Addiction & Substance Use Disorders
Addiction is a treatable medical condition, not a moral failing. Recovery is possible.
This information is educational and is not a diagnosis. Diagnosis requires a comprehensive psychiatric evaluation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
What it is
A substance use disorder is a pattern of alcohol or drug use that leads to significant problems or distress. It changes brain systems involved in reward, motivation, stress and self-control, which is why it can be so hard to stop through willpower alone.
Substance use disorders exist on a spectrum from mild to severe and can involve alcohol, cannabis, opioids, stimulants, sedatives, tobacco and other substances. They often occur alongside depression, anxiety, trauma or ADHD, and treating both together leads to better outcomes.
Diagnostic features (DSM-5-TR)
A plain-language summary of key features described in the DSM-5-TR. This is not the official criteria text and is not a self-diagnosis tool.
DSM-5-TR describes 11 criteria, occurring within a 12-month period. They can be grouped into four categories:
Impaired control
- Using more, or for longer, than intended.
- A persistent desire to cut down, or unsuccessful efforts to do so.
- Spending a lot of time getting, using or recovering from the substance.
- Craving, or a strong urge to use.
Social impairment
- Falling behind on major responsibilities at work, school or home.
- Continuing to use despite ongoing relationship or social problems caused or worsened by use.
- Giving up or reducing important social, work or recreational activities.
Risky use
- Repeated use in physically hazardous situations, such as driving.
- Continuing to use despite knowing it causes or worsens a physical or psychological problem.
Physical (pharmacological) changes
- Tolerance: needing more to get the same effect, or less effect from the same amount.
- Withdrawal: characteristic symptoms when stopping, or using to relieve or avoid them.
- Tolerance and withdrawal are not counted when they occur only with medications taken as prescribed under medical supervision.
Severity
- Mild: 2 to 3 criteria.
- Moderate: 4 to 5 criteria.
- Severe: 6 or more criteria.
- Remission specifiers describe early remission (3 to 12 months) and sustained remission (12 months or more) without criteria other than craving.
Common signs
- Using more than planned or being unable to cut back
- Strong cravings
- Needing more to feel the same effect
- Withdrawal symptoms such as shakiness, sweating, nausea, anxiety or poor sleep
- Missing work, school or family responsibilities
- Conflict with loved ones about use
- Giving up hobbies or activities
- Using in risky situations
- Hiding or minimizing use
How it's evaluated
I take a respectful, nonjudgmental history of what you use, how often, and how it affects your health, relationships and goals. Screening tools such as the AUDIT (alcohol) and other validated questionnaires can help clarify severity.
I also assess withdrawal risk, physical health, co-occurring mental health conditions and safety. Withdrawal from alcohol or sedatives such as benzodiazepines can be medically dangerous, so planning when and how to stop is an important part of care.
Evidence-based treatment options
Medications for opioid use disorder
Buprenorphine, methadone and naltrexone are FDA-approved and reduce cravings, relapse and overdose risk.
Medications for alcohol use disorder
Naltrexone, acamprosate and disulfiram are FDA-approved options that can support reduced drinking or abstinence.
Tobacco and nicotine
Varenicline, bupropion and nicotine replacement therapy are effective, especially when combined with counseling.
Behavioral treatments
Cognitive behavioral therapy, motivational interviewing and contingency management are evidence-based. Contingency management has strong evidence for stimulant use disorders, for which no medications are FDA-approved.
Levels of care and overdose prevention
Some people need medically supervised withdrawal, intensive outpatient or residential care. Naloxone can reverse opioid overdose and is recommended for people at risk and their families.
How I can help
I meet you where you are, without shame or judgment. Whether you want to cut back, stop completely or simply understand your options, I will complete a thorough evaluation and talk through what the evidence shows.
When appropriate, I discuss medication options, treat co-occurring conditions such as anxiety, depression or ADHD, and help connect you with counseling, support groups or a higher level of care if you need it. Recovery is a process, and I am here for each step.
Insight
Relapse does not mean treatment failed. Like other chronic conditions, substance use disorders can involve setbacks, and they are a signal to adjust the plan, not to give up.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- National Institute on Drug Abuse (NIDA): Treatment and Recovery
- National Institute on Alcohol Abuse and Alcoholism (NIAAA): Understanding Alcohol Use Disorder
- SAMHSA National Helpline: 1-800-662-HELP (4357)
- FindTreatment.gov (SAMHSA treatment locator)
Heal • Grow • Thrive
Ready When You Are.
Putting your mental health first is a strength. It is okay to ask for help.