SUD (Substance Use Disorder): Treatment, Symptoms, Diagnosis, and Online Care

At Talkiatry, we know that navigating mental health can feel overwhelming. Our mission is to make it easier—starting with information you can trust. As a national mental health practice with over 600 psychiatrists and other providers, we combine clinical excellence with real-world understanding to deliver incredible care and reliable information. This article has been medically reviewed by the same doctors who treat our patients every day, ensuring it meets the highest standards. Whether you’re seeking care now or simply looking to learn more, we’re here to help.

Substance use disorder (SUD) is a medical condition marked by the recurrent use of drugs or alcohol despite negative consequences. It can impact how a person thinks, feels, and functions—often worsening physical and mental health over time. In this article, we’ll cover the types, causes, and symptoms of SUD, how it’s diagnosed, and the treatment options available—including how psychiatry can help and what to expect from online care.

Substance use disorder treatment at Talkiatry

As physicians, it’s our role to provide care that gives patients the best chance at getting better. So, we only treat what we’re equipped to treat—safely, effectively, and responsibly.
That’s why we do not treat what’s known as primary substance use, cases where drug or alcohol use is the main or only concern. Treating primary substance use often requires in-person support, like group therapy, frequent urine toxicology screenings, and/or injectable medications. These wraparound services are essential for success—but they’re not something we can provide in an online setting.
Instead, we provide care for secondary substance use, where a person may be struggling with both substance use and a co-occurring mental health condition, such as depression, anxiety, PTSD, or ADHD. In these cases, our psychiatrists can address the underlying psychiatric concerns and help the patient get on the best path to healing.

What is substance use disorder (SUD)?

Substance use disorder (SUD) is a medical condition that involves the repeated use of drugs or alcohol in a way that causes significant problems in a person’s life. It goes beyond occasional use—SUD is marked by a pattern of behavior where substance use interferes with work, relationships, health, or daily responsibilities.

SUD affects the brain’s reward system and can disrupt decision-making, impulse control, and emotional balance. Over time, it often leads to physical dependence, mental health challenges, and strained social connections. In some cases, it can increase the risk of serious outcomes like self-harm or suicidal thoughts—knowing what to look for and what to do can make a life-saving difference.

Importantly, SUD is treatable. With the right support, people can manage their symptoms, reduce or eliminate substance use, and improve their overall well-being.

Types of substance use disorders

Substance use disorder can involve a range of substances, each with its own signs, risks, and challenges. Below are some of the most common types:

Alcohol Use Disorder

Alcohol use disorder involves a pattern of drinking that leads to significant distress or difficulty functioning. People may find themselves drinking more than intended, struggling to cut back, or needing alcohol to get through the day.

Opioid Use Disorder

This type involves the misuse of prescription pain medications (like oxycodone or morphine) or illicit opioids such as heroin. It often leads to physical dependence, intense cravings, and withdrawal symptoms when not using.

Cannabis Use Disorder

Cannabis use disorder is characterized by frequent or heavy marijuana use that interferes with daily life. Signs may include using more than intended, feeling unable to stop, or continuing to use despite negative effects on memory, motivation, or mood.

Stimulant Use Disorder

Stimulant use disorder involves substances like cocaine, methamphetamine, or prescription stimulants such as Adderall. It may lead to cycles of intense energy followed by crashes, and can quickly lead to increased tolerance and risky behaviors.

Signs and symptoms of SUD

The signs of substance use disorder can vary depending on the individual and the substance involved. They often show up as changes in behavior, mood, and physical health. Here are some of the most common indicators:

Cravings

An intense urge or desire to use a substance, often making it difficult to focus on anything else.

Withdrawal Symptoms

Physical or emotional symptoms that occur when a person reduces or stops using a substance—such as anxiety, nausea, sweating, irritability, or tremors.

Neglecting Responsibilities

Missing work, skipping school, or ignoring family obligations due to substance use.

Unsuccessful Attempts to Quit

Repeated efforts to cut down or stop using without success, even when the person wants to change.

Increased Tolerance

Needing more of the substance over time to get the same effect, which can lead to more frequent or higher-risk use.

Risky Behavior

Using substances in dangerous situations—such as while driving—or engaging in unsafe activities while under the influence.

What causes SUD?

Substance use disorder doesn’t have a single cause—it’s influenced by a combination of biological, psychological, and environmental factors. Understanding these risk factors can help clarify why some people are more vulnerable to developing SUD than others.

• Genetics: A family history of substance use disorder can increase a person’s risk. Research suggests that genetic factors may account for roughly half of someone’s likelihood of developing SUD.
• Mental health conditions: People with depression, anxiety, PTSD, ADHD, or other psychiatric conditions may use substances as a way to cope with emotional pain or distress—often without realizing that substance use can worsen those underlying symptoms over time.
• Trauma history: Experiencing trauma—especially early in life—can raise the risk of SUD. This includes physical, emotional, or sexual abuse, neglect, or witnessing violence.
• Environmental exposure: Growing up in an environment where substance use is common, or experiencing high levels of stress without healthy coping strategies, can make substance use more likely.
  
  

While these factors can increase risk, they don’t determine a person’s future. With the right treatment and support, recovery is always possible.

Do psychiatric medications lead to addiction?

It’s common to feel unsure about starting psychiatric medication—especially if you’re already worried about substance use. The good news is that most psychiatric medications are not addictive, and your psychiatrist will always take your history and risk factors into account when making a treatment plan.

Here’s what you should know:

• Antidepressants, like SSRIs or SNRIs, are commonly used to treat depression, anxiety, and PTSD. These medications are not addictive, and there’s no “high” or compulsion to misuse them.
• Mood stabilizers and antipsychotic medications, which may be used in certain cases of bipolar disorder or severe mood symptoms, also do not carry a risk of addiction.
• Stimulants, like the ADHD medication , can have misuse potential—but when used correctly under medical supervision, they can be safe and effective. If you have a history of substance use, your psychiatrist may consider non-stimulant alternatives like atomoxetine (Strattera) or guanfacine.
• Benzodiazepines (like Xanax or Ativan), which are sometimes used for acute anxiety or panic, do carry a risk for dependence and are prescribed with caution—especially for those with a history of SUD. These are rarely part of long-term treatment plans at Talkiatry.
  

Your psychiatrist’s job is to help you feel better without putting you at risk. That’s why every medication decision is made with care, collaboration, and your full medical picture in mind. If you have concerns, bring them up—it’s a conversation we’re always ready to have.

How a psychiatrist can help

Psychiatrists are medical doctors who specialize in diagnosing and treating mental health conditions—including those that commonly co-occur with substance use. When someone is experiencing both substance use and symptoms of depression, anxiety, PTSD, or another condition, a psychiatrist can help get to the root of what’s going on. 

Through comprehensive evaluation and evidence-based treatment planning, psychiatrists can identify underlying issues, prescribe a wide range of medications when appropriate, and provide ongoing care to track progress over time. This consistent support can be especially valuable when navigating the complexities of substance use alongside other mental health challenges—especially if you’ve been hesitant to seek treatment in the past. There are many reasons people avoid mental health care, but working with a psychiatrist can be a helpful first step toward clarity and support.

SUD diagnosis

Diagnosing substance use disorder starts with understanding how substance use is affecting a person’s life—physically, mentally, and emotionally. The process typically involves three key steps:

1. Clinical interview: A psychiatrist or licensed mental health professional will ask about your substance use history, symptoms, mental health, and overall functioning. This conversation helps identify patterns and determine whether certain diagnostic criteria are present.
2. Medical and psychiatric history: The clinician will review your medical background, including any mental health conditions, past treatments, or medications. This step is essential for identifying co-occurring disorders that may influence the treatment plan.
3. Additional assessments (as needed): In some cases, lab tests or standardized screening tools may be used to better understand the scope of substance use and its impact. These assessments help inform the most appropriate level of care.
   
   

This thorough evaluation ensures that treatment is tailored to your specific needs—and that any underlying mental health conditions are addressed alongside substance use.

Psychiatry vs. therapy

For many people, the most effective treatment for substance use disorder involves both psychiatry and therapy. These two approaches work together—each supporting the other—to help patients make meaningful, lasting progress.

Psychiatry focuses on the biological and medical aspects of mental health. Psychiatrists are medical doctors who can diagnose conditions, prescribe medications, and monitor how those medications affect a patient’s symptoms over time. In the context of substance use, psychiatrists can also identify co-occurring disorders like depression, anxiety, PTSD, or ADHD, which often contribute to or complicate substance use.

Therapy, also known as psychotherapy or talk therapy, helps people understand their thoughts, emotions, and behaviors. Therapists use evidence-based techniques to help patients develop coping skills, manage triggers, process trauma, and make behavioral changes. While therapists don’t prescribe medication, they’re a crucial part of many treatment plans—offering insight and support that medication alone can’t provide.

When combined, psychiatry and therapy offer a more comprehensive approach to care—addressing both the underlying causes and the day-to-day challenges of living with substance use disorder.

Treatment options for SUD

Effective treatment for substance use disorder isn’t one-size-fits-all. It works best when it’s tailored to the individual—taking into account their symptoms, medical history, mental health, and goals for recovery. In many cases, the most successful plans combine both medical and therapeutic approaches.

Detox and withdrawal management

For people who have developed a physical dependence on a substance, medically supervised detox may be the first step. This process helps manage withdrawal symptoms safely and can be an important foundation for ongoing treatment.

Medication-Assisted Treatment (MAT)

MAT involves the use of FDA-approved medications to reduce cravings, ease withdrawal, or block the effects of certain substances. It’s often used in combination with therapy, and is especially effective for opioid and alcohol use disorders.

Behavioral therapies

Evidence-based therapies like cognitive behavioral therapy (CBT), contingency management, and motivational interviewing help patients build healthier coping strategies, change patterns of thinking, and stay engaged in recovery.

Inpatient vs. outpatient programs

Inpatient treatment provides intensive, 24/7 care in a structured environment—ideal for those with severe symptoms or safety concerns. Outpatient programs offer more flexibility, allowing patients to attend treatment sessions while continuing with daily responsibilities.

Online SUD treatment: How Talkiatry can help

Talkiatry treats substance use disorder—but only when it’s not the primary concern, or when a patient wouldn’t be better served by in-person, wraparound treatment. If your main challenge is substance use, or if your care would benefit from services like group therapy, urine testing, or injectable medications, we’ll help guide you toward a provider that offers the right level of support.

For patients managing substance use alongside a mental health condition—like depression, anxiety, PTSD, or ADHD—Talkiatry can help. Our psychiatrists focus on the full picture, addressing both the underlying psychiatric symptoms and how they may be linked to substance use.

Here’s what you can expect from online SUD treatment with Talkiatry:

• A full psychiatric evaluation to understand your symptoms and determine if we’re the right fit
• A personalized treatment plan, including medication management when appropriate
• Regular virtual follow-ups with the same psychiatrist, so you have consistent, ongoing care
  

We’ll never recommend care that’s not likely to work. If you need a different kind of support, we’ll help you find it.