Mental Disorders of Behaviour: (ADHD, Substance Related Disorders, Conduct Disorder) Substance Use Disorder.
There is a spectrum of harm that can develop from using various substances. Along this spectrum of harm is abuse and dependence. Substance Related Disorders Substance use and substance misuse occur commonly in young people and are not the same as Substance Use Disorders or Substance Induced Disorders, however the onset of the latter most commonly occurs during the teen years.
Currently, alcohol and tobacco are the most commonly used substances with marijuana ranking a more distant third on the list. Clinical interventions to help young people who are misusing substances are often provided based on the realization that some types of substance misuse may raise the probability of substance related harm, even if the young person does not go on to develop a Substance Use Disorder. Indeed, most people who misuse substances in their youth do not go on to develop a Substance Use Disorder.
To this end, the CRAFFT youth substance assessment measure can be used to identify those young people for whom a clinical intervention may be indicated, before they go on to develop a Substance Use Disorder. Young people who endorse one or more items on the CRAFFT screening tool could be considered as candidates for early intervention.
Substance Use Disorders (SUDs) are characterized by excessive and continued use of substances in spite of numerous negative consequences (physical, social, academic/vocational, interpersonal and legal). People with SUDs crave the substance and exhibit persistent drug seeking behaviors, which can include various anti-social components, such as theft. Young people who meet diagnostic criteria for a SUD require intensive treatment that may include short-term residential care. Treatment relapse is common.
Adolescent Alcohol & Substance Use Screen (CRAFFT):
C – Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
R – Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A – Do you ever use alcohol/drugs while you are by yourself, ALONE?
F – Do you ever FORGET things you did while using alcohol or drugs?
F – Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
T – Have you gotten into TROUBLE while you were using alcohol or drugs?
Substance Induced Disorder describes the impact of a substance on a person at a particular point in time. For example: intoxication or withdrawal. Substance Induced Disorder (SID) can occur without the presence of Substance Use Disorder. For example, a young person can be intoxicated from excessive use of alcohol and behave inappropriately or dangerously (driving a car) or be admitted for emergency medical care due to an inability to function or as a result of a neurological event (such as a seizure). During this time, the person would be considered to exhibit a Substance Induced Disorder.
Many young people, especially if they are involved in binge drinking of alcohol can meet diagnostic criteria for SID if excessive amounts of alcohol are ingested over a short period of time. This would be called Alcohol Induced Disorder. Some SIDs can, in the short term, be difficult to distinguish from certain types of mental disorders, such as psychoses or mood disorders.
This is because the substance can elicit delusions and hallucinations or severe depressions or extreme excitement and agitation. In such cases, admission to hospital is often indicated, both to treat the SID and also to differentiate symptoms related to an SID from those of a psychosis or mood disorder. With Substance Use Disorder, the person demonstrates a longstanding pattern of negative behaviors as described above, related to the persistent seeking out of and use of a particular substance.
For example, a person with Alcohol Use Disorder could be intoxicated for hours in a day, may steal to obtain funds to purchase alcohol, may neglect their personal hygiene when drinking, may run afoul of the law or act inappropriately at school, etc.
This pattern of behavior would occur frequently over time and would be associated with significant functional impairment (for example: failing at school; legal charges, traffic accidents while drinking, etc.). Individuals with SUD’s may frequently also demonstrate SID at numerous points over time, while many people who demonstrate SID at infrequent time points may not meet diagnostic criteria for SUD.
There are many types of SUDs. An SUD can occur with substances that are legal (for example: tobacco or alcohol) or illegal. These include but are not limited to: Alcohol Use Disorder, Cannabis Use Disorder, Opioids Use Disorder, etc. Not infrequently the type of SUD can change over time or a person can meet criteria for more than one SUD concurrently. Treatments are a combination of psychological and social (often peer supported) interventions. Sometimes medications are used, depending on the substance and the situation.