Warning Signs a Loved One May Have an Substance Use Disorder

Substance use disorder (SUD) is the term used in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to covers the mental health conditions previously known as substance abuse, addiction, dependency, and so on.^1,2

SUDs can be named according to the substance or type of substance (e.g. alcohol use disorder, fentanyl use disorder, club drug use disorder, etc.). Additionally, they could be classed according to their severity (mild, moderate, or severe) which is determined by how many diagnostic criteria a clinician deems applicable in a specific case.¹

As with any illness, only a qualified doctor can make an official SUD diagnosis. However, laypeople can make reasonable assumptions about whether or not they or someone they’re close to has a problem with their substance misuse.^1,3,4

Here we’ll show some of the ways you can spot a potential issue with substance misuse. If you suspect an SUD, please get in touch with a psychiatric professional immediately.

SUD Diagnostics Criteria

The National Institute on Drug Abuse recommends using the DSM-5 criteria to check for signs of a possible substance use disorder. If the check is on another person, you may choose to talk to them first and tell them your intent so that they can provide feedback for the assessment.^1,3,4

Below are the 11 standard SUD criteria in the DSM-5. More than one item applicable in the past 12 months may be an indication of a substance use disorder and should be cause for immediate examination by a psychiatrist. Four or more may mean a moderate or severe SUD:¹

1. Taking drugs, prescription medications, or alcohol in large quantities or for longer than needed.
2. Difficulty reducing or stopping substance intake.
3. Inordinate time and effort obtaining, using, or recuperating from substances
4. Continued cravings.
5. Inability to keep up with responsibilities.
6. Continuing substance misuse despite recognizing problems.
7. Disinterest in friends, hobbies, and work because of drugs or alcohol.
8. Continuing to use substances in potentially dangerous situations (e.g driving or operating heavy machinery under the influence).
9. Continued substance misuse despite direct knowledge of harm to physical and mental health.
10. Increased tolerance to the substance/s of choice.
11. Withdrawal symptoms upon ceasing use, include but are not limited to aggression, irritability, extreme discomfort, excessive sweating, muscle pains, clammy skin, spasms, gastrointestinal upset, hallucinations, delirium, paranoia, etc.^1,3,4

If more than one of the criteria above applies, please seek the help of a qualified mental health professional.

Other Widely-used SUD Tests

In addition to the DSM-5 SUD criteria, there are also other tests that are designed for laypeople, as pre-screening tools for trained clinicians, or with a specific purpose other than simply identifying a potential SUD. These include but are not limited to the following:5

• CAGE– This popular prescreening test is mainly used for alcohol use disorders, though it has been adapted for other SUDs as well. Each of the letters corresponds to key concepts in the four test questions (cut down, annoyed, guilty, eye-opener). It’s designed to be administrable by anyone, easy to remember, and easily completed within a minute.⁵
• AUDIT– The Alcohol Use Disorder Identification Test is a 10-item prescreening tool endorsed by the World Health Organization. It is not intended for diagnostics and is usually used to aid triage. It may be self-tested or facilitated by a clinician.⁵
• MAST – In the United States, the Michigan Alcohol Screening Test is the second most popular alcohol screening test after CAGE. It is comprised of 25 items and is highly focused on alcohol misuse. It may be done as a self-test or with the assistance of a clinician.⁵
• ASUS– The Adult Substance Use Survey is a 64-item self-reported test that is part of many states’ standard assessments for individuals going through the justice system.⁵
• DAST -The Drug Abuse Screening Test is a 10-item test focused on drugs other than alcohol. It may be self-administered or done with the assistance of a clinician. It is often paired with an AUD-specific test such as CAGE and AUDIT as part of pre-screening for treatment.⁵
• DUSI-R– The Drug Use Screening Inventory (Revised) test covers 159 items and is mostly used for adolescent and young adult screening. It is designed to be administered by a trained clinician rather than self-reported.⁵

Other Signs of Substance Misuse

If you have concerns that you or someone in your home has a problem with drugs or alcohol, you don’t necessarily need to complete a specific pre-screening tool before you go to a doctor.³

If you know that you are using drugs or alcohol heavily, you can just directly go to a doctor for screening and diagnostics. If you’re concerned about someone else you know, you can check for these signs before getting in touch with a medical professional:^3,4

Finding illicit drugs.

• Finding medications they have no prescriptions for, particularly opioids, benzodiazepines, or stimulants.
• A decline in hygiene and grooming.
• Frequent intoxication.
• Looking intoxicated but without the smell of alcohol.
• Unusual lethargy or wakefulness.
• Reclusive behavior.
• A lack of interest in hobbies and relationships one found enjoyable.

While these may not necessarily indicate a substance use disorder, they may also be a sign of other issues, such as a physical or other psychiatric illness. In any case, finding any of these signs may be reason enough to seek professional help.

Find Help for SUD in Massachusetts

Boston Drug Treatment Centers offers access to accredited SUD treatment and rehabilitation programs in the Greater Boston area. Call (617) 517-6448 to find options for drug and alcohol treatment that meet your unique recovery needs.

Resources:

1. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American journal of psychiatry, 170(8), 834–851. https://doi.org/10.1176/appi.ajp.2013.12060782

2. S. Substance Abuse and Mental Health Services Administration. (2017). Trends In Substance Use Disorders Among Adults Aged 18 Or Older.

3. National Institute on Drug Abuse. (2021, April 13). How to Recognize a Substance Use Disorder.

4. S. Department of Health & Human Services. (2019). Mental Health and Substance Use Disorders.

5. S. Substance Abuse and Mental Health Services Administration. (n.d.). Examples of Screening and Assessment Tools for Substance Use Disorders.