DSM-IV - DEFINITIONS OF SUBSTANCE ABUSE AND DEPENDENCE
DSM-1V-TR 2002 UPDATE
On the continuum of drug/alcohol use, abuse, dependence (addiction/alcoholism) the criteria for determining addiction to drugs or alcohol and/or alcoholism is clearly spelled out by the American Psychological Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The definition is key to intervention with drug/alcohol abusers as it classifies abusive drug/drinking behaviors and impacts on the type of treatment that medical insurance will cover. Reflected in the definition is the current research on brain chemistry. Important for us are the guidelines that are offered by these definitions so that we, in turn, can identify drug/alcohol (SUBSTANCE) abuse and drug/alcohol addiction (SUBSTANCE DEPENDENCE).
The term drug encompasses alcohol and, from this point forward, alcohol is included in the term “drug”. In turn, the DSM-IV uses the term “SUBSTANCE” to encompass drugs of abuse, medication or a toxin; for our purposes we shall limit the discussion to drugs of abuse. The DSM-IV-TR (text revision of 2002) continues using the same definitions as DSM-IV of 1996.
SUBSTANCE ABUSE:
One or more of the following:
* FAILURE TO FULFILL MAJOR OBLIGATIONS
* USE WHEN PHYSICALLY HAZARDOUS
* RECURRENT LEGAL PROBLEMS
* RECURRENT SOCIAL OR INTERPERSONAL PROBLEMS
With SUBSTANCE ABUSE the user has a choice: he/she uses in spite of illegal, unsafe consequences, or inappropriateness of the drinking/drugging experience.
SUBSTANCE DEPENDENCE (ADDICTION/ALCOHOLISM)
Three or more of the following:
* TOLERANCE
* WITHDRAWAL
* LARGE AMOUNTS OVER A LONG PERIOD
* UNSUCCESSFUL EFFORTS TO CUT DOWN
* TIME SPENT IN OBTAINING THE SUBSTANCE REPLACES
SOCIAL, OCCUPATIONAL OR RECREATIONAL ACTIVITIES
* CONTINUED USE DESPITE ADVERSE CONSEQUENCES
The terms “addiction” “dependence” and “alcoholism” are interchangeable. They are characterized by impaired control over drug use - in other words, the question to the user is: “Did you continue to behave in a manner that has previously caused problems for you?”
The relationship with the drug becomes primary - it is like a consuming love affair - it becomes the most important relationship for the individual and all decisions made are based on the maintenance of this relationship.
This definition has psychological and physiological characteristics. Psychological because the individual has an obsessive preoccupation with the drug and physiological because of the neuro-chemical action taking place in the brain.
The definition differs from the traditional definition of dependence/addiction as it is now not necessary to have the three criteria of (1) tolerance, (2) withdrawal (physical dependence) and (3) compulsion (psychological dependence). These three criteria are sufficient but not necessary for “dependence”. With this new definition “cocaine” is classified as addictive even though it has no significant physical withdrawal. The DSM-IV-TR defines this by specifying the following:
With Physiological Dependence –evidence of tolerance or withdrawal
(i.e. item #1 or #2 is present)
Without Physiological Dependence – no evidence of tolerance or withdrawal
(i.e. neither item #1 nor item #2 is present) (DSM-IV-TR p. 198.)
DSM-IV - DEFINITIONS OF ABUSE AND DEPENDENCE