Substance use disorder (SUD)

Substance use disorder is a medical condition in which the use of alcohol or drugs becomes compulsive and continues despite significant harm.

It applies to alcohol, opioids, stimulants, sedatives, cannabis, nicotine and other substances, and it exists on a spectrum from mild to severe. Core features include using more than intended, failed efforts to cut down, cravings, tolerance, withdrawal, neglect of responsibilities and continued use despite physical, mental or social consequences. Repeated use alters the brain circuits that govern reward, stress and self-control, which is why willpower alone is often not enough.

Diagnosis follows criteria in the DSM-5 based on how many of eleven symptoms are present over a twelve-month period. Assessment includes a clinical interview, screening tools and sometimes laboratory tests. Behavioral therapies, mutual support and, for some substances, prescription medications are the established approaches. Cannabidiol has been studied in early trials for craving in several substance use disorders, and there is no approved use.