Substance Abuse and Dependence
The guide universally considered the primary reference tool for mental health practitioners is the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the treatment and research of mental disorders. (APA, 2014) This is the primary source for most of the information you will read here.
The Primary Differences Between Substance Abuse and Substance Dependence
The typical Substance Abuser is someone who engages in recurrent, but consequential periods of recreational binges. This is in contrast to the continuous and compulsive pattern of use that is typical of Substance Dependence.
At the extremes, the differences between abuse and dependence are clear-cut. The Abuser goes through periods of indifference, using the substance in a controlled way or abstaining from it altogether. An opportunity and/or desire will eventually return to an active period of binging, followed again by the same habit of abstinence. The individual doesn’t learn from experiences for example, that a couple of drinks (or snorts or pills or joints) can lead to a binge and a binge can, and often does, have serious (even catastrophic) consequences.
Substance Abuse is distinguished from run-of-the-mill recreational bingeing, which, while dangerous, does not qualify as a mental disorder. The definition of Substance Abuse requires that there be “a maladaptive pattern of substance use manifested by significant adverse consequences” in at least 1 of 4 different domains: 1. Driving under the influence 2. Other legal problems (eg, disorderly conduct, assault, etc) 3. Reduced performance at work or school 4. Problems with interpersonal relations and family life
Substance Abuse can be the first step on a path that eventually leads to Substance Dependence. The threshold between the 2 is crossed when the periodic bingeing turns into continuous use and the motivation switches from pleasurable recreation to requiring the substance to function. Substance Dependence requires some combination of tolerance, withdrawal, and a pattern of compulsive use. Tolerance equates with a diminished pleasurable return—increasing quantities of the substance are necessary to achieve the desired effect. Trying to reduce or stop usage of the substance leads to unpleasant (and sometimes dangerous) symptoms that will compel one to start using again. Compulsive use creates a craving to obtain satisfaction (i.e. a hit) regardless and mindless of potential consequences.
Substance addiction is a growing issue in the United States that impacts millions of people and their families.
– Twenty-three million Americans age 12 or older suffer from alcohol and drug addiction.
– More than 15 million of those are dependent on alcohol, roughly 4 million are dependent on drugs and remainder are dependent on both.
– In 2006, nearly 1.8 million Americans were admitted to drug and alcohol treatment facilities.
– Preliminary data for 2009 from the CDC show the highest percentage in a decade measured for adults who have consumed more than 5 drinks a day (23 percent).
– Individuals treated for alcohol misuse are approximately 10 times more likely to commit suicide than those who do not misuse alcohol, and people who abuse drugs have about 14 times greater the risk for eventual suicide.
Yet, there is good news about recovery.
- In any given day, over 700,000 Americans seek treatment for alcohol or drug addiction.
- At least one-third of alcoholics fully recover.
- Using prescription drugs to ease alcohol withdrawal, in combination with treatment, boost the recovery success rate to 50 percent.
- There are an estimated 1.25 million Alcoholics Anonymous members in the U.S.
- There are more than 25,000 Narcotics Anonymous groups in the world.
- A majority of Americans (80 percent) have positive feelings about prevention and recovery from substance use disorders.
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