# Substance-related & addictive disorders

A CTEVT PSC curriculum topic (substance abuse and the stages of change). DSM-5 merged the old "abuse" and "dependence" into one graded disorder per substance.

**Shaking, sweating, confusion, seeing things, or a fit after stopping heavy drinking or sleeping pills** is withdrawal and can be dangerous: go to a hospital today. For thoughts of self-harm, call [1166](tel:1166).

## Substance Use Disorder; the 11-criteria frame

A problematic pattern of use causing clinically significant impairment or distress, shown by **≥2 of 11 criteria within 12 months**. Severity:

- 2–3: mild
- 4–5: moderate
- ≥6: severe
The same frame applies to alcohol, opioids, cannabis, stimulants, sedatives and tobacco. Gambling disorder sits beside them as the one behavioural addiction.

### Impaired control (1–4)

- More/longer than intended
- Wants to cut down, can't
- Much time obtaining, using, recovering
- Craving

### Social impairment (5–7)

- Fails role obligations
- Continues despite relationship problems
- Gives up important activities

### Risky use (8–9)

- Use in hazardous situations
- Continues despite physical/psychological harm

### Pharmacological (10–11)

- Tolerance: needs more for the same effect
- Withdrawal, or use to avoid withdrawal
Nepal · International

Globally, alcohol and tobacco dwarf all illicit drugs in disease burden. In Nepal, alcohol sits inside culture unevenly, customary in some communities, prohibited in others, so "how much is a problem" must be judged by the 11 criteria, not by drinking per se. The National Mental Health Survey 2020 found alcohol use disorder in 4.2% of adults over the past year (95% CI 3.6 to 4.8); see [Nepal in numbers](https://manoatlas.com/data.md). Home-brew (raksi, jaand) makes quantity hard to estimate; ask in local units. Watch returned migrant workers, transport and security workers; and screen for depression and suicide risk alongside alcohol in every assessment. Pair the criteria with the Stages of Change (precontemplation → contemplation → preparation → action → maintenance → relapse) from your Month-4 block for counseling planning.

The addiction cycle (after Koob & Volkow's three-stage model). Counselling enters at the craving stage: mapping each person's cues and building a plan for the moment the tea shop comes into view, which is why "just promise to stop" fails and cue-plans work.

The stages of change (Prochaska and DiClemente). The counselor's job changes with the stage: information, then weighing, then planning, then support. Relapse re-enters the wheel; it is expected, not failure.

A skill to try · two minutes

**Ride the craving.** A craving crests and passes, often within 20 to 30 minutes; the cycle diagram above shows the moment it strikes. Delay (10 minutes first), drink water, move your feet, phone one safe person. You do not have to defeat the wave, only outlast it. This is for cravings; shaking, sweating, confusion or fits after stopping heavy alcohol or sleeping-pill use is withdrawal, and needs a doctor.

A coping skill, not a treatment: it supports care, it does not replace it.

Key points

1. Substance use disorder is a pattern of use causing harm, judged by 11 criteria, not by how much someone drinks.
2. Addiction is a cycle: use, withdrawal, craving, use again; tolerance rises and control falls each turn.
3. Meet the client at their stage of change; withdrawal from heavy alcohol or sedatives can be dangerous and needs a doctor.
Learn more

Pick one, not all: these are chosen to be light, not exhaustive.

Video · 15 min[Everything you think you know about addiction is wrong (TED)](https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong): Connection vs addiction: reframes counseling goals. Its "connection" thesis is contested; take it as a lens, not a finding.

Book chapter**Where There Is No Psychiatrist: alcohol & drug sections**: Screening and brief intervention, step by step.


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*Source: https://manoatlas.com/substance · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*