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Substance Use and Getting Help

11/10/2025 | What's On The Brain Therapy Services LLC |

Hi all! It’s good to see you again and I’m glad you’re taking a moment to read this month’s post. I know the holidays are around the corner, which can mean having to navigate family and social situations with or without substances. My goal for this month is to give you some information about substance use to bring you a bit of inner peace or plant seeds if this is something you want to work on for yourself. Now- onto the show!

What’s the Criteria for a Substance Use Disorder?

Time for a mini-dose of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-V-TR)! The DSM-V-TR holds all of the criteria for the kinds of mental illnesses people experience. The American Psychiatric Association (APA) is tasked with synthesizing new research and updating the DSM, making it a standard diagnostic tool amongst mental health professionals. Heads up- The DSM-V-TR is a thick tome of over 1000 pages of information and is very easy to drown in. All of the mental health disorders are grouped into categories based on similarities in symptom presentation and where they might pop up in the course of a human life.  

All substance use disorders fall into the Substance-Related and Addictive Disorders category. The category encompasses 10 different classes of drugs (alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives; hypnotics and anxiolytics; stimulants; and tobacco). Different classes of drugs impact brains, bodies, nervous systems, and social connections in different ways. And, the core criteria that makes up a substance use disorder in the DSM-V-TR is the same across the board. Here’s the core criteria of a substance use disorder:

  1. Using more of the substance than you meant to, or for a longer time than planned.
  2. Wanting to cut back or stop, but not being able to.
  3. Spending a lot of time getting, using, or recovering from an episode of substance use.
  4. Really strong urges or cravings to use.
  5. Using the substance so much that you can’t keep up with your responsibilities.
  6. Continuing to use even when it causes problems with your relationships.
  7. Giving up or cutting back on important activities because of substance use.
  8. Using the substance in situations where it could be dangerous.
  9. Still using the substance even when you know it’s causing or making physical or mental problems worse.
  10. Needing more and more of the substance to get the same effect.
  11. Experiencing withdrawal symptoms when you stop or cut back.

You get assigned a substance use disorder if there is a problematic pattern that occurs in a 12-month period. The severity specifiers of mild, moderate, or severe get assigned depending on how many symptoms you are presenting with. It is possible to be sober for only a few months and still get a diagnosis of substance use disorder- that’s because you’re still technically meeting criteria when you’re in early recovery.

Dual Diagnosis or Co-Occurring Disorders

Oftentimes, a substance use disorder order happens at the same time as a mental health disorder. This is known as a dual diagnosis or co-occurring disorders. There are no specific combinations of mental and substance use disorders that are uniquely defined as co-occurring. So you can have a diagnosis of generalized anxiety disorder and alcohol use disorder. Counts as co-occurring disorders. Or have diagnoses of attention-deficit-hyperactivity disorder with major depression disorder and an amphetamine use disorder. Counts as a co-occurring disorder too. Keep in mind that there can be some similarities between one person’s co-occurring presentation and another, and there are a lot of important nuances to tease out for the best chance at recovery.

The best treatment for co-occurring disorders is an integrated intervention where a person can receive care for both their mental health illness and substance use disorder at the same time. There’s been historical thinking that you can only treat one disorder at a time and there’s lots of research that shows this kind of approach is ineffective. It’s important to be able to understand how each condition affects the other. 

Getting Help

Getting help can be hard. If you’re looking for help for yourself- yeah! Wanting help is a big part of the battle. Keep going! It’ll also help to know that recovery looks different from person to person. Recovery is a journey and the only person who can make it is you. There are different ways to seek treatment. You might do well with an outpatient therapist, like me. Or, you might need something more like an outpatient program or a residential treatment. If you think there’s something co-occurring going on like was discussed in the previous section, do yourself a favor and find a provider who understands the co-occurring nature between mental illness and substance use.

If you’re not personally struggling with substance use and want to do something for a loved one who is- pause. It’s easy to fall into the trap of telling someone what to do. Nobody likes being told what to do, especially when it involves shame and confrontation. Instead, find yourself a therapist so you can talk through your own feelings, get help clarifying your boundaries, and have a safe person to practice what you would want to say to your loved one on before any confrontation. You can pull some ideas from the Community Reinforcement and Family Training (CRAFT) Method.  

Here’s my hot take on substance use- it’s complicated. There is plenty of research out there that is very clear that any kind of substance use is not good for our over-all well-being. However, we live in a society that places people in a double bind where substance use is a constant presence in our culture yet society can shame the shit out of people who are really struggling. At the end of the day everyone needs to figure out their own relationship to substance use. If you’re looking for some sort of measurement to evaluate your substance use, I suggest using this phrase: “If you’re going to use, use to celebrate fullness, not to fill emptiness.” If you are using to fill a sense of emptiness, it’s time to get help.

So there you have it! Something that’s been on my brain. I hope this finds you well. Know that I see you and I’m rooting for you. Take care of yourselves and each other.

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