User:Markworthen/SUD definitions

This is a DRAFT for Substance use disorders "Definitions" and "Signs and symptoms" sections. Please see Talk:Substance use disorder#Definitions section.

Signs and symptoms

The DSM-5 diagnostic criteria for substance use disorders (and similar criteria in ICD-11) are all either signs or symptoms (or both). This section will therefore concentrate on signs and symptoms that are not necessarily specified in diagnostic criteria.

Signs and symptoms differ depending on the substances used, with the understanding that many people suffer from more than one substance use disorder. Detailing the signs and symptoms of every substance use disorder is beyond the scope of this article. Consequently, this article reviews signs and symptoms of Alcohol Use Disorder as an exemplar. Wikipedia articles about other (specific) substance use disorders, such as Opioid use disorder, contain more detailed information about signs and symptoms of those disorders.

Signs of alcohol use disorder

Signs of alcohol use disorder include the following, arranged in (approximate) order of distinctiveness, starting with signs that best distinguish alcohol use disorder from other maladies, and moving down to the most nonspecific signs. Almost all of these signs may arise from other disorders, therefore physicians will usually rule out other causes before having reasonable confidence that alcohol use disorder causes the sign or symptom. For example, if a patient has been diagnosed with essential tremor, in the absence of other evidence for alcohol dependence, hand tremors are unlikely to be a sign of Alcohol Use Disorder.

• smell of alcohol on the person when presenting for a doctor's appointment, either due to recent drinking or a result of consuming large quantities of alcohol many hours previously, which the body has not had time to metabolize
• hand tremors
• diseases of the liver: cirrhosis (irreversible destruction and scarring of liver tissue), hepatic steatosis (fatty liver), hepatitis (inflamed liver); and conditions associated with liver dysfunction, such as an enlarged liver, elevated liver enzymes, jaundice (yellowing of the eyes and skin), multiple spider angiomas, and esophageal varices
• pancreatitis
• dry skin, brittle hair and nails (usually caused, at least in part, by dehydration)
• vitamin B1 (thiamin) deficiency
• swelling of the legs and ankles
• ascites
• frequent excessive sweating
• nystagmus (involuntary rapid eye movement)
• unexplained weight loss
• gastrointestinal disorders such as gastritis, GERD, and stomach ulcers
• numbness or pain in the hands or feet

References

Symptoms of alcohol use disorder

Symptoms of Alcohol Use Disorder include the following, in approximate order of specificity (most specific to least).

• delirium tremens
• other withdrawal symptoms, such as "the shakes" (hand tremors), excessive sweating, agitation, or nausea that are relieved by drinking
• blackouts (alcohol-induced amnesia)
• feeling like or actually drinking in the morning or waking up at night and drinking or using a related drug, such as benzodiazepines, to "take the edge off"
• worrying about when or how you will have your next drink
• frequently feeling a strong need, urge, or craving for alcohol
• abdominal pains, nausea, frequent vomiting (including vomiting blood), frequent diarrhea, loss of appetite, abdominal tenderness and swelling
• recurrent depressed mood, guilt, shame, regret, despair, suicidal thoughts
• fatigue, malaise, weakness
• anxiety, nervousness, restlessness, irritability, insomnia
• gastrointestinal distress such as dyspepsia, "acidy" stomach, "heartburn", queasiness, lack of appetite
• recurrent dermatologic problems without a clearly identified cause or disease process, such as Palmar erythema, brittle hair and nails, excessive bruising, otherwise unexplained purpura
• erectile dysfunction, loss of libido.

Definitions

Substance use occurs on a spectrum from beneficial to problematic to lethal use. Substance use researchers, clinicians, and policy makers have debated how to best categorize substance use along that spectrum for several decades. A clear consensus has not yet emerged regarding the meaning or clinical utility of terms like substance abuse, chemical dependency, or drug addiction. Nonetheless, consensus has developed for some important terms, particularly "substance use disorder".