Tuesday, August 30, 2011

Substance Use Disorders

Substance use disorders differ from substance-induced disorders.  I find the names self-explanatory – substance use disorders are related to disordered use of substances and substance-induced disorders are disorders brought on by use of substances.  Rather than covering each individual substance related disorder, I am simply going to review the difference between abuse & dependence & you can apply these general criteria to most substances.

Criteria for Substance Dependence

Substance dependence is a maladaptive pattern of substance use that leads to either impairment or distress.  Person must have 3 or more of the following symptoms within 12 months. 
  • Tolerance – either needing to use more & more to get the same effect or less of an effect using the same amount
  • Withdrawal – either the person experiences withdrawal symptoms when they stop use or substitute a similar substance to avoid withdrawal
  • Use of more or over a longer time period than intended (I go out for one drink & stay out all night; I'm only going to do two lines… ten lines later.)
  • The person often wants to cut down or control use or makes unsuccessful attempts at the same.
  • Much time is spent in obtaining, using & recovering from use of the substance.
  • Other activities are reduced or given up because of use.
  • Use is continued despite being aware that the use is exacerbating physical or psychological problems (like smoking cigs despite having cancer)
Criteria for Substance Abuse

Substance abuse is also a maladaptive pattern of use of a substance that causes impairment or distress.  The person must not have ever met the criteria for substance dependence for the class of substance in question.  The person must have one or more of the following symptoms within a 12-month period.
  •  Recurrent use that results in the person being unable to fulfill role obligations (missing work, neglecting children).
  • Recurrent use in hazardous situations (driving while intoxicated, etc.)
  • Recurrent substance-related legal problems.
  • Continued use despite social/interpersonal problems that are either caused by or exacerbated by the substance use (arguing with significant others about use, fighting due to intoxication).


  1. In my experience, one way to summarize this section is that substance disorders can generally be said to interfere with a person's ability to live their lives on a daily basis. Anyone may meet one or more criteria of either diagnosis for various substances (or other addictions, for that matter), but this may have little to no impact on their ADLs, mental health, work, relationships, etc., thereby distinguishing substance use from substance abuse or dependence.
    - Sarah S.

  2. I like the way you sum that up. It is important to remember that not all use is necessarily abuse or dependence. As you point out, there has to be some impairment or distress to meet the criteria.