Chapter 4
Definitions of
Substance Abuse,
Dependence, and
Addiction
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Diagnostic Categories
 Substance-Abuse
Disorders
 Substance-Dependent
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Disorders
Substance Abuse – Definition A
DSM-IV-TR Definition

A maladaptive pattern of substance abuse
use, leading to clinically significant
impairment or distress, as manifested by one
(or more) of the following, occurring within a
12-month period:
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Substance Abuse cont’d
1.
2.
3.
4.
Recurrent substance use, resulting in a failure to fulfill
major role obligations at work, school, or home
Recurrent substance use in situations in which it is
physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance
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Substance Abuse – Definition B
DSM-IV-TR Definition
B. The symptoms have never met the criteria for
substance dependence for this class of
substances.
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Substance Dependence
DSM-IV-TR Definition
A.
A maladaptive pattern of substance abuse,
leading to clinically significant impairment or
distress, as manifested by three (or more) of
the following, occurring at any time in the
same 12-month period:
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Substance Dependence cont’d
1. Tolerance, as defined by either of the following:
A.
B.
A need for markedly increased amounts of the substance to
achieve intoxication or desired effect
Markedly diminished effect with continued use of the same
amount of the substance
2. Withdrawal, as manifested by either of the following:
A.
B.
The characteristic withdrawal syndrome for the substance
The same (or a closely related) substance is taken to relieve
or avoid withdrawal symptoms
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Substance Dependence cont’d
3. The substance is often taken in larger amounts or over
a longer period that was 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 (e.g. visiting multiple doctors or
driving long distances), use the substance (e.g., chainsmoking), or recover from its effects
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Substance Dependence cont’d
6. Important social, occupational, or recreational activities
are given up or reduced because of substance use
7. The substance abuse is continued despite having
knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been
caused or exacerbated by the substance (e.g., current
cocaine use despite recognition of cocaine-induced
depression, or continued drinking despite recognition
that an ulcer was made worse by alcohol consumption)
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Substance Withdrawal
Substance withdrawal is described by the
following diagnostic criteria (APA 2000):
A. The development of substance-specific
syndrome due to the cessation of (or reduction
in) substance use that has been heavy and
prolonged
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Substance Withdrawal cont’d
B. The substance-specific syndrome causes
clinically significant distress or impairment in
social, occupational, or other important areas
of functioning
C. The symptoms are not due to general medical
condition and are not better accounted for by
another mental disorder
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Functional Definition of Addiction
The Three “C”s (from David Smith, MD)
Compulsion – Obsession with alcohol/drugs
Control – inability to stop using alcohol/drugs
Consequences – continued use despite adverse
consequences
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DENIAL = D – E – N – I – A – L
Don’t
Even
kNow
I
Am
Lying
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Identification of Adolescent
Alcohol/Drug Problem







Mood
Responsibility
Motivation
School
Negative Activities
Lying, stealing &
cheating
Defense mechanisms:
Rationalization,
minimization
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





Community
Physical signs
Parents
Criminal justice
problems
Adolescent behavior (i.e.
moodiness) sometimes
mimics alcohol/drug
induced behaviors
Changes
Alcohol/Drug Assessment




Age of initial drug and
alcohol use
Frequency of use,
amounts used, set and
setting of use
Patterns of use, binges,
periods of nonuse
Do any of your family
members (esp. mother
or father) have an
alcohol/drug problem?
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



Use of medications,
coffee, cigarettes
Medical history:
conditions that might be
affected by drug use
History of negative
consequences: physical,
psychological, financial,
familial and spiritual
Stage of current use

The following stages are found in Richard
Fields, Ph.D. model of stages of alcohol/drug
use
– Experimental
– Non-use
– Periodic excessive
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Screening for What?

The purpose of a screening tool is to:
– FIRST determine if an alcohol/drug problem
exists, not the extent of the use
– Some symptoms can mimic drug use so you
have to first determine that drugs are the
reason for the behaviors
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Preventing Suicide

According to the American Association of
Suicidology:
– Suicide is preventable.
– Most suicide victims do not want to die.
– More than 80 percent of people
communicate their intent to suicide before
they attempt to suicide.
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Suicide Assessment Questions
1.
2.
Is there a family history of alcohol/drug
problems, suicide or depression?
Do you use alcohol/drugs to:
A.
B.
C.
3.
Overcome bad/shameful feelings?
Deal with sleeping problems, depression or stress?
Quiet suicidal or self-destructive thoughts?
Do you have suicidal thoughts?
(continued)
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Assessment Questions cont’d
4.
5.
6.
How will you do it? Do you have a plan?
(Assess the availability or means to commit
suicide and the lethality of the means).
Have you previously had suicidal thoughts
and have you attempted suicide before? How
frequently do these thoughts occur?
What role does alcohol/drug use have in
relation to suicide? Does it make you more
likely or less likely to follow through?
(continued)
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Assessment Questions cont’d
7.
8.
9.
10.
On a scale of 1 to 10, how likely are you to kill
yourself?
How much do you want to die? To live?
What would prevent you from committing
suicide?
What might occur to make life worth living?
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