Substance-Induced Disorders

What Is a Substance-Induced Disorder?

When drug and alcohol abuse produces altered mental states resembling mental illness, it is called substance-induced disorder (SID). SIDs are illnesses or conditions directly caused by substance abuse, lasting from days to weeks.

Substance-induced disorders differ from co-occurring disorders or dual diagnoses because rather than a mental health condition co-existing with addiction, substance abuse causes the mental health condition.

Although many people experiencing SIDs find that stopping the substance makes the disorder go away, others may find treating substance use disorder challenging, depending on the substance and circumstances.

What Substances Can Cause Mental Health Conditions?

Certain substances are notorious for causing substance-related disorders because of their chemical makeup or how they are used.

For example, a documented link exists between sedating substances like alcohol and substance-induced depression.

According to research from the South Carolina Dept of Mental Health, 40-60% of people with alcohol use disorder experience substance-induced depression.

The most common substances known to cause substance-induced disorders include:

• Caffeine
• Cocaine
• Methamphetamines
• Hallucinogens
• Alcohol
• Nicotine
• Opioids
• Benzodiazepines
• Sedatives
• Barbiturates

Types of Substance-Induced Disorders

Substance-induced disorders fall into three categories: intoxication, withdrawal, and substance-induced mental disorders.

1. Intoxication accounts for any physiological changes that occur while using the substance, like euphoria, hallucinations, impaired judgment, elevated mood, and aggression.
2. Withdrawal describes any physiological changes once a person stops using a substance, such as nausea, tremors, and vomiting.
3. Substance-induced disorders typically match up with symptoms of their non-substance-related counterparts. (Example: substance-induced bipolar has the same symptoms as bipolar disorder; the main difference is how the condition is triggered.)

Substance-Induced Depression

Substance-induced depression appears exactly like depressive disorders not caused by drugs or alcohol. People struggling with substance-induced depression often experience the same symptoms and risks.

Substances that can trigger substance-induced depression include:

• Alcohol
• Phencyclidine (i.e., PCP or angel dust)
• Hallucinogens (e.g., LSD, mushrooms)
• Inhalants (e.g., spray paint, cleaners, markers)
• Opioids (e.g., hydrocodone, oxycodone, heroin)
• Amphetamines (e.g., Ritalin, Adderall, crystal meth)

Common symptoms of substance-induced depression include:

• Sadness
• Worthlessness
• Low energy
• Difficulty concentrating
• Isolation
• Suicidal thoughts

Substance-Induced Anxiety Disorder

Anxiety disorders define a broad group of mental health conditions, and the exact symptoms of each anxiety disorder can vary. However, anxiety and substance-induced anxiety disorders share similar worry, fear, and physical tension features.

Substances that can trigger substance-induced anxiety include:

• Alcohol
• Cannabis (i.e., marijuana)
• Hallucinogens (e.g., LSD, mushrooms)
• Inhalants (e.g., spray paint, cleaners, markers)
• Cocaine
• Methamphetamine (i.e., crystal meth)
• Opioids (e.g., hydrocodone, oxycodone, heroin)
• Benzodiazepines (e.g., Xanax)

Common symptoms of a substance-induced anxiety disorder include:

• Irritability
• Insomnia
• Fast heart rate or pounding heartbeat
• Excessive sweating
• Shakiness
• Shortness of breath
• Pain or tightness in the chest
• Feeling dizzy or lightheaded
• Low energy and fatigue
• Muscle tension
• Panic attacks
• Significant worry and nervousness
• Trouble concentrating or paying attention

Substance-Induced Psychotic Disorder

Substance-induced psychotic disorder or substance-induced psychosis looks very similar to conditions with psychosis, auditory and/or visual hallucinations, and delusions often seen in schizophrenia or schizoaffective disorder.

However, instead of having other causes, substance-induced psychotic disorder occurs due to substance abuse.

Substances that can trigger substance-induced psychotic disorder include:

• Cannabis (i.e., marijuana)
• Cathinones (i.e., bath salts)
• Methamphetamines (i.e., crystal meth)
• Hallucinogens (e.g., LSD, mushrooms)
• Cocaine
• MDMA (i.e., ecstasy)

Common symptoms of substance-induced psychotic disorder include:

• Hallucinations
• Delusions
• Unable to distinguish fantasy from reality
• Trouble taking care of yourself
• Paranoia and suspicion
• Difficulty communicating clearly, including disordered speech and thoughts
• Hypersensitivity to sounds, smells, or other sensory input
• A flat affect or lack of emotional expressions

Substance-Induced Mood Disorder

In the case of substance-induced mood disorder or substance-induced bipolar disorder, symptoms present similar to those of bipolar disorder. However, manic highs and depressing lows are absent when substances are not used.

Substances associated with substance-induced mood disorder include:

• Alcohol
• Phencyclidine (i.e., PCP or angel dust)
• Hallucinogens (e.g., LSD, mushrooms)
• Amphetamines (e.g., Ritalin, Adderall, crystal meth)

Common symptoms of substance-induced mood disorder mania or hypomania include:

• Inflated self-esteem
• A marked decrease in the need for sleep
• Extremely talkative, thoughts racing from one topic to the next
• Low levels of concentration, easily distracted
• Engagement in risky and potentially dangerous behavior like unrestrained shopping sprees, sexual indiscretions, or substance use
• Engaging in activities or exhibiting behavior that is uncharacteristic of the individual

Common symptoms of substance-induced mood disorder depression include:

• Feeling sad, hopeless, or empty
• Diminished interest or pleasure in all activities
• Significant weight loss or gain in a short period
• Sleeping too much or too little
• Fatigue or a loss of energy
• Diminished ability to concentrate

Substance-Induced Sleep Disorder

Substance-induced sleep disorder provides an official diagnostic name for insomnia and other sleep problems caused by the use of alcohol, drugs, or taking certain medications.

Most people with substance-induced sleep disorder fall under one of four types: insomnia type, daytime sleepiness type, parasomnia type, and mixed type.

Substances linked to substance-induced sleep disorders include:

• Alcohol
• Caffeine and other legal stimulants
• Cannabis
• Opioids (e.g., hydrocodone, oxycodone, heroin)
• Sedatives
• Hypnotics (e.g., sleep medications)
• Anxiolytics (i.e., antidepressants, benzodiazepines)
• Amphetamines (i.e., Ritalin, Adderall)
• Cocaine
• Tobacco

Common symptoms of a substance-induced sleep disorder include:

• Difficulty falling asleep or staying asleep
• Waking up a lot during the night
• Not feeling rested from sleep
• Excessive sleepiness or tiredness during the daytime
• Sleeping much longer than intended
• Displaying abnormal behaviors during sleep

Substance-Induced Delirium

While drugs and alcohol can create short-term intoxication and delirium, substance-induced delirium is a more serious state. It can last much longer and disrupt a person’s daily life and safety.

Substances that can trigger substance-induced delirium include:

• Alcohol
• Amphetamines (e.g., Ritalin, Adderall, crystal meth)
• Anxiolytics (i.e., antidepressants, benzodiazepines)
• Cannabis
• Cocaine
• Hypnotics (e.g., sleep medications)
• Inhalants (e.g., spray paint, cleaners, markers)
• Opioids (e.g., hydrocodone, oxycodone, heroin)
• Hallucinogens (e.g., LSD, mushrooms)
• Stimulants (e.g., caffeine)
• Phencyclidine (i.e., PCP or angel dust)
• Sedatives

Common symptoms of substance-induced delirium include:

• Disruptions in attention, awareness, and ability to process information
• Loss of memory and/or focus
• Unpredictable behavior and moods
• Sudden onset of confusion, anxiety, euphoria, agitation, depression, anger, and/or irritability
• Being unaware of who you are or what you’re doing

Additional Substance-Related Disorders

Aside from the formerly recognized substance-induced disorders we’ve discussed, research has defined other related disorders caused by substance use.

While not an exhaustive list, these additional conditions often get overlooked or misdiagnosed.

Cannabinoid Hyperemesis Syndrome (CHS)

Cannabinoid hyperemesis syndrome (CHS) occurs when a daily, long-term user of cannabis develops a sudden intolerance to the substance. While cannabis often helps with things like nausea, vomiting, and abdominal pain, people with CHS often report the substance begins to cause those symptoms.

The condition is still not fully understood, but it’s believed that specific receptors in the brain may stop responding to the substance in the same way, resulting in uncomfortable side effects.

Common symptoms of CHS include:

• Ongoing nausea
• Repeated episodes of vomiting
• Belly pain
• Decreased food intake and weight loss
• Dehydration

Hallucinogen Persisting Perception Disorder (HPPD)

Hallucinogen Persisting Perception Disorder (HPPD) is a rare clinical condition where patients with previous exposure to hallucinogenic substances continue to experience perceptual distortions for months to years after complete cessation of the initial substance use.

HPPD has two recognized forms:

• Type 1 HPPD: Patients experience brief, random short-lived “flashbacks”
• Type 2 HPPD: Patients experience recurring hallucinations that “wax and wane” in intensity over months to years

Both forms of HPPD can arise after a single use of a hallucinogenic drug, although most patients diagnosed with it have a history of preexisting psychological disturbance or chronic substance abuse.

Common symptoms of HPPD include:

• Visual and auditory hallucinations
• Altered perception of motion
• Flashes of color
• Color enhancement
• Trails or tracers
• Fractals (curved geometric figures)
• Distorted perception of distance
• Monochromatic vision

Sexual Dysfunction

Substance-induced sexual dysfunction is a condition in both men and women that causes difficulties with sexual desire, arousal, and/or orgasm due to a side effect of certain substances.

Men may complain of: 

• Erectile dysfunction
• Premature or absent ejaculation
• Anorgasmia (i.e., difficulty or inability to achieve orgasm)
• Pain with intercourse

Women may experience: 

• Decreased lubrication (i.e., vaginal dryness)
• Anorgasmia (i.e., difficulty or inability to achieve orgasm)
• Pain with intercourse
• Decreased libido

Although the topic can be embarrassing, sexual dysfunction often occurs with prescribed medications and illicit substances.

Alcohol and Drug Withdrawal

When using drugs or alcohol, a person’s body adapts over time to the increased level of substance. When they stop using the substance, the sudden shift in brain chemicals leads to withdrawal symptoms that are physical, emotional, and mental.

Symptom severity depends on the type of substance used, the length of use, the amount regularly used, and any other health conditions a person has, such as diabetes, depression, or high blood pressure.

Common symptoms of alcohol withdrawal include:

• Intense worry, nervousness, and anxiety
• Sweating
• Nausea and vomiting or diarrhea
• Shaking hands (tremors)
• Problems sleeping and nightmares
• Delerium Tremens (e.g., body shakes, confusion, agitation, hallucinations, seizures)

Common symptoms of drug withdrawal include:

• Nausea
• Muscle aches
• Sweating
• Runny nose and teary eyes
• Anxiety and irritability
• Trouble sleeping
• Diarrhea
• Abdominal cramps
• Vomiting
• Enlarged (dilated) pupils
• Goosebumps

Mental Illness VS Substance-Induced Disorders

Symptoms of a particular mental illness and the corresponding substance-induced disorder may look similar, but they are two entirely different conditions.

For example, substance-induced bipolar disorder and normal bipolar disorder can appear the same from the outside.

The key difference between them depends on the cause: substance-induced bipolar disorder is caused by abuse of medications like stimulants, while it’s believed that a mixture of genetics and upbringing causes normal bipolar disorder.

If a person had these symptoms before they started using the drug, even if it worsens their symptoms, it is not considered a substance-induced disorder.

Diagnosing Substance-Induced Disorders

While symptoms of substance-induced disorders may be similar to mental health conditions, diagnosis and treatment for the two are different.

Healthcare providers must ensure the condition is substance-induced rather than part of a co-occurring mental health condition.

First, doctors will need to assess when the patient’s symptoms began. According to the disorder’s diagnostic criteria, symptoms must appear within 30 days after using the substance.

Doctors may also need to monitor the patient for weeks or months after quitting a substance to ensure a correct diagnosis.

Substance-induced disorders can be difficult to diagnose and treat unless the patient is honest about their substance abuse.

Dual Diagnosis

Many people battling substance abuse may also have comorbidities contributing to their addiction. This combination can create confusion if they begin developing a substance-induced disorder.

Understanding the difference between a true co-occurring disorder and one brought on by drug or alcohol use can be difficult. However, this process becomes much easier with the right healthcare providers and psychiatrists on your side.

Substance-Induced Disorder Treatment

The first step is often to stop taking the substance altogether to see if the symptoms lessen. Depending on the substance in question, some patients can quit “cold turkey.” For others, slowly weaning off the substance may be necessary.

More severe cases may need medical detox. This option is vital in the case of alcohol addiction and benzodiazepine addiction, as withdrawal symptoms of these substances can be life-threatening.

Medical Detoxification

For those individuals on substances that require medical detoxification, certain treatment centers offer a controlled, medically-supervised environment to detox off the substance safely.

Physicians can also treat the symptoms of any substance-induced disorders while under their care. Again, this ensures detox goes as smoothly and painlessly as possible for the patient.

Therapy

Counseling is foundational to any drug and alcohol treatment program. Therapy typically includes group, individual, or family sessions in psychotherapy or cognitive behavioral therapy (CBT).

The primary goal of therapy focuses on identifying the thought patterns and beliefs that lead the patient to drug or alcohol-seeking behavior in the first place. Through peer support and skill-building exercises, patients can learn to identify problematic thoughts and stop drug-seeking urges they can lead to action.

Medication

Different medications may be used depending on the type of substance-induced disorder a person has.

For example, antipsychotics like Risperdal, Seroquel, or Halcion might be used for substance-induced psychosis, while an antidepressant may be prescribed for substance-induced depression.

Inpatient and Outpatient Treatment Options

For some patients, living at an inpatient treatment center provides a peaceful place to focus on recovery from their addiction and substance-induced disorder.

Outpatient programs usually last 10 to 30 hours per week. These programs provide the same treatment options, but patients will go home after their time at the treatment center.

Getting Treatment For Substance-Induced Disorders

Dealing with substance-induced disorders can be incredibly challenging. Thankfully, you don’t have to do it alone.

Mental healthcare providers and treatment centers are ready and willing to help you or a loved one find freedom from addiction and SIDs. Visit SAMHSA’s online treatment locator at https://www.findtreatment.gov or call (800) 662-4357 to find a treatment center that fits your needs.