatment facility for a certain period of time and receiving around-the-clock care and support.
• Outpatient treatment. This type of treatment allows individuals to receive therapy and other forms of treatment while continuing to live at home. It can include individual or group therapy, medication management, and support groups.
• Integrated treatment. This type of treatment approach addresses both substance use disorder and any co-occurring mental health disorders at the same time, in a coordinated and comprehensive way.

Key takeaways

• Substance abuse is a pattern of using drugs or alcohol in a way that causes significant harm to an individual’s physical, mental, and social wellbeing.
• Substance use disorder (SUD) is a clinically diagnosed condition characterised by a problematic pattern of using a substance leading to clinically significant impairment or distress.
• Risk factors for substance abuse include genetic predisposition, psychological and emotional factors, social and cultural influences, and availability of the substance.
• Symptoms of substance abuse may include neglecting responsibilities, using the substance in hazardous situations, legal problems, continued use despite interpersonal problems, and tolerance.
• Common treatment approaches for substance abuse include medications, behavioural therapies, psychotherapy, support groups, residential or inpatient treatment, outpatient treatment, and integrated treatment.