Substance-Induced Disorders: Types, Causes, Treatment, Prognosis

The substance related disorders are commonly seen among adolescents and is indeed a grave societal problem. It is more prominent among men and is common in urban areas. The use of drugs or substances leads to intoxication and has various side-effects including altered perception, problems in behaviour and judgement. Let us understand Substance Induced Disorder in detail including the types, warning signs, and treatment.

Substance-Induced Disorder is a type of medical condition related to addiction. When an individual takes a substance (or drug) it directly affects him and causes a problem or a disorder. Substance-induced disorders (SIDs) are symptoms caused during drug intake or immediately after discontinuing its use. In simple words, these are alcohol or drugs which are mind altering substances, causing mental illness.

Substance-Induced Disorder or SID is caused by any substance which is legal or illegal and whether socially accepted and has medical use. The symptom of Substance-Induced Disorder or SID persists till the drug is taken (or withdrawn) and does not last for a long time. There is no dependency on the substance.

The types of substance-induced disorders include:

• Intoxication: It refers to immediate and temporary effects of substance (drug) used. Intoxication occurs since the drug directly affects the central nervous system (CNS). Many drugs impair both physical and mental states of an individual. When it affects mental functions, it impairs judgement and may alter mood. While taking the drug the person may feel a sense of well-being (happiness) or feel relaxed and calmer than usual. When the drugs affect physical being, it impairs body’s coordination, leading to loss of balance (fall or vehicle accidents), and in some cases aggressive behaviour leading to fights. Excessive amounts of these drugs have adverse effects on health with serious complications and even risk of death. All classes of drugs except tobacco cause substance intoxication.
• Withdrawal: It refers to immediate effects (or symptoms) when the substance is discontinued or taken in less amounts than the usual dose. These are set of substance specific effects. Withdrawal of a substance (drug) causes various effects which are unpleasant, depending on the type of the substance taken. Stopping consumption of some drugs can be serious and even dangerous to life. Some prescribed drugs such as opioids, sedatives and stimulants are known to cause withdrawal symptoms even when taken for medical reasons.
• Substance-Induced Mental Disorders: These are mental changes (symptoms) caused by long term effects of frequent use of substance or on its withdrawal. The symptoms are observed as impairments in brain and CNS, impaired cognitive functioning and behavioural problems. As per Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), the use of specific psychoactive drugs can induce syndromes called organic mental disorders.

For a mental disorder to be considered substance induced, the substance involved must be known to cause mental illness. Substances can be members belonging to class-10 substances like alcohol, caffeine, cannabis, anti-anxiety drugs, opioids, hallucinogens (LSD), inhalants, stimulants (amphetamines and cocaine), tobacco, sedatives and others (steroids) causing substance-induced disorders. The other substances include anti-cholinergic drugs and corticosteroids, which causes temporary psychosis.
DSM–IV TR has classified substance induced disorders into following categories as:

• Substance-Induced Delirium: This is a type of substance induced disorder which occurs during both intoxication and withdrawal of a substance. This condition leads to problem with perception. There is confusion and decreased consciousness along with abnormal thoughts and altered perception till the time the substance is taken or discontinued.
• Substance-Induced Persisting Dementia: It is a condition where there is impairment in a person’s cognitive ability. It is characterized by loss of memory, thinking ability, trouble in planning and changes in personality. There is impairment in social and career related functioning due to dementia.
• Substance-Induced Persisting Amnestic Disorder: This is a type of substance induced disorder which is characterized by significant loss of memory, difficulty in remembering new things and inability to recall past memories.
• Substance-Induced Mood Disorder: This is a type of substance induced disorder mainly associated with depression or maniac mood. In depression, there is diminished interest in doing things; while, maniac mood is characterized by increased sense of pleasure and excitement. It can last for days or weeks.
• Substance-Induced Anxiety Disorder: It is characterized by state of excessive worry. This leads to false belief that negative experiences will occur in future and there is difficulty in controlling the worrying thoughts. These may be present as panic attacks, phobia or obsessive compulsive symptoms. This state causes significant distress and impairment in work, social or personal functioning.
• Substance-Induced Psychotic Disorder: It is caused by effects of psychoactive drug. It has peculiar features of delusions, false beliefs, disorientation and hallucinations. The person is not capable of recognizing real situations and hallucinations and cannot relate to others.
• Substance-Induced Sexual Dysfunction: There is loss of sexual desire and function.
• Substance-Induced Sleep Disorder: There is disturbance in sleeping pattern which leads to insomnia and fatigue. Overall there is lack of restful sleep.

Substance induced disorders is highly treatable. Treatment includes stopping the intake of substance and detoxification, since many Substance induced disorders or SIDs go away once the substance has been completely cleared from the body. Specific treatment depends on the drug being used. For depression, antidepressants may be given. Similarly for severe psychosis, Benzodiazepines are used for treatment under doctor’s supervision. Therapy in the form of counseling and behavioural intervention programs is more beneficial in treating substance induced disorders. Family support and support groups help people remain committed to stopping the use of the drug. In many cases, both medication and behavioural therapy is used to treat the person suffering from substance-induced disorders. The aim of any treatment for Substance induced disorders is to develop a meaningful lifestyle by abstinence from the substance, repair of behaviour, and to develop positive personality in the patient.

In majority of the cases, the prognosis of substance-induced disorders is good. This is because the effects are reversible on cessation of the intake of the substance. However, the time required for symptoms to completely disappear will vary for different substance-induced disorder cases depending on the substance taken. In some cases, just stopping of habit may be sufficient. While in others, strong medication with motivational therapies may be required. In rare cases such as, a prolonged habit of intake of substance (drug) and severe SID mental disorders, prognosis may not be good.

Substance induced disorder is a problem faced by the society very often. By identifying the substances which cause intoxication/withdrawal/substance induced mental disorders, accordingly the patient should be given specific treatment. As compared to severe cases, mild and moderate cases of SIDs are treatable and can have meaningful livelihood even after withdrawal.