Skip to Main Content




Substance abuse tends to be a chronic, progressive disease. Initiation of substance use is becoming such a common feature of an American adult that many authorities call it normative behavior. At this stage, substance use is typically limited to experimentation with tobacco or alcohol (so-called gateway substances). During adolescence, young people are expected to establish an independent, autonomous identity. They try out a variety of behaviors within the safety of families and peer groups. This process often involves experimentation with psychoactive substances, usually in culturally acceptable settings. Continuation of substance abuse, however, is a nonnormative risk behavior with the potential to compromise adolescent development.


The American Psychiatric Association has outlined criteria to judge the severity of substance use disorders (SUD). The most recent version, DSM-5 (Diagnosistic and Statistical Manual-5), has moved from the previous terms “substance abuse” and “substance dependency” to mild, moderate and severe SUD. There are 11 features described in DSM-5. Patients with mild SUD have two or three features, whereas those with moderate have four or five features without loss of control or compulsive features. Patients with severe SUD have more than six features, including loss of control or compulsive features.


Common physiologic effects and symptoms of intoxication (which can occur at any stage of substance use) and withdrawal (a symptom of dependency) for the major classes of substances are shown in Tables 5–1 and 5–2.

Table Graphic Jump Location
Table 5-1.Physiologic effects of commonly abused mood-altering substances by organ/system.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.