Is It Really Substance Abuse?

In When Usage Becomes Abusage we looked at the enormous emotional and financial cost of substance abuse. But how do you know when someone is really abusing rather than using a substance such as tobacco, alcohol or other recreational drugs? How do you know when the person you love is in trouble?

Fortunately the American Psychiatric Association lists the criteria for substance abuse in an attempt to better distinguish those who are in control of the drugs in their life and those who have crossed the line. The guidelines are as follows:

A. A maladaptive pattern of substance use which leads to significant impairment or distress and is displayed by at least one of the following in a 12-month period:

  1. Recurrent substance use that results in a failure to fulfill obligations at school, work or home. This may take the form of repeated absences, poor work performances, neglect of children or household duties, substance-related absences for significant social events.
  2. Recurrent substance abuse in situations in which it is hazardous to personal health or the health of others, for example, driving a car or operating machinery while under the influence of the substance.
  3. Recurrent substance-related legal problems, for example, arrests for substance-related disorderly conduct.
  4. Continuation of substance abuse despite ongoing social or interpersonal problems caused or exacerbated by the effects of the substance, for example, frequent arguments with spouse or partner about consequences of intoxication.

B. The symptoms do not meet the criteria for Substance Dependence.

There is a significant difference between Use, Intoxication, Abuse, and Dependence when dealing with psychoactive drugs such as nicotine, alcohol, and legal and illegal drugs. Next blog, we will look at the diagnostic criteria for Substance Dependence and ultimately address how a person moves from usage to abusage.

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