Substance Use Disorders Beyond Alcohol and Opioids
Substance use disorders include cannabis, cocaine, amphetamines, methamphetamines, hallucinogens, inhalants, synthetic drugs, club drugs, benzodiazepines, and other prescription medications (stimulants and sedatives) that are used nonmedically. 1
Classification of Substance Use Disorders
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) combines the previously separate terms "substance abuse disorder" and "substance dependence" under the umbrella term "substance use disorders," establishing a continuum of mild, moderate, and severe designations based on the number of criteria met by an individual 1.
Substance use disorders beyond alcohol and opioids include:
Stimulant Use Disorders
- Cocaine use disorder: Involves cocaine and crack cocaine
- Amphetamine-type stimulant use disorders:
- Methamphetamine
- Prescription stimulants (used nonmedically)
- Other stimulants
Cannabis-Related Disorders
- Cannabis (marijuana) use disorder
- Synthetic cannabinoid use disorders
Sedative, Hypnotic, or Anxiolytic Use Disorders
- Benzodiazepine use disorder
- Nonmedical use of prescription sedatives/tranquilizers 2
Hallucinogen Use Disorders
- LSD, psilocybin, mescaline, and other classic hallucinogens
- PCP and other dissociative drugs
Other Substance Use Disorders
- Inhalant use disorder
- Club drug use disorders (MDMA/ecstasy, GHB)
- Synthetic drug use disorders (synthetic cathinones/"bath salts")
Epidemiology and Clinical Significance
Substance use disorders are highly prevalent and exact a significant toll on health, well-being, and social functioning 3. According to the National Survey on Drug Use and Health, an estimated 21.6 million persons aged 12 years or older were classified with substance dependence or abuse (8.2% of the population) 1.
The breakdown of substance use disorders beyond alcohol includes:
- Cannabis remains the most commonly abused substance after alcohol
- Prescription pain relievers (nonmedical use)
- Cocaine
- Methamphetamine and other stimulants
- Hallucinogens
- Inhalants
- Sedatives/tranquilizers 1
Polysubstance Use
Polysubstance use is common among individuals seeking treatment for substance use disorders 4. Research has identified several patterns of polysubstance use:
- Alcohol primary users
- Moderate probability of alcohol, cannabis, and/or opioid use
- Opioid primary users with lifetime use of multiple substances
- High polysubstance users 4
Individuals who engage in polysubstance use face elevated risks of:
- Unstable housing
- Unemployment
- Depression, anxiety, and PTSD
- Self-harm
- Overdose 4
Health Implications and Stroke Risk
Substance use disorders significantly increase the risk of adverse health outcomes, including stroke. The American Heart Association/American Stroke Association recommends:
- Screening for substance misuse and substance use disorders in all adults to inform stroke risk 1
- Counseling to stop use or appropriate substance use disorder treatments for patients who use recreational drugs, misuse alcohol or prescription medications, or have a substance use disorder 1
Recreational drug use (including cannabis, synthetic cannabinoids, cocaine, heroin, methamphetamine) has been associated with increased risk of stroke, particularly in younger adults 1.
Treatment Approaches
Treatment approaches for substance use disorders beyond alcohol and opioids include:
Behavioral Therapies
- Cognitive-behavioral therapy
- Contingency management
- Relapse prevention
- Motivational enhancement therapy
Medication-Assisted Treatment
While medication options are more limited for substances beyond alcohol and opioids:
- No FDA-approved medications exist specifically for stimulant or cannabis use disorders
- Benzodiazepine dependence requires careful tapering protocols
Integrated Treatment for Co-occurring Disorders
Many individuals with substance use disorders have co-occurring mental health conditions that require integrated treatment approaches 3.
Prevention Strategies
Prevention strategies that target social risk factors can improve outcomes and decrease the risk for developing substance use disorders, particularly when deployed in childhood and adolescence 3.
Clinical Approach to Management
Substance use disorders should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with concomitant treatment of comorbid psychiatric and physical conditions 3.
Despite advances in understanding and management of substance use disorders, individuals with these conditions continue to be stigmatized, highlighting the need for policies that ensure support and access to prevention and treatment 3.