When use becomes problematical
Substance use can become substance use disorder in up to around a fifth of users (although for nicotine users the rate can be as high as 67%). And substance use disorder is formally recognised as a medical disorder.4,5
Neuroscience research has revealed that substance use disorder is progressive, chronic, relapsing disorder that can be treated.4
In formal terms, the diagnostic manual, ICD-11, describes three different disorders due to substance use or addictive behaviours: a single episode of harmful use / intoxication; harmful pattern of use continuously for a month or intermittently for 12 months, and dependence where craving makes it difficult for an individual to control use.5
The classification focusses on 14 classes or groups of psychoactive substances such as alcohol, cannabis, caffeine, nicotine and cocaine that have important clinical and public health consequences.
Disorders due to harmful non-medical use of non-psychoactive substances (eg laxatives, growth hormone, erythropoietin, and non-steroidal anti-inflammatory drugs) are also included.5
Substance use disorder exacts a heavy toll both in terms of health and quality of life on individuals and has significant repercussions for society.
A range of interacting factors contribute to the disease, including social, biological and the types of drugs involved. Individual susceptibility is influenced by aspects such as genetics, exposure to adverse childhood experiences, life developmental stage at which drug exposure first occurred, personality features and concomitant psychiatric disorders.
Family and community support, social disarray and inequalities, normal behaviour associated with drugs, and drug availability and legal status, also play a part.
The complex nature of the problem may explain why some people, although exposed to drugs, do not become addicted and why some people recover from addiction while others become ever more affected.4