Alcohol, Chemistry and You
Definitions of Substance Use, Abuse and Dependence
Dr. Bill Boggan

Problems

Case Study
 

Alcohol Addiction in America

"Approximately 14 million Americans (7.4%) of the population meet the diagnostic criteria for alcohol abuse or alcoholism. More than one-half of American adults have a close family member who has or has had alcoholism Approximately one in four children younger than 18 years old in the United States is exposed to alcohol abuse or alcohol dependence in the family. The estimated economic cost of alcohol abuse was $184.6 billion for 1998 alone, or roughly $638 for every man, woman, and child living in the United States that year These statements comprise part of the beginning of the first Chapter of the 10^th Special report to the U.S. Congress on Alcohol and Health (2000). Unfortunately they dramatically illustrate the deleterious side of ethanol use and abuse. Fortunately, most people who drink do so safely. It is only a minority who consumes alcohol heavily and produces the dramatic impact on self, family, friends and the community.

 
In talking about alcohol or drug use, distinctions must be made between:

1. use,
2. abuse, and
3. dependence.

Generally, these categories are differentiated based on the amount taken during a particular period of time and the outcome of taking the compound. The definitions and criteria for classification are from the National Institute of Medicine and from the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM IV, American Psychiatric Association, Washington, DC):

National Institute of Medicine:

Use = Taking of alcohol or drug

Abuse = Any harmful use of alcohol or drugs

Dependence = Addiction

DSM IV

Substance Abuse = A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, within a 12-month period:

a. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home

b. recurrent substance use in situations in which it is physically hazardous

c. recurrent substance-related legal problems

d. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

e. the symptoms have never met the criteria for substance dependence for this class of substance

Substance Dependence = A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following within the same 12-month period.

a. tolerance

b. withdrawal

c. substance taken in larger amounts or over longer period of time than intended

d. persistent desire or unsuccessful efforts to cut down or control use,

e. a great deal of time is spent in activities necessary to obtain the substance or recover from its effects,

f. important social, occupational, or recreational activities are given up or reduced because of use,

g. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

 

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