Table of Contents

SUD Diagnostic Overview

Formerly, in the 4th Edition of the American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV), substance use disorders (SUDs) were divided into two distinct categories–substance abuse and substance dependence. An individual could receive a current diagnosis of either abuse or dependence (not both) for a single drug class. A current SUD refers to continued use of the substance within the past 12 months that has resulted in problems and symptoms (1 symptom required for abuse, 3 for dependence). Drug classes for which an individual could be diagnosed with a SUD include: alcohol, cannabis, nicotine, opioids, inhalants, hallucinogens, amphetamine, caffeine, cocaine, and sedatives. An example diagnosis would be “cannabis abuse” or “amphetamine dependence”. Substance Dependence was considered the more severe use disorder; it’s criteria included physiological and tolerance and withdrawal, as well as continued use despite incurring health consequences.

Now, in the updated (2013) DSM-5, SUDs are not characterized by abuse vs. dependence. Without this distinction, an individual would receive the “use disorder” diagnostic label, referring to the specific drug class (for example, “cannabis use disorder”). See updated symptom criteria for substance use disorders.

Basic Principles of SUD Treatment

Most professionals recognize a dynamic interplay of factors as contributing to addictive tendencies involving alcohol and other substances. This is why, in addition to detoxification and inpatient rehab, psychosocial treatments are critical for recovery from a substance use disorder. Psychosocial treatments are programs that can target components of the social and cultural structures surrounding the patient and the problematic psychological and behavioral patterns of patient.

Overall, appropriate choice and context of therapy will depend on several factors, including the severity of the substance use problem, patient motivation to stop using, level of dysfunction in the patient’s sociocultural environment, patient’s cognitive functioning and level of impulse control, and presence of co-occurring mental illness in the patient. Oftentimes, a mental health professional will incorporate feedback from the patient as well as individuals close to the patient, when devising a treatment plan. Accumulating research supports positive reinforcement over punishment for treating addiction.

Residential Treatment (During Early Remission)

First 12-months’ post-cessation period is considered the early remission phase. Because social and cultural components of the patient’s old familiar environment has likely served as a previous trigger for using drugs and drinking, temporary relocation in a semi-controlled or monitored sober community can be a great ally to the patient during their early remission phase. This is especially the case if the individual aims to stay completely abstinent from drugs long-term, as opposed to cutting down or reducing harm resulting from their use.

Sober-living community homes (sometimes called “halfway houses”) are semi-controlled residences where the patient can live among other people who are in recovery. Sometimes these are court-mandated in the case when the patient has committed a crime. Still, a halfway house can serve as a vital psychosocial intervention for patients’ progressive entry into society. Oftentimes, residents will receive alcohol and drug counseling. In addition, the patient has a chance to receive beneficial social support from other residents who are in recovery and who may be able to relate to them. Additionally, the patient is included in regular, ongoing collaborative activities, such as group meals and recreational day trips that can serve as reinforcement for their efforts to remain sober.

See page 2. for behavioral and psychological treatments.