Substance Use Disorders and Co-Occurring Conditions

What Is a Substance Use Disorder?

A substance use disorder (SUD) is a clinical diagnosis defined by a problematic pattern of using alcohol or another drug that causes significant impairment or distress. The DSM-5 organizes all substance use disorders around eleven criteria grouped into four broad areas: impaired control, social impairment, risky use, and pharmacological signs.

To meet the diagnosis, a person must show at least two of the eleven criteria within a twelve-month period. Severity is rated by how many criteria are present: mild (2–3), moderate (4–5), or severe (6 or more). Two criteria that carry special clinical weight for psychiatric technicians are tolerance (needing more of the substance to get the same effect, or getting less effect from the same amount) and withdrawal (a characteristic syndrome that appears when use stops or decreases sharply). Both signal physical dependence and raise the medical stakes of monitoring.

Common Substance Classes: Intoxication and Withdrawal

As a psychiatric technician, you will observe patients, not diagnose them. Knowing what each substance class looks like — when someone is intoxicated and when they are withdrawing — helps you report accurately and catch danger early.

Alcohol is a central nervous system (CNS) depressant. Intoxication signs include slurred speech, unsteady gait, impaired judgment, flushed skin, and the smell of alcohol. Alcohol withdrawal is medically serious. Mild symptoms (anxiety, tremor, sweating, nausea) can begin within hours of the last drink. Severe withdrawal — including seizures and delirium tremens (DTs) — can develop within 24–72 hours and is life-threatening without medical management. Always report new-onset tremor, agitation, or confusion in a patient with known alcohol use history.

Opioids (heroin, prescription pain medications such as morphine and oxycodone) cause intoxication marked by pinpoint pupils, slowed breathing, drowsiness or unconsciousness, and slurred speech. Respiratory depression is the primary life threat. An unresponsive patient who is barely breathing requires a 911-level response and, where policy allows, naloxone administration. Opioid withdrawal is intensely uncomfortable but rarely fatal in otherwise healthy adults; signs include dilated pupils, runny nose, muscle aches, sweating, nausea, vomiting, diarrhea, and strong cravings, typically peaking 36–72 hours after last use for short-acting opioids.

Stimulants (cocaine, methamphetamine, prescription amphetamines) cause intoxication signs including elevated heart rate and blood pressure, dilated pupils, agitation, elevated body temperature, reduced appetite, and in severe cases paranoia or psychosis. Medical risks include cardiac arrhythmia, stroke, and hyperthermia. Stimulant withdrawal does not produce the dramatic physical syndrome seen with alcohol, but patients often experience profound fatigue, prolonged sleep, depressed mood, and intense cravings.

Cannabis intoxication presents with red eyes, increased appetite, slowed reaction time, impaired short-term memory, and sometimes anxiety or paranoia. Withdrawal (after heavy, prolonged use) includes irritability, sleep disturbance, decreased appetite, and mild anxiety. Medical risk is generally low compared with other substance classes, though cannabis-related psychosis requires monitoring.

Sedative-hypnotics (benzodiazepines, sleep medications) share many features with alcohol because they also act on CNS gamma-aminobutyric acid (GABA) receptors. Intoxication looks similar to alcohol intoxication. Withdrawal carries the same serious risk profile: seizures and death can occur. Report confusion, tremor, or seizure activity in any patient with known benzodiazepine or sedative dependence.

Co-Occurring Disorders (Dual Diagnosis)

A co-occurring disorder (also called dual diagnosis) is the presence of both a substance use disorder and at least one other mental health disorder in the same person at the same time. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), co-occurring disorders are common, not the exception, among people seeking behavioral health treatment.

Substance use and mental illness interact in ways that complicate both conditions. For example, a patient with major depressive disorder may drink heavily to relieve emotional pain (self-medication), but alcohol — a depressant — deepens the depressive episode over time. Conversely, chronic heavy alcohol use can produce depressive symptoms that are indistinguishable from primary depression until the patient has been abstinent for several weeks. This masking effect means the psychiatric technician's careful, objective observations are essential: document behaviors and physical signs exactly as you observe them rather than assuming one condition explains everything.

Three observation priorities when a patient has a dual diagnosis:

1. Track mood and behavior changes separately from any substance use timeline — note timing, not just the symptoms.

2. Report new physical symptoms promptly — withdrawal can begin even in a treatment setting if a patient was using recently.

3. Document sleep, appetite, and agitation patterns — these are often the earliest measurable signs of change in either condition.

Safety Priorities for Psychiatric Technicians

Your role is observation and reporting, not medical treatment. Know these rules:

• Altered consciousness + slow or absent breathing = immediate emergency response. Do not wait.
• New-onset seizure or severe agitation in a patient with CNS depressant history = notify nursing and medical staff immediately; prepare to call emergency services.
• Vital sign changes (very high or low heart rate, blood pressure spikes, high temperature) in any patient going through withdrawal must be reported without delay.
• Never leave an actively withdrawing patient alone if their condition is deteriorating.
• Document observations with time stamps, specific behaviors, and physical signs — avoid interpretive language such as "seems high." Write what you see and measure.