What is Substance Abuse? What is Substance Dependence?

Substance Abuse and Substance Dependence are defined in a book called the DSM-IV-TR. It is the standard book used by all doctors, psychologists, psychiatrists, social workers, drug & alcohol counselors, insurance companies. and the government to define problems related to emotions, thoughts, and behavior patterns. Lots of the DSM-IV-TR is written with all kinds of jargon. So I thought it might be useful for me to try to put quite a bit of it in my own words. I hope it helps. I ‘would encourage you to look at the actual DSM-IV-TR too.

Substance Abuse: “The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances…during the same 12-month period.” [p.198]

In other words, If bad things happen to you when you use drugs or alcohol, you probably fit the definition of substance abuse. What kind of “bad things”? Any one of these four counts (if it happens more than once within a year):

1. Hurting your role as a student, employee, son, daughter, sister, brother, etc.
2. Doing dangerous things while using (like driving a car or riding with someone who has been using).
3. Legal problems.
4. Problems in your relationships (like fighting, arguing about using, hurting your friends when your own using encourages them to use drugs or alcohol).

Substance Dependence: “The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.” [p.192]

In other words: There is not one single thing that counts as
substance dependence. You cart look at the exact definition from the book (on page 197) to be sure, but if you have three of the
things listed below, then you probably fit the definition of substance dependence:

1. Increased tolerance. It takes quite a bit more to get you
drunk or high than it used to. Or, using the same amount as you used to doesn’t have as strong an effect as it used to.
2. Withdrawal. You have physical withdrawal symptoms or you substitute other drugs to avoid withdrawal symptoms.
3. You plan to limit how much you will drink or use, but then you change your plans and drink/use more.
4. You have wanted to quit or cut down for a while, but have not done so.
5. Lots of time is spent high/drunk, or trying to get the
substance, or recovering from the effects of the substance.
6. You have given up or reduced your efforts in important social, recreational, school, or job activities. (Examples:
don’t do as much homework; lie to people you didn’t used to lie to; used to have a job but don’t now due to using; grades have gone down; used to skateboard, but don’t any more;
used to play on the sports team, but grades have gone down because of using so you don’t make the team).
7. Using or drinking even when you know it causes you physical or psychological problems.