Substance Abuse v. Dependence

 

 
        Psychoactive Substance Abuse:    maladaptive pattern of psychoactive substance use characterized by continued use despite adverse consequences or use during hazardous conditions (e.g., when driving).  The time requirement is at least one month and abuse cannot be diagnosed if the criteria for dependence are met.  Substance abuse creates disruption and dysfunction in multiple life areas:  occupational; legal; interpersonal; emotional; financial; and/or medical.  Note that nicotine is the most commonly abused substance in the United States (although if present, you would code it as nicotine dependence, not abuse (see below)).

        Psychoactive Substance Abuse (DSM-IV Criteria):   

  1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within the twelve-month period:
  1. recurrent substance use resulting in the failure to fulfill major role obligations at work, school, or home (e.g, repeated absences or poor work performance related to substance use; substance related absences, suspensions, or expulsion from school; neglect of children or household)
  2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  3. recurrent substance related legal problems (e.g., arrests for substance related disorderly conduct)
  4. continued substance use despite having persistent or recur in social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments espouse about consequences of intoxication, physical fights)
  1. The symptoms have never met the criteria for substance dependence for this class of substance.

Reference: DSM-IV, pages 182-3.

        Psychoactive Substance Dependence (DSM-IV Criteria):   

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 (or more) of the following, occurring at any time in the same 12-month period:

    1. tolerance, as defined by either of the following:

      2. a need for markedly increased amount of the substance to achieve intoxication…

      markedly diminished effect with continued use of the same amount of the substance.

    2. withdrawal, as manifested by either of the following:

      3. the characteristic withdrawal syndrome for the substance… or

      the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

    3. substance is often taken in larger amounts or overall longer period than was intended
    4. there is a persistent desire or unsuccessful efforts to cut down or control substance use
    5. great deal of time is spent in activities necessary to obtain the substance…
    6. important social, occupational, or recreational activities are given up or reduced because of substance use
    7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance… (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Reference: DSM-IV, page 181.

            - C: multiple attempts to Cut back or control substance use.
            - Eye opener:  substance taken to avoid withdrawal.
            - L: Larger amounts or longer period of substance use than intended.
            - T: Time spent seeking or thinking about the substance.
            - W: Interference with Work or other important obligation (e.g., childcare)
            - P:  continued drinking despite medical, financial, or other significant substance-related Problems related to substance use. If
            - Tolerance:  increased dose required for same effect.
            - Withdrawal symptoms.

        Substance Dependence usually (but not always) involves physiological dependence, characterized by tolerance (higher doses of the substance required to achieve the same effect) and withdrawal ("rebound" symptoms upon sudden discontinuation of the substance).  The main, "bottom line," criterion is continued use despite adverse consequences of use.
        According to the Diagnostic and Statistical Manual, the only substance that cannot be diagnosed as causing substance dependence is caffeine. The only substance that cannot be diagnosed as causing abuse is nicotine (it can only be coded as dependence).

        Who Uses Substances?  According to recent surveys:

            90% of Americans use alcohol in some form;
            80% use caffeine;
            25% use nicotine;
             7% use some type of illicit drug.

        Why Do People Use Substances?  Most psychoactive substances, according to Wise (1988) activate areas of the brain that are powerfully linked to reward and reinforcement, such as the ventral tegmental area, the medial forebrain bundle, and the nucleus accumbens.

 

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