Blending Perspectives and Building Common Ground. The Spectrum of Substance Use, Abuse, and Addiction

04/01/1999

The use of alcohol and other drugs is a multifaceted phenomenon, varying with the individual's level of use and the dysfunction he or she experiences as a result of his or her use.  The range includes the following:

Drug experimentation

The use of alcohol or illicit drugs at any time for experimentation.  While in and of itself experimentation may not appear to be abusive, even a single episode of experimentation can result in harm to self or to others.  For example, the use of alcohol or other drugs at all during pregnancy could result in harm to the fetus, the experimental use of alcohol or other drugs while driving can result in harm to the user as well as others, or a child may be injured when left unsupervised while a parent is intoxicated.  Also, if experimental use continues or serves as a gateway to additional use, as often it does, patterns of alcohol and other drug abuse may develop.

Social use of drugs

Use of any drug or combination of drugs in social situations, or for social reasons.  If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse.  Social use of alcohol or other drugs often leads to further and elevated use.

Binge drinking

Heavy use of alcohol periodically.  This can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others.  For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence.  The National Household Survey on Drug Abuse defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past 30 days.

Substance abuse

The characteristic feature of abuse is the presence of dysfunction related to the person's use of alcohol or other drugs.  One standard definition (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes it as "the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning."  Abuse may or may not involve physiologic dependence or tolerance.  For example, use of substances in weekend binge patterns may not involve physiologic dependence; however, it may have adverse affects on a person's and possibly others' lives.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association is used across the medical and mental health fields for diagnosing both substance abuse and mental health disorders.  According to the DSM-IV, substance abuse is "a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by" a variety of possible symptoms of impairment.  Neglect of children is specifically listed as a potential symptom of substance abuse (American Psychiatric Association, 1994).

Addiction or Chemical Dependency

With continued use, many persons' use or abuse of alcohol or other drugs becomes addiction, a disease in which the substances have caused changes in a person's body, mind, and behavior.  As a result of this disease, addicted persons are unable to control their use of substances, despite the bad things that happen when they use them.  Addiction may be a chronic, relapsing disorder and if the disease process progresses, recovery becomes more difficult.  Chemical dependency occurs most frequently in those who have a family history of the disease.  Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a).  The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms when the substance is not used).

The American Society of Addiction Medicine describes drug dependence as having two possible components:  1) psychological dependence and 2) physical dependence.  Psychological dependence centers on the user's need of a drug to reach a level of functioning or feeling of well-being.  Due to the subjective nature of this term, it is not very useful in making a diagnosis.  Physical dependence, however, refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of alcohol or other drug use.  Tolerance, dependence, and withdrawal develop differently depending on the particular substance (HHS/SAMHSA, 1994).