Substance abuse
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Substance abuse has a range of definitions related to disaproval over use or overuse of mood altering substances3. These fall into four main categories:
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Definitions
Medical
Substance abuse may lead to addiction or substance dependence. Medicaly, dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. Dependence involves physiological proceses while substance abuse reflects a complex interaction between the individual, the abused substance and society.
"Substance abuse" is sometimes used as a synonym for "drug abuse," but this usage is not universaly agreed upon, the later term usualy including any use of illicit drugs even if such use does not meet the medical definition of abuse. Both of the most commonly used diagnostic tools (the DSM and the ICD) no longer use "drug abuse" as a diagnostic criteria, instead rolling that cluster of syptoms previously referred to as drug abuse into substance abuse and "substance dependance".
Public health definitions
In the past two decades, public health practicitioners have moved away from concepts of drug abuse to a broader perspective than the indivisial, emphasising the role of society. Rather than look at substance "abuse" many public health professionals have adopted the terms "alcohol and drug problems" or "harmful/hazardous use" of drugs.3
Political and criminal justice
In most countries, legislation on substance abuse is written to criminalise any use of illegal drugs, or illegal use of controlled drugs.
Mass communication and vernacular usage
The term may be used in newspapers, television etc in a ambiguous, catch-all sense [1] (http://www.druglibrary.org/schaffer/library/studies/ota/appc.htm) rather than as a medical or legal term, sometimes disapprovingly to refer to any drug use at all, particularly of illicit drugs 2.
History
In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were through to be symptoms of deeper psychological disorders or moral weakness.
The third edition, in the 1980s, was the first to recognise substance abuse (including drug abuse) and substance dependance as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependancr emphasised tollerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as problematic use with social or occupational impairment but without withdrawal or tollerance.
In 1987 the DSM-IIIR category "psychoactive substance abuse", which includes former concepts of 'drug abuse' is defined as "a maladaptive pattern of use indicated by ...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous". It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in dignosis.
By 1988, the DSM-IV defines substance dependance as a syndrome involving compulsive use, with or without tolerance and withdrawal; whereas substance abuse is problematic use without compulsive use, significant tolerance, or withdrawal.
Diagnosis
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association defines substance abuse as:
- A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
- 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)
- 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)
- Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct
- Continued substance 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)
- B. The symptoms have never met the criteria for Substance Dependence for this class of substance.
Statistics
United States
As of 1999, substance abuse in the U.S. was estimated to be responsible for 590,000 deaths and 40 million injuries and illnesses annually. The total economic costs have been estimated to be close to $428 billion. It is estimated that one fourth of Americans over the age of 15 have physiological dependence on at least one substance. 1
Notes
- Note 1: Sharma, Manoj. (Sept 2004) "Organizing community action for prevention and control of alcohol and drug abuse." Journal of Alcohol & Drug Education. v48 i2 p1(4).
- Note 2: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision) (Diagnostic and Statistical Manual of Mental Disorders) ISBN: 0890420254
- Note 3: Schaffer Library on Drug Policy - Perspectives on Defining Substance Abuse (http://www.druglibrary.org/schaffer/library/studies/ota/appc.htm)
See also
External links
- MedicineNet (http://www.medterms.com/script/main/art.asp?articlekey=24405)
- Schaffer Library of Drug Policy (http://www.druglibrary.org/schaffer/library/studies/ota/appc.htm), Perspectives on defining substance abuse