Substance Abuse - Wikipedia

Substance abuse

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Substance abuse refers to the use of any legal or illegal substance when that use is causing damage to the user's physical and/or mental health and causes the person legal, social, financial or other problems including endangering their lives or the lives of others. The phrase "problematic substance use" is a newer term for "substance abuse" that is gaining acceptance.

When science began to study addictive behavior in the 1930s, substance abusers were thought to be morally flawed and lacking in willpower. Those views shaped society's responses to substance abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punitive rather than preventative and therapeutic actions.[1]

According to the US National Institute on Drug Abuse, abuse and addiction to alcohol, nicotine, and illegal substances cost Americans upwards of half a trillion dollars a year, considering their combined medical, economic, criminal, and social impact. Every year, abuse of illicit drugs and alcohol contributes to the death of more than 100,000 Americans, while tobacco is linked to an estimated 440,000 deaths per year.[1]


Some definitions of substance abuse

Abuse refers to the use of a given substance which has an unwanted impact on the user. It is not the amount of the substance used that constitutes abuse. Rather, it is the effect that substance has on the individual and that person's life that determines whether the subtance is being abused.[2] The disorder is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. There are on-going debates as to the exact distinctions between substance abuse and substance dependence, but current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use.[3]

Substance abuse may lead to addiction or substance dependence. Medically, physiologic 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 processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.[4]


Related terms

Substance use generally refers to a psychoactive substance, which could be legal or illegal. The substance could be used in any manner of different ways such as sniffing, inhaling, swallowing, drinking, smoking or injecting. Various substances produce an effect that may be short or long in duration. Substance use can become abuse or problematic use when it starts to cause the substance user medical, legal, social, economic, and other problems.

Substance misuse is the using of substances in a manner for which they were not intended. Substance misuse is the administration of a substance that deviates from the norm or valid standard.

Other terms associated with substance abuse are substance use, substance misuse, problematic substance use, substance dependency, substance addiction, drug use, drug abuse, drug dependency, drug addiction, drinking, taking drugs, using drugs/substances, on a prescription, getting drunk, getting high, etc.


Factors used to define substance abuse

Two criteria are used to characterize substance use as abuse:

  1. The substance must interfere with the individual's functioning in some way.
  2. The substance must not be culturally sanctioned.[2]



Addiction: Though "addiction" is not a scientific term, addiction is defined as "a global pattern in which the individual's substance use (and in this case "abuse") dominates the person's life. A great deal of time and energy is spent in locating and obtaining the substance, planning for its use, and in using it. "Addiction" is a pejorative term that implies a maladaptive pattern of behavior.[2]

Dependence has two components: physiological and psychological.[2]

  • Physiological Dependence means the individual's body has adapted to a substance such that one's body actually needs the substance for the individual to feel "normal."
  • Psychological Dependence will cause the individual to experience withdrawal symptoms when they stop using the substance.

Tolerance refers to the need for increasing amounts of the substance to achieve the same effect. Tolerance dissipates well and reverts back to its original state if the individual abstains from using the substance.[2]

Withdrawal is a response an individual may experience after an addictive substance of abuse is removed from the body. Withdrawal may be physiological, psychological, or both. Generally the withdrawal state is the exact opposite of the addictive state. Alcohol withdrawal is perhaps the most dramatic and dangerous withdrawal syndrome. Each substance of abuse has its own withdrawal syndrome.[2]

Relapse is a recurrence of symptoms of a disease after a period of improvement; that is, a person in recovery drinks or uses drugs again after a period of abstinence.[5]

Relapse Prevention is any strategy or activity that helps keep a person in recovery from drinking alcohol or using drugs again. It may include developing new coping responses; changing beliefs and expectations; and changing personal habits, lifestyles, and schedules.[5]

Rehabilitation is the process of restoring an individual (such as an alcoholic, substance abuser or drug addict) to a useful and constructive place in society especially through some form of vocational, correctional, or therapeutic measures and reeducation to participation in the activities of a normal life within the limitations of the person's disability.[5]

Denial is the thought process in which a person does not believe he or she has a problem, despite strong evidence to the contrary. It is a way of protecting oneself from painful thoughts or feelings.[5]

Detoxification (Or "Detox"). A process that helps the body rid itself of substances while the symptoms of withdrawal are treated. It is often a first step in a substance abuse treatment program.[5]

Medication-Assisted Treatment (MAT). MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication assisted treatment (MAT) is clinically driven with a focus on individualized patient care.[6]

Followup Care. Also called continuing care. Treatment that is prescribed after completion of inpatient or outpatient treatment. It can be participation in individual or group counseling, regular contact with a counselor, or other activities designed to help people stay in recovery.[5]

Halfway House / Sober House. A place to live for people recovering from substance use disorders. Usually several people in recovery live together with limited or no supervision by a counselor.[5]

Inpatient Treatment. Treatment in a setting that is connected to a hospital or a hospital-type setting where a person stays for a few days or weeks.[5]

Outpatient Treatment. Treatment provided at a facility. The services vary but do not include overnight accommodation. Sometimes it is prescribed after inpatient treatment.[5]

Residential Treatment. Treatment in a setting in which both staff and peers can help with treatment. It provides more structure and more intensive services than outpatient treatment. Participants live in the treatment facility.[5]

Trigger. Any event, place, thing, smell, idea, emotion, or person that sets off a craving to drink alcohol or use drugs.[5]

Self-Help / 12-Step Groups. Support groups consisting of people in recovery that offer a safe place where recovering people share their experiences, strengths, and hopes. AA’s 12 Steps help the members recover from addiction, addictive behavior, and emotional suffering. These groups are free and are not supported by any particular treatment program.[5]

Supportive Living. Also called transitional apartments. A setting in which the skills and attitudes needed for independent living can be learned, practiced, and supported. It provides a bridge between supervised care and independent living.[5]


Why people take drugs

According to the US National Institute on Drug Abuse, people begin abusing substances for a variety of reasons:[7]

  • To feel good. Most abused substances produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of substance used. For example, with stimulants such as cocaine, the "high" is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction.
  • To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs or other substances in an attempt to lessen feelings of distress. Stress can play a major role in beginning substance use, continuing substance abuse, or relapse in patients recovering from addiction.
  • To do better. The increasing pressure that some individuals feel to chemically enhance or improve their athletic or cognitive performance can similarly play a role in initial experimentation and continued substance abuse.
  • Curiosity and "because others are doing it." In this respect, adolescents are particularly vulnerable because of the strong influence of peer pressure. They are more likely, for example, to engage in "thrilling" and "daring" behaviors, to include underage drinking and "experimentation" with illegal or legal drugs.



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 thought to be symptoms of deeper psychological disorders or moral weakness.

The third edition, in the 1980s, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance 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 tolerance.

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 diagnosis.

By 1989, the DSM-IV defines substance dependence 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".

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association defines substance abuse as:[8]

  • A. Any 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:
  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 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.

The fifth edition of the DSM, planned for release in 2010, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present. Rather, it means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-V discussion.



  1. ^ a b "How Science Has Revolutionized the Understanding of Drug Addiction." National Institute on Drug Abuse/National Institutes of Health. Available online: Accessed 10-22-2007
  2. ^ a b c d e f McDowell, David M., and Henry I. Spitz. Substance Abuse: From Principles to Practice. Brunner-Routledge, 1999. ISBN 0876308892
  3. ^ Pham-Kanter, Genevieve. (2001). "Substance abuse and dependence." The Gale Encyclopedia of Medicine. Second Edition. Jacqueline L. Longe, Ed. 5 vols. Farmington Hills, MI: Gale Group.
  4. ^ McLean Research Harvard Univ
  5. ^ a b c d e f g h i j k l m 12 Step Program Web Site
  6. ^ Medication-Assisted Treatment (MAT)
  7. ^ Drug Abuse and Addiction
  8. ^ American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.


See also


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