Substance Use Disorders 483
Substance-Related Disorders
Substance Use Disorders
Features
The essential feature of a substance use disorder  is a cluster of cognitive, behavioral, and
physiological symptoms indicating that the individual continues using the substance de-
spite significant substance-related problems. As seen in Table 1, the diagnosis of a sub-
stance use disorder can be applied to all 10 cl asses included in this chapter except caffeine.
For certain classes some symptoms are less sa lient, and in a few instances not all symptoms
apply (e.g., withdrawal symptoms are not sp ecified for phencyclidin e use disorder, other
hallucinogen use disorder, or  inhalant use disorder). 
An important characteristic of substance use disorders is an underlying change in brain cir-
cuits that may persist beyond detoxification, part icularly in individuals with severe disorders.
The behavioral effect s of these brain changes may be exhibited in the repeated relapses and in-
tense drug craving when the individuals are exposed to drug-related stimuli. These persistent
drug effects may benefit from long-term approaches to treatment.
Overall, the diagnosis of a su bstance use disorder is based on a pathological pattern of
behaviors related to use of the substance. To as sist with organization, Criterion A criteria can
be considered to fit within overall groupings of impaired control,  social impairment,  risky use,
and pharmacological criteria.  Impaired control over substance use is the first criteria grouping
(Criteria 1–4). The individual may take the substance in larger amounts or over a longer pe-
riod than was originally intended (Criterion 1). The individual may express a persistent de-
sire to cut down or regulate substance use and may report multiple unsuccessful efforts to