Abnormal Psychology

Substance Use Disorders 383

Substance Abuse and Dependence

The Beatles used stimulants nightly when performing in Germany, but does that

mean they were abusing the drugs? Were they dependent on the pills? Were they

addicted? Some mental health clinicians and researchers avoid using the term

addiction, partly because of its negative moral connotations and partly because the

term is less exact than abuse or dependence. Moreover, addiction has been applied

to other objects or behaviors such as chocolate, work, sex, love, and Internet use—

which obscures its meaning. However, other clinicians and researchers believe that

the upcoming revision of the DSM (DSM-V) should incorporate the term addiction

in its classifi cation system (O’Brien, Volkow, & Li, 2006). Those clinicians and re-

searchers defi ne addiction as the compulsion to seek and then use a psychoactive

substance either for its pleasurable effects or, with continued use, for relief from

negative emotions such as anxiety or sadness. These compulsive behaviors persist,

despite negative consequences (National Institute on Drug Abuse [NIDA], 2007g).

Anorexia Nervosa Problems With the DSM-IV-TR Defi nition of

focuses on the behaviors related to obtaining and using a drug, as well as the con-

sequences of that use. According to DSM-IV-TR, substance abuse is a pattern of

harmful use of a psychoactive substance that leads to harm or other adverse effects;

see Table 9.2 (American Psychiatric Association, 1994, 2000). Whereas intoxica-

tion refers to the direct results of using a substance, substance abuse focuses more

on the indirect effects of repeated use, such as legal problems, unmet obligations, or

reckless behavior while using the substance (for instance, driving while under the

infl uence). Although occasional illegal use of a substance may be associated with

medical, legal, and psychological risks, it does not necessarily constitute substance

abuse according to DSM-IV-TR. Consider someone who takes a stimulant such as

Ritalin to stay awake only when cramming for exams during fi nals. Although such

use could create medical, social, legal, or occupational problems, unless problems

do arise and meet the criteria in Table 9.2, the use would not be considered abuse.

Use or abuse of a psychoactive substance can lead to substance dependence,

the pattern of persistent and compulsive use of a psychoactive substance, despite its

negative effects on work, relationships, health, or its legal consequences; Table 9.3

lists the specific DSM-IV-TR diagnostic criteria. Note that the criteria for sub-

stance abuse refer to the indirect effects of repeatedly using the substance—such as

legal or social problems—whereas many of the criteria for substance dependence

refer to the direct effects of compulsive and repeated substance use. According to

DSM-IV-TR, patients cannot be diagnosed with both substance abuse and substance

dependence; patients who meet the criteria for both disorders are only diagnosed

with substance dependence.

DSM-IV-TR uses the terms abuse and dependence

rather than addiction, in part because the word

addiction has been overused. However, abuse and

dependence may come to be similarly overused.

That’s Life © 2005. Reprinted with the permission of Mike Twohy and the Cartoonist Group. All rights reserved.

Table 9.2 • DSM-IV-TR Diagnostic Criteria for Substance Abuse

A. A maladaptive pattern of substance use leading to clinically signifi cant impairment or distress,

as manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfi ll major role obligations at work, school,

or home (e.g., repeated absences or poor work performance related to substance use;

substance-related absences, suspensions, or expulsions from school; neglect of children or

household)

(2) recurrent substance use in situations in which it is physically hazardous to use the substance

(e.g., driving an automobile or operating a machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly

conduct)

(4) continued substance use despite having persistent or recurrent social or interpersonal

problems caused or exacerbated by the effects of the substance (e.g., arguments with

spouse about consequences of intoxication, physical fi ghts).

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,

Fourth Edition, (Copyright 2000) American Psychiatric Association.

Substance abuse

A pattern of use of a psychoactive substance

that leads to harm or other adverse effects.

Substance dependence

The persistent and compulsive use of a

psychoactive substance, despite its negative

effects on work, relationships, health, or its

legal consequences.