Substance Abuse vs. Substance Dependence

 

DSM-IV-TR Substance Dependence Criteria

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

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

  • a need for markedly increased amounts of the substance to achieve intoxication or desired effect
  • markedly diminished effect with continued use of the same amount of the substance

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

  • the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
  • the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

3. the substance is often taken in larger amounts or over a longer period than was intended

4. there is a persistent desire or unsuccessful efforts to cut down or control substance use

5. a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

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., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

  • With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either item 1 or 2 is present)
  • Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither 1 nor 2 is present)

Course specifiers:

  • Early Full Remission
  • Early Partial Remission
  • Sustained Full Remission
  • Sustained Partial Remission
  • On Agonist Therapy
  • In a Controlled Environment

DSM-IV-TR Substance Abuse Criteria

A maladaptive pattern of substance use leading to clinically significant impairment of distress, as manifested by one (or more) of the following, occurring within a 12-month period:

  1. recurrent substance use resulting in a 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 expulsions 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 use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

Or that the symptoms have never met the criteria for Substance Dependence for this class of substance.

Epidemiology

Alcohol use reportedly has been on the decline in recent years. Reports indicate that roughly two thirds of all adults drink alcohol occassionally. Approximately 13% of people in the US are alcoholics, and 1 person in 5 who uses alchol for recreational purposes becomes dependent for some period of time. Studies perfomed in urban EDs indicate that up to 20% of patients may have problems with alcohol, with the highest rate in patients who present late at night. In contrast to alcohol use, heroin use is rising. Estimates place the number of heroin users in the US at 750, 000. Heavy cocaine use has remained fairly steady since its peak in the late 1980s and early 1990s, with an estimated 600,000-700,000 regular users. On the rise in rural communities is use of methamphetamine, also known as crystal meth. It is easily manifactured as the base ingredient is over-the-counter cold medication. It is found to be abused most often in the 15-to-25-year-old age bracket. Abuse of prescription and over-the-counter drugs is rapidly increasing, especially in teenagers.

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