Substance abuse, addiction and dependence all have different meanings. Using a substance (such as a painkiller, antidepressant, narcotic, sedative or other drug) without medical supervision or in larger quantities than prescribed is substance abuse. This does not mean that the individual is addicted or dependent on the substance. Substance dependence is characterized by tolerance or withdrawal symptoms. Addiction, the "worst" of the three if you will, is a mental disease where the user is dependent on the substance and continues to use it despite its harmful effects on the individual or their family. See also Dependence vs Addiction.
|Harmful use of substance||Yes||Yes|
|Tolerance||No||Usually, but not always|
What is substance abuse?
Here is a good definition and overview of substance abuse from Wikipedia:
Substance abuse, also known as drug abuse, is a patterned use of a substance (drug) in which the user consumes the substance in amounts or with methods neither approved nor supervised by medical professionals. If an activity is performed using the objects against the rules and policies of the matter (as in steroids for performance enhancement in sports), it is also called substance abuse.
Clinical definitions of substance abuse are tricky. The DSM-IV definition is
Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress.
What is substance dependence?
Physical dependence is a natural expected physiological response to drugs such as opioids, benzodiazepines, antidepressants, stimulants, and corticosteroids. It is characterized by withdrawal symptoms with the patient being unable to cope when the drug is stopped. Another characteristic is tolerance i.e., a progressively higher dosage of the drug is needed before the body can feel its desired impact.
Clinicians will diagnose substance abuse if, in a twelve month period, a person exhibits one or more of the following behavioral patterns:
- Recurrent use resulting in failure to fulfill major obligations at work, home or school
- Recurrent use in physically hazardous situations
- Recurrent substance-related legal problems
- Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance use.
In addition, symptoms must not meet the criteria for substance dependence for the class of substance. A diagnosis of substance dependence supersedes that of substance abuse. i.e., if a person is diagnosed with substance abuse, further consideration should be given to whether the individual meets the criteria for substance dependence and if yes, then the diagnosis for substance dependence overrides that of abuse.
Dependence is diagnosed when a patient meets three or more of the following criteria:
- Physiological symptoms:
- Tolerance (a need to take more of the drug to achieve the same effect)
- Characteristic withdrawal symptoms, and substance taken to relieve withdrawal
- Behavioral patterns
- Substance taken in larger amount and for longer periods than originally intended
- Persistent desire to or repeated unsuccessful attempts to quit
- Excessive time spent obtaining and using the drug
- Less time spent on important social, occupational, or recreational activities
- Use continues despite knowledge of adverse consequences (e.g., failure to fulfill obligations, use when physically hazardous)
Depending upon whether the patient exhibits physiological symptoms (withdrawal or tolerance), the diagnosis for substance dependence is specified as either with or without physiologic dependence.
Remission can be divided into four subtypes -- full, early partial, sustained, and sustained partial -- depending on if and when any of the criteria for abuse or dependence have been met. The remission category can also be used for patients receiving agonist therapy (e.g., methadone maintenance) or for those living in a controlled drug-free environment.
Research suggests that no treatment method for substance abuse is preferable to any other, but that social support is a very important factor. An openness to accept the abuse is also paramount to successfully treat the illness. Organizations such as AA and NA have had better than average success in reducing relapse.
Detoxification treatment may need to be administered to those with substance dependence due to the dangerous nature of some withdrawal symptoms. As with substance abuse, research suggests that no treatment method is superior, but that social support is very important and that organizations such as AA and NA have better than average success rates in reducing relapse.