USE, ABUSE AND DEPENDENCE / ADDICTION

There are many ways to define the criteria for abuse and/or dependence, but the most standard is from the Diagnostic and Statistical Manual of Mental Disorders, and they are as follows. First, let's look at the criteria for substance abuse:

DSM-IV Substance Abuse Criteria

Substance abuse is defined as 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:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use).
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct) - (this includes domestic violence; see #4—gh)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).
5. Alternatively, the symptoms have never met the criteria for substance dependence for this class of substance.

Now, it's important to understand, that in many cases, abuse will develop into dependence. Also, many people are dependent on one chemical, and abuse another.

Here are the criteria for substance dependence:

DSM-IV Substance Dependence Criteria

Addiction (termed substance dependence by the American Psychiatric Association) is

defined as a maladaptive pattern of substance use leading to clinically significant impairment

or distress, as manifested by three (or more) of the following, occurring any time in the same

12-month period:

1. Tolerance, as defined by either of the following:

(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or

(b) Markedly diminished effect with continued use of the same amount of the substance.

2. Withdrawal, as manifested by either of the following:

(a) The characteristic withdrawal syndrome for the substance or

(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

3. The substance is often taken in larger amounts or over a longer period than intended.

4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

5. A great deal of time is spent in activities necessary to obtain the substance (such as visiting multiple doctors or driving long distances), use the substance (for example, chain-smoking), or recover from its effects.

6. Important social, occupational, or recreational activities are given up or reduced because of substance use.

7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic dependence (no evidence of tolerance or withdrawal). (THIS MEANS THAT A PERSON CAN STILL BE ADDICTED WITHOUT PHYSICAL WITHDRAWAL—gh).

You may be someone who is dependent upon a substance, and not be experiencing “physical withdrawal”, but when you can't catch that buzz when you want to, you become depressed, anxious, bitchy and irritable, or any combination of uncomfortable feelings. For example, have you ever known a pothead, who likes to get high on a real regular basis, who is out of pot and can't get high? How do they act? They don't call marijuana “nature's prozac” for nothing! Or how about the withdrawal symptom for cocaine—(depression).

What is now known is that the person becomes addicted to these things on the brain chemistry level (which is physical at a chemical level) , which sets off the “psychological” withdrawal that every addict knows is, well, uncomfortable as hell.

In 1968, when I was in my 8 th grade health class, they told us that pot, caffeine, cocaine and nicotine were not addictive, but this was a “psychological” phenomenon. So - we all wrote this down in our little notebooks. Well, many of us knew pretty soon after that, that there are withdrawal symptoms for caffeine, and nicotine dependence (2 of the most additively usedsubstances in history). Another example,is that many people know there is a depression that follows exstasy use. Anyone who has experienced these “psychological” discomforts know that they can set up cravings to ingest the chemical again.

A risk of dependence exists in most drugs that provide pleasure or relief.