Talk:Substance use disorder/Archive 1

Archive 1

Outdated term?

I don't see how Wiki can classify substance abuse as 'an outdated term still frequently used', when there is a major wiki article dedicated to it. Valetude (talk) 14:55, 7 March 2014 (UTC)

Assessment and Diagnosis Sandbox Edits for Substance Use Disorder

Hello all, I have made changes in my Sandbox about this topic focusing on evidence-based assessment and diagnosis. It would be great if people would look at it and leave comments on my talk page before I post it on the article.

The sandbox link can be found here (https://en.wikipedia.org/wiki/User:Mfrumkin/sandbox).

I appreciate it! YenLingChen (talk) 20:55, 3 November 2014 (UTC)

see Talk:Autism_spectrum#Assessment_and_Diagnosis_Sandbox_Edits_for_Autism_Spectrum_Disorder Jytdog (talk) 00:18, 4 November 2014 (UTC)

and see User_talk:YenLingChen Jytdog (talk) 00:21, 4 November 2014 (UTC)

Must remain an independent article

I am here to strongly disagree with the merging of the two articles. In my eyes, this is like suggesting merging "Depression (Mood)" and "Major Depressive Disorder". Please, for the naive, research the difference between a patient with this disorder and the act of misusing substances. Thanks! 50.141.113.11 (talk) 15:06, 17 March 2015 (UTC)

Strongly disagree with the merging.

It would be foolish to group these together, as substance abuse is usually, though not limited to, factors other than mental illness. This is a subtopic for substance abuse purely relate to mental illness, so the grouping would be, in my view, abhorrent and completely incorrect. 62.253.68.10 (talk) 12:51, 19 March 2015 (UTC) — Preceding unsigned comment added by 62.253.68.10 (talk) 12:42, 19 March 2015 (UTC)

Alcoholism and alcohol use disorder have been merged in the DSM 5. I think the difference between substance abuse and substance use disorder is small enough that a merge is reasonable. Doc James (talk · contribs · email) 07:49, 22 May 2015 (UTC)

I strongly disagree too against merge with Substance abuse article.

Doc James, fist of all we are not bounded to DSM 5, and this would be POV. And more: I'm not sure that merging alcoholism and alcohol use disorder is OK, anyhow is a broad situation, so there are more relate; while for example a simple one time substance abuse (although important, and endangering health and even life, so even so encyclopaedic topic) may be not a broad situation as a substance use disorder. Anyhow, even more, substance use disorder stated in DSM have criteria set by DSM's authors (and build up by them, a they claim copyright rights about them generally in DSM), which my be not be in every substance abuse kinds and single person's occurences.

More simply; how you can surely say that every substance abuse is a substance use disorder as set and delimited in DSM? --5.170.65.168 (talk) 07:07, 29 July 2015 (UTC)

Isn't "substance use disorder" a political invention?

The "problem" with using substances is that other people disapprove of it.

Substance "abuse" is distinct from substance "use", but a billion dollars a year of biased NIDA funding conflates the two.

Also, the article is supposedly about "substance use disorder" but it spends a lot of time talking about "abuse" and "dependence" and "addiction". Shouldn't those topics mostly be discussed on their own pages? Is there really a disorder when substance use is not accompanied by abuse, dependence or addiction? Gnuish (talk) 20:51, 22 March 2014 (UTC)

see Talk:Autism_spectrum#Assessment_and_Diagnosis_Sandbox_Edits_for_Autism_Spectrum_Disorder Jytdog (talk) 00:21, 4 November 2014 (UTC)

and see User_talk:YenLingChen Jytdog (talk) 00:21, 4 November 2014 (UTC)

You can't be diagnosed with SUD just because do an unpopular drug (e.g. snorting cocaine and injecting heroin), do a drug under a certain age (e.g. drinking and toking at 14) or engage in other disapproved drug uses. SUD is diagnosed when the usage of the drug impairs your life, directly endangers you or others around you or causes withdrawal.

SUD is a broad term covers many different substance-related diagnoses. I think this article should stay. Andrea Carter (at your service | my evil deads) 03:47, 13 August 2015 (UTC)

US surgeon general's report

https://addiction.surgeongeneral.gov/ could be a valuable source for this and related articles. Sizeofint (talk) 20:39, 28 January 2017 (UTC)

@Sizeofint: I haven't read it yet, but this looks like it is a very comprehensive source. Thanks for posting the link here. Seppi333 (Insert 2¢) 21:27, 28 January 2017 (UTC)

References

Work Plan

Over the next month I will be updating this article as a project/course in my medical school. I plan a fairly substantial overhaul of the article. The article needs to be tightened up to remain specific to substance use disorder. I will begin with disambiguation from substance use, substance abuse, and substance abuse. I will add appropriate wiki links to those pages. I will reference the wiki page on alcohol use disorder (alcoholism) as a standard/model to emulate. I expect time will be a factor that limits the scope of the updates. Current plans include:

Add section: Diagnosis 1. Impaired control 2. Social impairment 3. Risky use 4. Tolerance and withdrawal.

Update definitions section.

Mechanisms: this section contains too much primary research and jargon, and will likely be deleted until a more generalized discussion about SUD and pathways can be included.

Management needs to be generalized as specific experimental drugs are not core to Wikipedia’s mission. Neurofeedback isn’t first line and probably does not deserve equal consideration to standard of care. Epidemiology is a bit thin.

Legality: I am not certain if this is important to include.

Eliminate section: opposition to common views. This section seems more germane to substance abuse, substance use, and addiction. It is not relevant to a clinical diagnosis. These are theories about why someone might use drugs, and are far from comprehensive or representative of the spectrum of theories available.

This list is not exhaustive and I may not be able to work on all of the stated sections in the time available. I will be using resources such as ClinicalKey, AccessMedicine, MedlinePlus, and Pubmed to gather appropriate research. I will attempt to make use of plain language writing guidelines to minimize unnecessary medical jargon. Please reach out if you have any suggestions/comments as I am editing the work.MedicalEdits (talk) 21:18, 19 November 2018 (UTC)

substantially increased and updated section on epidemiology

I pulled several resources and substantially added to the epidemiology section. It would still benefit from statistics outside of the united states. MedicalEdits (talk) 23:53, 6 December 2018 (UTC)

streamlining detox section

Streamlining detox section. It may be difficult to include this section given the amount of substances one might withdrawal from. I decided to eliminate much of what was there because it contained experimental drugs which are outside of the scope of wikipedia, as well as an incomplete and unbalanced view both in terms of which drugs require detox, what the detox is, and what the best treatments available are. For instance, placing neurofeedback above buprenorphine therapy for managing opiate detox is not the standard of care. I have been excited about the potential for neurofeedback for some time, but it is not first line and should not be placed above buprenorphine as an option. I decided to include a brief reference to delerium tremens as acute ETOH withdrawal can be deadly. Feel free to add detox links for individual substances or add short blurbs on particular drug detoxes if you feel so inclined. Before editing, the section included:

"Detoxification[edit] Early treatment of acute withdrawal often includes medical detoxification, which can include doses of anxiolytics or narcotics to reduce symptoms of withdrawal. An experimental drug, ibogaine,[42] is also proposed to treat withdrawal and craving.

Neurofeedback therapy has shown statistically significant improvements in numerous researches [2] conducted on alcoholic as well as mixed substance abuse population. In chronic opiate addiction, a surrogate drug such as methadone is sometimes offered as a form of opiate replacement therapy. But treatment approaches universal focus on the individual's ultimate choice to pursue an alternate course of action." MedicalEdits (talk) 00:25, 7 December 2018 (UTC)

created section on diagnosis

Created a section on diagnosis based on DSM 5 criteria. Attempting to reword the 11 criteria without plagiarizing or altering the DSM's very nuanced meaning was challenging. Please feel free to make edits or updates if you feel any wording is too similar/ is inaccurate, or misrepresents the information. Thank you.MedicalEdits (talk) 00:43, 7 December 2018 (UTC)

added subheading to diagnosis: severity

Added description of DSM severity specifier, and a brief blurb on remission specifier. MedicalEdits (talk) 00:51, 7 December 2018 (UTC)

removal of paragraphs on eating disorders and gambling disorders

Removed paragraphs on eating disorders and gambling disorders as they are not SUD, they are other mental disorders. If it could be rewritten to make a meaningful connection to SUD in 1-2 sentences, perhaps it could be of benefit to the article without getting too far off topic? MedicalEdits (talk) 01:30, 7 December 2018 (UTC)

Request for assistance. Help streamlining "Causes" section.

Is someone willing and able to condense/update the section on causes? I think there is a lot of good information, but in it's current form it is long enough that it could probably be better adapted into a spinoff standalone article. I think the article on alcoholism/alcohol use disorder https://en.wikipedia.org/wiki/Alcoholism#Causes , which received the "GA: good article rating" might be a good model to emulate in terms of length, content, and layout. Overall this topic is very sociological and out of my wheel house. A strong succinct revision of "causes" could go a long way in improving this article's quality.MedicalEdits (talk) 01:43, 7 December 2018 (UTC)

Upcoming section removal

Plan to remove section: entitled: "Opposition to common views" (below). While interesting, it is referring to individuals who use drugs, but are not significantly clinically impaired or distressed by their drug use, and as such are indeed not suffering from a psychiatric illness. I will be sure to make a clear distinction between drug use without psychiatric problem, vs drug use consistent with SUD in my upcoming edits. Perhaps the points made could be better subsumed under a category of sociology of SUD?

"Opposition to common views[edit] Thomas Szasz denies that addiction is a psychiatric problem. In many of his works, he argues that addiction is a choice, and that a drug addict is one who simply prefers a socially taboo substance rather than, say, a low risk lifestyle. In Our Right to Drugs, Szasz cites the biography of Malcolm X to corroborate his economic views towards addiction: Malcolm claimed that quitting cigarettes was harder than shaking his heroin addiction. Szasz postulates that humans always have a choice, and it is foolish to call someone an "addict" just because they prefer a drug induced euphoria to a more popular and socially welcome lifestyle.

Professor John Booth Davies at the University of Strathclyde has argued in his book The Myth of Addiction that "people take drugs because they want to and because it makes sense for them to do so given the choices available" as opposed to the view that "they are compelled to by the pharmacology of the drugs they take."[46] He uses an adaptation of attribution theory (what he calls the theory of functional attributions) to argue that the statement "I am addicted to drugs" is functional, rather than veridical. Stanton Peele has put forward similar views."MedicalEdits (talk) 01:23, 5 December 2018 (UTC)

MedicalEdits, I'm being a devil's advocate here, but would not a theory that SUD isn't a psychiatric illness be entirely appropriate here? Ifnord (talk) 01:34, 5 December 2018 (UTC)

It depends on what we are arguing. Substance use disorder is a specific medical diagnosis with particular diagnostic criteria described in DSM and elsewhere. Not all substance use, or abuse, misuse, etc. necessarily qualifies as a psychiatric disorder. It's when it becomes a pattern that causes significant distress/impairment to the individual. In a medical article, wikipedia favors being conservative as using well established research, rather than individual theories and primary resources. The consequences of misleading a reader when discussing the medical diagnosis of SUD can be deadly if it motivates an individual away from seeking treatment due to misinformation/confusing theories.

 Taken directly from wiki article on mental disorder: 

"A mental disorder, also called a mental illness[2] or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[3] Such features may be persistent, relapsing and remitting, or occur as a single episode. Many disorders have been described, with signs and symptoms that vary widely between specific disorders.[4][5] Such disorders may be diagnosed by a mental health professional."MedicalEdits (talk) 15:13, 5 December 2018 (UTC)

I agree with the removal of this section. I think that the purpose of these articles is to discuss the consensus and not necessarily discuss all of the dissenting beliefs Barnecar92 (talk) 17:51, 14 December 2018 (UTC)

planned removal of "legality" section

Again, I apologize in advance if this change offends anyone. I have decided to remove the legality section for two main reasons: 1) I'm not certain the connection to SUD. Many substances included in the definition of a SUD are legal. If expanded, I think it's a very interesting topic that could be its own stand alone article? 2) There are no citations and as such it cannot be determined if this is strictly the author's opinions. Please feel free to comment.

"Legality Most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. Typically this legislation covers any or all of the opiates, substituted amphetamines, cannabinoids, cocaine, barbiturates, hallucinogens (tryptamines, LSD, phencyclidine, and psilocybin) and a variety of more modern synthetic drugs, and unlicensed production, supply or possession may be a criminal offense.

Usually, however, drug classification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, whilst others rarely cause any form of compulsive need whatsoever.

Also, although the legislation may be justifiable on moral grounds to some, it can make addiction or dependency a much more serious issue for the individual. Reliable supplies of a drug become difficult to secure as illegally produced substances may have contaminants. Withdrawal from the substances or associated contaminants can cause additional health issues and the individual becomes vulnerable to both criminal abuse and legal punishment. Criminal elements that can be involved in the profitable trade of such substances can also cause physical harm to users." MedicalEdits (talk) 01:17, 7 December 2018 (UTC)

I agree with the removal of this section. It does not seem pertinent to the overall article and it does not have enough literature support as it is currently written. Barnecar92 (talk) 17:54, 14 December 2018 (UTC)

shortened/abbreviated introduction

The introduction was a bit lengthy so I decided to update and eliminate some of the definitions, especially regarding DSM 4 material. The introduction definitely still needs more work, especially including links to addition, AUD, opiate use disorder, etc. But hopefully this change provides a basis for a more streamlined introduction. Please feel free to edit or comment, this still needs work. The portion eliminated: "Although the term substancecan refer to any physical matter, 'substance' in this context is limited to psychoactive drugs. Addictionand dependenceare components of a substance use disorder and addiction represents the most severe form of the disorder.[1][2] A SUD involves the overuse of, or dependence on, a drugleading to effects that are detrimental to the individual's physical and mental health, or the welfareof others.[3]An SUD is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, which results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. There are ongoing debates as to the exact distinctions between substance abuseand substance dependence, but current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use.[4]In the DSM-5substance use disorder replaced substance abuse and substance dependence.[5][6][7]Another term, substance-related disorder, has also been used."

MedicalEdits (talk) 19:48, 14 December 2018 (UTC)

removed section on physical and physiologic dependency

I have decided to delete this section for the time being due to length, it already being covered in definitions section, the relative importance of the topics falling out of favor/importance in DSM 5, and finally the lack of any citations. Please feel free to comment if you think these sections still need to be included or if they should perhaps be included in another form not considered.

Section deleted:

"Physical dependency Physical dependence on a substance is defined by the appearance of characteristic physical withdrawal symptoms when the substance is suddenly discontinued. Opiates, benzodiazepines, barbiturates, alcohol and nicotine induce physical dependence. On the other hand, some categories of substances share this property and are still not considered addictive: cortisone, beta blockers and most antidepressants are examples.

Some substances induce physical dependence or physiological tolerance - but not addiction — for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.

The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some people may exhibit alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become attached to a pleasurable routine.

The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. High-quality, long-term studies are needed to better delineate the risks and benefits of chronic opiate use. [citation needed]

Psychological dependency Psychological dependency on a substance is defined by the appearance of emotional-motivational withdrawal symptoms (e.g., anxiety, irritability, anhedonia, depressed mood, restlessness, etc.) when the substance is suddenly discontinued. Psychological dependence is not unique to substances; for example, separation anxiety occurs in young children when they lack exposure to individuals to whom they're emotionally attached."

MedicalEdits (talk) 20:24, 14 December 2018 (UTC)

Planned removal of Mechanisms section

I apologize in advance for any feathers this ruffles. I believe a section mechanisms is valuable. I have decided to remove this section as a challenge to the authors to rewrite this material in a manner that's accessible to your average wikipedia reader. This is very well written if it's target audience is a psych PHD, but not for a general wikipedia audience. For context, I am months away from completing my medical degree, and plan to pursue psychiatry, I know all the terms in this section, but it's still way over my head. Additionally wiki medical writing guidelines prefer avoiding primary literature in favor of textbook type references. Feel free to comment.

"Mechanisms[edit] Addiction[edit] ΔFosB, a gene transcription factor, has been identified as playing a critical role in the development of an addiction.[31][32][33] Overexpression of ΔFosB in the nucleus accumbens is necessary and sufficient for many of the neural adaptations seen in drug addiction;[31] it has been implicated in addictions to alcohol, cannabinoids, cocaine, nicotine, phenylcyclidine, and substituted amphetamines[31][34][35][36] as well as addictions to natural rewards such as sex, exercise, and food.[32][33] Moreover, reward cross-sensitization between amphetamine and sexual activity, a property in which exposure to one increases in the desire for both, has been shown to occur preclinically and clinically as a dopamine dysregulation syndrome;[33][37] ΔFosB expression is required for this cross-sensitization effect, which intensifies with the level of ΔFosB expression.[33]

Dependence[edit] Upregulation of the cyclic adenosine monophosphate (cAMP) signal transduction pathway by cAMP response element binding protein (CREB), a gene transcription factor, in the nucleus accumbens is a common mechanism of psychological dependence among several classes of drugs of abuse.[38][13] Upregulation of the same pathway in the locus coeruleus is also a mechanism responsible for certain aspects of opioid-induced physical dependence.[38][13]

Increased brain-derived neurotrophic factor (BDNF) signaling in the ventral tegmental area (VTA) has been shown to mediate opiate-induced withdrawal symptoms via downregulation of insulin receptor substrate 2 (IRS2), protein kinase B (AKT), and mechanistic target of rapamycin complex 2 (mTORC2).[13][39] As a result of downregulated signaling through these proteins, opiates cause VTA neuronal hyperexcitability and shrinkage (specifically, the size of the neuronal soma is reduced).[13] It has been shown that when an opiate-naive person begins using opiates in concentrations that induce euphoria, BDNF signaling increases in the VTA.[40]"MedicalEdits (talk) 01:05, 7 December 2018 (UTC) MedicalEdits (talk) 01:03, 7 December 2018 (UTC)

I'm not inclined to rewrite that. Molecular neurobiology is not lay a topic. Seppi333 (Insert 2¢) 03:30, 8 December 2018 (UTC)

I agree with the removal of this section in its current state. It was tough to understand from a lay perspective. I think it would be more accessible in 4-6 sentences saying something like: the nucleus accumbens is where scientists think the reward pathway lies. many substances and activities including sugar, sex, and substances cause this pathway to activate and make us associate the activity with pleasure. This is thought to establish addictive behavior. Other areas of the brain like the VTA (which does motivation and emotional processing) have been found to have association with the withdrawal symptoms in substance abuse disorder. Barnecar92 (talk) 18:29, 14 December 2018 (UTC)

Originally, I didn't object to the removal; but, since your description of what causes an addiction made me facepalm, I think it's best to just restore the section and link to the mechanism sections of the articles on addiction and dependence. Seppi333 (Insert 2¢) 11:12, 22 January 2019 (UTC)

Suggested changes and additions

"Signs and Symptoms" (the whole section and all claims) needs citations. Additionally "Therapists often classify people with chemical dependencies as either interested or not interested in changing." under "Therapies" also needs a citation.

Citation #20, that uses percentages regarding the number of people who seek treatment and who relapse is a study from 2000, an incredibly outdated article considering the current status of substance use disorders and substances in the U.S. now (i.e. Opioid epidemic).

On "Management Regarding "management" and "detoxification". First, is it too far out to mention 12-step fellowships? Rehabs? Detox wards? Intensive Out-patient? Church organizations? Interventions? Drug court? Maintenance drugs like suboxone, vivatrol and methadone (MAT)? All of these options can be mentioned without assigning value judgment (i.e. "you *should* go to this or that"). Regardless of popular opinion they are all resources that are apart of the larger context of SUDs and I think they belong here. None of them really need to be fleshed out either, just hyperlinked. And regarding "detoxification" benzodiazepines are dangerous to withdraw on too (and all withdraw is rough) so maybe adding more to this section, although I'm not sure what that looks like yet, just seems like more than a warning and alcohol mention should be included. LSislen (talk) 03:16, 5 February 2019 (UTC)

"Other hallucinogen use disorder" listed at Redirects for discussion

An editor has asked for a discussion to address the redirect Other hallucinogen use disorder. Please participate in the redirect discussion if you wish to do so. Steel1943 (talk) 06:25, 31 October 2019 (UTC)

Illicit drugs

Sentence goes on to include alcohol, tobacco etc which are not illicit drugs.--Iztwoz (talk) 11:03, 4 January 2020 (UTC)

The 271 million does not include alcohol, tabacco, etc... It only includes illicit drugs. Doc James (talk · contribs · email) 11:04, 4 January 2020 (UTC)

This is all very unclear and mixed, for example the earlier paragraph "Drug classes that are involved in SUD include: alcohol; caffeine; cannabis; hallucinogens (such as arylcyclohexylamines); other hallucinogens (such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco; and other or unknown substances". This includes both illicit and legal drugs, which is not clearly separated in later para.--Iztwoz (talk) 11:12, 4 January 2020 (UTC)

GA Review

This review is transcluded from Talk:Substance use disorder/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Markworthen (talk · contribs) 23:57, 8 March 2020 (UTC)

Review in progress.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 23:57, 8 March 2020 (UTC)

Review completed.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 20:57, 19 March 2020 (UTC)

GA review – see WP:WIAGA for criteria

• GA Criterion 1: Is it well written?

Criterion 1a: The prose is clear and concise, and the spelling and grammar are correct:

Explanation: There are several instances of imprecise prose. Verbosity is not a problem. Grammar can be improved. Spelling looks okay.

Here are some examples of murky prose:

Lead: "The number of deaths directly caused by drug use has increased over 60 percent from 2000 to 2015." - The phrase, "directly caused", should be explained.

Definitions: "Substance use may lead to drug addiction, drug dependence, or both, depending on the substance. Both substance abuse and substance dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency." (emphasis added; footnotes and citations omitted) - The words used to describe alcohol and other drug problems have changed frequently over the past several decades, which has led to confusion and uncertainty. Authorities still disagree on how to best define the terms. We must therefore tread cautiously when we use these terms—if we use them at all. I suggest close adherence to DSM-5 definitions and descriptions since "substance use disorder" is a DSM-5 diagnosis. "Substance use disorder" is also a general term in the scholarly literature, but this article is (mostly) about the diagnosis.

Severity: "Some medical systems refer to an Addiction Severity Index to assess the severity of problems related to substance use." (citation omitted) - The term, "medical systems" is vague, as is the phrasal verb, "refer to". The Addiction Severity Index should be briefly described, especially since we do not have an article on it.

• GA Criterion 1b: It complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation:

Explanation:

Lead section - Currently I would rate the lead section B-class (which is good!), although it will need to be updated as edits are made to the body of the article. ¶ I will offer a couple of suggestions to help improve the lead section (and other sections).

(α) "In 2017 globally 271 million people (5.5% of adults) were estimated to have used one or more illicit drugs. Of these 35 million had a substance use disorder." - This is important data to include, but I suggest clarifying that the 35 million number refers only to illicit drug use disorders, i.e., the number does not include alcohol use disorders.

(β) Be careful about "pointing words" (more formally, deictic words), such as demonstratives that are not clear without additional cues. The sentence, "Of these 35 million had a substance use disorder", is unclear because the reader does not quickly apprehend what "of these" refers to. One way to rewrite the sentence would be, "Of those 271 million people, 35 million (13%) had a substance use disorder."

Layout - The following aspects of the layout look very good: Short description; date style; Infobox; Images; Table of contents; See also; Notes and references; footer navbox; Categories. Further reading has a solid recommendation, but it should be updated since it was published in 2002.

Words to watch - I did not see a pattern of several or repeated words to watch, although this aspect of our style guide is worth reviewing because we often legitimately use words to watch in other contexts, e.g., social media, email, blog posts, even academic articles. In other words, we often don't realize we are using a word to watch. (When I write, "we", I include myself.)

List incorporation - Very good.

• GA Criterion 2: Is it verifiable with no original research?

Criterion 2a: It contains a list of all references (sources of information), presented in accordance with the layout style guideline:

Criterion 2b: All in-line citations are from reliable sources, including those for direct quotations, statistics, published opinion, counter-intuitive or controversial statements that are challenged or likely to be challenged, and contentious material relating to living persons—science-based articles should follow the scientific citation guidelines:

Explanation: For example, this statement, while well-written and important, needs a citation to a reliable source: "Substance use may be better understood as occurring on a spectrum from beneficial to problematic use. This conceptualization moves away from the ill-defined binary antonyms of "use" vs. "abuse" towards a more nuanced, public health-based understanding of substance use."

Another example: I found a promotional link (diff).

Criterion 2c: It contains no original research:

Note: I did not see any obvious instances of original research, but as editors continue to expand and improve this article, please be on the lookout for something I might have missed.

Criterion 2d: It contains no copyright violations nor plagiarism:

Note: I did not see any obvious instances of copyright violations, but as editors continue to expand and improve this article, please be on the lookout for something I might have missed.

• GA Criterion 3: Is it broad in its coverage?

Criterion 3a: It addresses the main aspects of the topic:

The article needs expansion on several fronts, e.g., causes (epidemiology), screening tools, assessment (not present currently), and more.

Criterion 3b: It stays focused on the topic without going into unnecessary detail (see summary style):

• GA Criterion 4:Is it neutral?

It represents viewpoints fairly and without editorial bias, giving due weight to each:

• GA Criterion 5: Is it stable?

It does not change significantly from day to day because of an ongoing edit war or content dispute:

• GA Criterion 6: Is it illustrated, if possible, by images?

Criterion 6a: Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:

Criterion 6b: Images are relevant to the topic, and have suitable captions:

Overall: I would classify this article as C-class, but close to B-class. (I realize it is rated B-class by three out of four WikiProjects.) It needs expansion; improved prose; consistency and clarity regarding terminology, and others. Regarding clarity regarding terminology, here is one example: the Signs and symptoms section begins, "Addiction is a brain disorder ...." The article is about substance use disorder but the section discusses addiction. Admittedly, the English Wikipedia is not consistent with how we use various substance use disorder terms, although this is understandable given relatively quick changes in terminology even over the past 16 years and the lack of consensus regarding terminology among clinicians, researchers, journalists, policy-makers, and the public.

Pass or Fail:

Note: Again regarding terminology, the Addiction and dependence glossary is well-written and mostly accurate (IMHO, of course). Perhaps we (editors across WikiProjects interested in this general topic) can reach consensus regarding terminology, including what the various terms mean, which terms we should use, and which terms we should avoid using, and then begin to edit relevant articles to (eventually) achieve greater consistency and improved comprehension.

Definitions section

The Substance Use Disorder#Definitions section is a mess - confusing, disjointed, and very inaccurate. I temporarily deleted the entire section while I write a brief replacement, whcih we can expand as time goes on. My "working copy" is at User:Markworthen/SUD definitions. Feel free to edit it or make suggestions here. I hope to finish writing a "bare bones" section within 2 days, and then restoring the Definitions section to the article.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 02:14, 26 April 2020 (UTC)

I also deleted the Signs and symptoms section, explaining: "This section does not contain accurate information, in fact, none of it has to do with signs and symptoms. So rather than present erroneous, misleading, confusing information, it's better to delete the section. I have started rewriting the section, but I could use some help. Please see the TALK page." I'll add what I write on the page I mentioned above - User:Markworthen/SUD definitions - Feel free to edit it or make suggestions here.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 12:46, 2 May 2020 (UTC)

Rewriting project

The more I read, the more I realized that this article needs a major overhaul. I will create subsections—corresponding with the article's sections—under this heading of "Rewriting project" for updates, questions, and discussions.

Introduction

For article's introduction (also referred to as the lead or lede) I have thus far done a lot of copy editing to improve clarity and conciseness.

I made more edits (diff), including to the introduction, primarily copy edits to improve grammar/usage, clarity of expression, and conciseness. I also combined all the DSM-5 citations under one named reference.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 08:57, 12 July 2020 (UTC)

UNODC statistics commingled with population survey data

The last two paragraphs of the lead report a bunch of statistics, mainly from the United Nations Office on Drugs and Crime (UNODC). Unfortunately I discovered several mistakes, mostly in these areas:

(a) Referencing drug use disorder statistics in a discussion of substance use disorder. This is an understandable mistake because the terms are so similar, and because when people see "substance abuse" or "substance use disorder", they (we) often assume without thinking about it that substance means drugs other than alcohol. However, in both DSM-5 and ICD-11, substance use disorders include alcohol use disorders.

(b) Mixing statistics from one study with stats from a separate survey or research report. It took me a long time to sort through the dense World Drug Reports and a cited Lancet article before I discerned the problem. For example, the Lancet article measured change from 2005 to 2015 based on the Global Burden of Disease 2015 Study, which includes statistics on alcohol use disorders, whereas the World Drug Reports collect date on drugs other than alcohol only.

I deleted those two "stats paragraphs" (diff). If someone wants to write up relevant statistics about all substance use disorders, or clearly differentiate different databases, please feel free.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 09:46, 3 May 2020 (UTC)

Per (a) so add alcohol stats as well if your concern is that they are missing. This states illicit. We should also add nicotine.

(b) I am not seeing the issue? Yes we use different sources... Doc James (talk · contribs · email) 10:25, 3 May 2020 (UTC)

Okay added alcohol aswell. Doc James (talk · contribs · email) 10:33, 3 May 2020 (UTC)

I spent 90 minutes reading those reports and comparing them with what was written in the two paragraphs. It's not as simple as you describe. There are several inconsistencies, errors, misleading presentations of the data, and more. I've worked in the substance abuse/dependence/disorder field for 40 years, keeping up with the empirical literature along the way, so I bring a fair amount of education, training, and experience to the subject, which helps when it comes to discerning if data is not presented accurately (as you know). I have devoted several hours to trying to improve this article. Your revert without discussing it first is disappointing and discouraging.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 10:35, 3 May 2020 (UTC)

User:Markworthen it sounded like your concern was that alcohol was missing? I found a ref that covered it and added.

Do you have further concerns with "In 2017 globally 271 million people (5.5% of adults) were estimated to have used one or more illicit drugs"?

Seems to be supported by the ref that says "In 2017, an estimated 271 million people, or 5,5 per cent of the global population aged 15-64, had used drugs in the previous year."

We than say "Of these 35 million had a substance use disorder" well the title of that UN document is "35 million people worldwide suffer from drug use disorders" Doc James (talk · contribs · email) 10:40, 3 May 2020 (UTC)

Have updated and clarified the details around deaths and added deaths from ETOH. Agree that the WDR cannot be compared with the GBD. Doc James (talk · contribs · email) 10:53, 3 May 2020 (UTC)

Text in question

In 2017 globally 271 million people (5.5% of adults) were estimated to have used one or more illicit drugs. Of these 35 million had a substance use disorder. And additional 237 million men and 46 million women have alcohol use disorder as of 2016. In 2017 substance use disorders from illicit substances directly resulted in 585,000 deaths. Direct deaths from drug use has increased over 60 percent from 2000 to 2015. Alcohol use resulted in an additional 3 million deaths in 2016.

User:Markworthen have moved here for discussion. Wondering your thoughts? Doc James (talk · contribs · email) 11:01, 3 May 2020 (UTC)

@Doc James: Perfect. Thank you very much for not only looking further into the nitty gritty details of those reports, but also recognizing and responding to the subtext of my message. :o) All the best   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 15:52, 4 May 2020 (UTC)

User:Markworthen agree with you that what we had previously was less than ideal as it confused a bunch of things and compared incomparable numbers. You okay with this?[1] Just condensed it a bit. Doc James (talk · contribs · email) 04:25, 5 May 2020 (UTC)

Yes! You improved it. :)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 23:07, 5 May 2020 (UTC)

Causes section

At present (November 2020), the causes section is sparse. I will begin expanding this section and I welcome contributions by other editors! Many thanks - Mark D Worthen PsyD (talk) [he/his/him] 17:46, 13 November 2020 (UTC)

I made some edits (diff) to begin expanding this section. Please note, as I said in one of my edit summaries, that the edits I am making constitute a "work in progress", therefore please DO NOT DELETE them en mass because a sentence needs a citation or the like; instead, please add a citation, or modify the sentence, or discuss here on the TALK page. Thank you! - Mark D Worthen PsyD (talk) [he/his/him] 19:54, 13 November 2020 (UTC)

Signs and symptoms section

I started a rough draft rewriting this section. Please feel free to edit the draft (located at User:Markworthen/SUD definitions#Signs and symptoms) or offer suggestions here. (The rough draft is too detailed at present. One of the problems is that signs and symptoms vary a lot from one substance use disorder to another. I started with alcohol use disorder to get a sense of what might be best to include in this section.)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 09:51, 3 May 2020 (UTC)

Definitions section

I thought it best to begin with the Addiction and dependence glossary because if the definitions in that glossary (which is included in several articles) differ from what we include in a definitions section for this Substance use disorder article, it will confuse everyone.

Addiction and dependence glossary

I made one change to the Addiction and dependence glossary (diff). I changed the definition of "addiction" as follows.

OLD: "addiction – a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences" to

NEW: "addiction – a biopsychosocial disorder characterized by compulsively seeking to achieve a desired effect, such as intoxication, despite harm and adverse consequences to self and others."   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 10:01, 3 May 2020 (UTC)

I made that edit because "brain disorder" is a vague term, and because, as most neuroscientists will tell you, understanding psychological, socioeconomic, and cultural variables, along with insights from neuroscience, leads to a more complete understanding of etiology, natural recovery, potential therapeutic interventions, and related topics.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:06, 4 May 2020 (UTC)

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References

Request updating the information related to approved medication for certain drug use disorders

I'm now working on translating the whole article into Traditional Chinese. As for "There are no approved medications for cocaine, methamphetamine, or other substance use disorders as of 2002", can the original writer, or anyone who's familiar with this, help update the information on the approved medication? 2002 is a bit too far from now. Thanks.ThomasYehYeh (talk) 12:56, 27 September 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 19 November 2018 and 14 December 2018. Further details are available on the course page. Student editor(s): MedicalEdits. Peer reviewers: Barnecar92.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:22, 17 January 2022 (UTC)

Upcoming updates to first half of article and possible new definition

I along with two peers will be working on improving this article by adding new research and sources where the information may be lacking and improving the overall structure of the article. We are also considering updating the definition of SUD. If anyone has a different view, please share it here. Otherwise, we will move along with these edits. BlackNightingale88 (talk) 17:09, 28 March 2023 (UTC)