Thursday, July 25, 2013

SUD's - Close but no cigar

With the DSM-V out the move in the world of addiction has gone toward the term SUD's which stands for Substance Use Disorders. That term has been bouncing around for years but now its really gaining momentum as the accepted term to describe the overall spectrum of problems related to substance use/abuse. Personally I think its a step in the right direction but I believe that a small adjustment is needed.

The move away from trying to define whether someone's use of substances is actually substance ABUSE or substance DEPENDENCE is actually a good idea. The criteria for determining substance abuse vs. substance dependence really was never very practical as it was not based on "real-life" ways most of us view problems with substances or addiction. SUD - "Substance Use Disorder" seems to accept the fact that there is more of a spectrum when it comes to the problems that people may develop when it comes to drugs, alcohol and other addictions. When you think about what defines a problem, in reality there are so many variables to consider. Consider alcohol for example: the interplay between the amount someone uses, the frequency of use as well as the consequences that occur as the result of use. This can result in a lot of different ways to categorize a Substance Use Disorder. For example compare someone who uses drinks only once every other month but on those infrequent occasions, this person drinks a fifth of vodka to the point of blackout and at times becomes suicidal and as a result has been hospitalized three times in the past six months. Now compare that with the guy who works full time and drinks a six pack every night of the week who has never officially been in trouble but every day his wife complains about his drinking. Now compare that further with the 20 year old college girl who is an A student who drinks too much at parties only on the weekends, but she just got her second DUI. Three different examples, with three different patterns when it comes to amount and frequency of use. Often, the variable that is most influential with regard to someone's motivation for getting help is the consequences. It is the consequences that people experience as a direct or at times indirect result of their substance use is what drives people to get help.

With that said, my book, "Taking the Escalator: An Alternative to the 12 Steps" proposes use of the term SUI - Substance Use Issues instead of substance dependence, substance abuse or SUD's (Substance Use Disorders). Its the "Issues" (consequences) that people care about the most when it comes to their substance use and these issues are such a critical factor in determining the degree of one's problem. Substance Use Issues is an easy to accept term as avoids "hard to swallow' terms like "dependence" and "disorder". Most people would have an easier time accepting that they have an "issue" than openly confessing that they have a "disorder". In addition, most people who end up in treatment do not want to be there, especially early on. Would you like to enter a treatment program and right away be told that you have a "disorder". Probably not. Do you think teenagers and young people are ready to hear that they have a "disorder"? -Doubtful.

Substance Use Issues, on the other hand considers the wider spectrum of types of problems that trigger people to get help while leaving the door open to a non-threatening, non-judgemental dialogue with people seeking help and that is exactly what we need.


  1. Well I've been using the term disorder myself Kenneth, which has helped me to understand how to view what has happened to and through me. But I take your point about the judgemental and off-putting nature of that term for some, and will refashion my own dialogue with others accordingly. So thanks for the guidance.

  2. I agree, when we choose our own terms then anything is wide open but treatment providers need to be careful with labels, especially those with a negative connotation that can reduce motivation. Thanks for your feedback