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Epidemiology
The prevalence of substance use disorders varies by nation and by given substance, but the overall prevalence is high. On a global level, research consistently shows that men are affected by SUD at a much higher rate than women. Studies have also demonstrated that younger individuals are more likely to suffer from SUD than older adults.

In the United States:
The Substance Abuse and Mental Health Services Administration (SAMHSA) releases an annual report on alcohol and drug use in the United States. SAMHSA's 2017 report found that roughly 7% of Americans aged 12 or older suffered from a SUD in the past year. The same study found the incidence of alcohol use disorder in the past year to be just over 5%. Approximately 3% of people aged 12 or older had an illicit drug use disorder. Further stratification reveals that the highest prevalence of illicit drug use disorder was among those aged 18 to 25 years old, at roughly 7%. This finding is consistent with other epidemiological studies which have consistently shown that substance use disorder is most prevalent among younger individuals.

The were over 72,000 deaths from drug overdose in the United States in 2017. This represents a 3-fold increase in mortality from overdose from 2002 to 2017. Overdose fatalities from synthetic opioids, which typically involve fentanyl, have risen sharply in the past several years to contribute to nearly 30,000 deaths per year. Death rates from synthetic opioids like fentanyl have increased 22-fold in the period from 2002 to 2017. Heroin and other natural and semi-synthetic opioids combined to contribute to roughly 31,000 overdose fatalities. Cocaine contributed to roughly 15,000 overdose deaths, while methamphetamine and benzodiazepines each contributed to roughly 11,000 deaths. Of note, the mortality from each individual drug listed above cannot be summed because many of these deaths involved combinations of drugs, such as overdosing on a combination of cocaine and an opioid.

Deaths from excessive alcohol consumption account for the loss of over 88,000 lives per year. Tobacco remains the leading cause of preventable death, responsible for greater than 480,000 deaths in the United States each year.

Diagnosis
Individuals whose drug or alcohol use cause significant impairment or distress may have a substance use disorder (SUD). Diagnosis usually involves an in-depth examination, typically by psychiatrist, psychologist, or licensed drug and alcohol counselor. The most commonly used guidelines are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are 11 diagnostic criteria which can be broadly categorized into issues arising from substance use related to loss of control, strain to one's interpersonal life, hazardous use, and physiologic effects.

DSM-5 guidelines for the diagnosis of a substance use disorder requires that the individual suffers significant impairment or distress from their pattern of drug use, and at least two of the symptoms listed below in a given year.


 * 1) Using more of a substance than planned, or using a substance for a longer interval than wanted to
 * 2) Inability to cut down despite desire to so
 * 3) Spending substantial amount of the day obtaining, using, or recovering from substance use
 * 4) Craving or intense urges to use
 * 5) Repeated usage causes or contributes to an inability to meet important social, or professional obligations
 * 6) Persistent usage despite user's knowledge that it is causing frequent problems at work, school, or home
 * 7) Giving up or cutting back on important social, professional, or leisure activities because of use
 * 8) Using in physically hazardous situations, or usage causing physical or mental harm
 * 9) Persistent use despite the user's awareness that the substance is causing or at least worsening a physical or mental problem
 * 10) Tolerance: needing to use increasing amounts of a substance to obtain its desired effects
 * 11) Withdrawal: characteristic group of physical effects or symptoms that emerge as amount of substance in the body decreases

Of note, there are additional qualifiers and exceptions outlined in the DSM. For instance, an individual prescribed opiates, who is taking them as prescribed, may experience tolerance and withdrawal, but would not meet criteria for a SUD without additional symptoms. A medical professional trained to evaluate and treat substance use disorders will take these nuances into account during a diagnostic evaluation.

Severity
Substance use disorders range can range widely in severity, and there are numerous methods to monitor and qualify severity of SUD. The DSM-5 includes specifiers for severity of a SUD. Individuals who meet only 2 or 3 criteria are often deemed to have mild SUD. Substance users who meet 4 or 5 criteria may have their SUD described as moderate, and persons meeting 6 or more criteria as severe. The quantity of criteria met offer a rough gauge on the severity of illness, but licensed professionals will also take into account a more wholistic view when assessing severity that includes specific consequences and behavioral patterns related to an individual's substance use. They will also typically follow frequency of use over time, and assess for substance-specific consequences, such as occurance of blackouts when evaluating someone for an alcohol use disorder. There are additional qualifiers for stages of remission that are based on the amount of time an individual with a diagnosis of a SUD has not met any of the 11 criteria except craving.

Detoxification[edit]
Depending on the severity of use, and the given substance, early treatment of acute withdrawal may include medical detoxification. Of note, acute withdrawal from heavy alcohol use should be done under medical supervision to prevent a potentially deadly withdrawal syndrome known as delirium tremens. See also Alcohol detoxification.