Substance Use Disorder (SUD)
Substance Use Disorder (SUD) is a medical condition characterized by the compulsive use of substances despite harmful consequences, involving changes in brain circuitry related to reward, stress, and self-control. Classified in the DSM-5 on a spectrum from mild to severe, SUD replaces the older terms "substance abuse" and "substance dependence" with a single, unified diagnostic framework.
DSM-5 Diagnostic Criteria
The DSM-5 defines SUD using 11 criteria organized into four categories: impaired control (using more than intended, unsuccessful efforts to cut down, excessive time spent obtaining or using, cravings), social impairment (failure to fulfill role obligations, continued use despite interpersonal problems, giving up activities), risky use (use in physically hazardous situations, continued use despite physical or psychological problems), and pharmacological indicators (tolerance and withdrawal). Mild SUD requires 2-3 criteria, moderate requires 4-5, and severe requires 6 or more.
Substances and Classification
SUDs are classified by the specific substance involved. Common categories include alcohol use disorder, opioid use disorder, stimulant use disorder (cocaine, methamphetamine), cannabis use disorder, sedative/hypnotic use disorder (benzodiazepines, barbiturates), and tobacco use disorder. Each substance class has unique withdrawal profiles, treatment protocols, and billing considerations. Polysubstance use — involving multiple substances — is common and complicates both treatment and documentation.
Treatment Approaches
Evidence-based SUD treatment includes medical detoxification for withdrawal management, Medication-Assisted Treatment (MAT) for opioid and alcohol use disorders, individual and group psychotherapy using approaches like CBT and motivational interviewing, family therapy, peer support services, and continuing care planning. Treatment is delivered across the continuum from outpatient settings through residential care, with ASAM criteria guiding level-of-care decisions.
Privacy Protections: 42 CFR Part 2
SUD treatment records receive heightened federal privacy protections under 42 CFR Part 2, which restricts disclosure of patient-identifying information from federally assisted SUD treatment programs. These protections go beyond HIPAA and require specific written patient consent before records can be shared, even for treatment, payment, or healthcare operations purposes. Behavioral health EHR systems must support Part 2 compliance through segmented consent management and role-based access controls.
Billing for SUD Treatment
SUD treatment billing uses ICD-10 diagnosis codes from the F10-F19 range, categorized by substance and severity. CPT codes for common SUD services include H0015 (intensive outpatient), H0020 (alcohol/drug services methadone administration), 90853 (group psychotherapy), and HCPCS codes for MAT medications. Payer requirements for SUD services vary significantly, and prior authorization is common at higher levels of care.
FAQs
What is the difference between substance abuse and substance use disorder?
The DSM-5 eliminated the distinction between "abuse" and "dependence" in 2013, replacing both with a single "Substance Use Disorder" diagnosis measured on a mild-moderate-severe spectrum based on the number of criteria met.
How is SUD severity determined?
Severity is based on the number of DSM-5 criteria present: 2-3 criteria indicates mild SUD, 4-5 indicates moderate, and 6 or more indicates severe. This classification affects treatment planning, level-of-care recommendations, and insurance authorization.
Why do SUD records have special privacy protections?
42 CFR Part 2 was enacted to reduce barriers to seeking SUD treatment by preventing disclosure of treatment records without explicit patient consent, protecting patients from potential discrimination related to substance use history.
What is the most common SUD in the United States?
Alcohol use disorder is the most prevalent SUD, affecting approximately 29.5 million Americans annually according to SAMHSA data. Marijuana use disorder and opioid use disorder are the next most common.
Learn More
- Substance Abuse Billing Guide — Billing codes and documentation for SUD treatment
- 42 CFR Part 2 Guide — Federal privacy protections for SUD records
- Best EHR for Addiction Treatment — EHR systems designed for SUD treatment centers