Substance Use Disorders

sec_arr Introduction

Author: Charl Els, MBChB, FCPsych and Chris Stewart-Patterson MD, CCBOM

Publication year: 2018



According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the essential feature of a substance use disorder is a “cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems…. An important characteristic of substance use disorders is an underlying change in brain circuitry that may persist beyond detoxification, particularly in individuals with severe disorders.”1

DSM-5, released in May 2013, contains significantly revised diagnostic criteria for substance use disorders. The 2000 Diagnostic and Statistical Manual of Mental Disorders. 4th ed – Text Revision (DSM-IV-TR)2 diagnoses of abuse and dependence were replaced by substance use disorder – mild, moderate, or severe, combining the DSM-IV-TR prior two diagnoses (abuse and dependence) into a single disorder (substance use disorder). Each specific substance is addressed as a separate use disorder (e.g., alcohol use disorder, opioid use disorder, etc.), diagnosed based largely on the same overarching criteria. The diagnosis can apply to all 10 categories of substances in the DSM (with the exception of caffeine).

This guideline addresses substance abuse and dependence (jointly referred to as substance use disorders) as defined in the DSM-IV-TR (see Appendix A).2 Issues outside these criteria such as past experimentation with illegal substances or current use of illegal substances without meeting DSM-IV-TR criteria for substance abuse or dependence are administrative issues. This document does not address administrative issues.

Active, ongoing substance consumption is incompatible with working in a safety-sensitive position. However, the dedicated, highly motivated law enforcement officer (LEO) with a substance use disorder is in full remission (see Appendix A) can be capable of safe and effective performance of essential LEO job functions. An active or only partially remitted substance use disorder may place the LEO at risk for significant impairment or sudden incapacitation, thus jeopardizing his or her ability to perform essential job functions.

An individualized clinical evaluation of the LEO’s substance use disorder should be performed to determine whether the individual’s condition impedes safe and effective job performance. Such evaluation must include the following key elements which are discussed in detail below:

  • a review of the history of substance use and any periods of abstinence;
  • relevant laboratory tests (e.g., MCV, GGT, AST, ALT, and bloodborne pathogens);
  • risk for substance use relapse;
  • complications or comorbidities of substance use disorders; and
  • compliance with treatment and relapse prevention programs.