Defining the Terms ............................................................................................................
Part of the problem in understanding the nature
of addiction is the lack of precision and
uniformity in the terms used to describe it and
distinguish it from substance use that threatens
health and safety but is not addiction.^158 Various
terms such as experimentation, use, misuse,
risky use, hazardous use, excessive use, abuse,
dependence and addiction can be found in the
research literature and in popular parlance.
There are no standard connotations in use with
regard to the severity of the behavior, the
consequences of the behavior or the ability of
the individual to stop the behavior. Nor is there
recognition that the severity and consequences
of different levels of use vary considerably by
substance and with the age, gender and health
status of the user.
Further confusion can be found in the misuse of
the word “treatment” which historically has been
used to refer to a host of interventions including
detoxification, clinical treatment and
professionally-administered disease
management, social and mutual support and
other auxiliary services.* 159 Rarely has the term
treatment been reserved for those interventions
that are based in the clinical and scientific
evidence, as it is for the treatment of other
diseases.
As with other diseases, precise definitions are
essential to be able to stage the disease and
develop effective interventions and treatments.
The Continuum of Substance Use................................................................................
Substance use includes smoking or otherwise
ingesting tobacco products, drinking alcohol or
- Detoxification services are not considered
components of addiction treatment; rather, they are
precursors to treatment designed to manage acute
states of intoxication or withdrawal. Social and
mutual support and other auxiliary services can be
critical in supporting a patient through treatment and
helping over the long term to sustain advances
achieved through clinical treatment and to avoid
relapse.
using other addictive substances.† The health
consequences of use of these substances increase
with frequency and quantity of use.^160 The
continuum of use ranges from no use on one
end, to use that does not involve negative
consequences, to risky use--a public health
problem, to addiction--a medical problem.Risky Substance Use: A Public Health
Problem. Risky substance use is defined, for
the purposes of this report, as the use of tobacco,
alcohol or other drugs in a way that can increase
the probability of harm to the user or to others
but does not meet clinical criteria for addiction.‡
More specifically, it includes the following
(sometimes-overlapping) categories: Use of any addictive substance by people
under the age of 21, for whom there is no
known safe level of use.§† Regardless of the legal status of the substance.
‡ The term risky use was chosen to reflect a range of
health and social risks inherent in the use of these
substances and to underscore the fact that significant
hazards can result from such use even in the absence
of clinical addiction. See Chapter III for a complete
account of the health and social consequences of each
of the following types of substance use that accounts
for their designation as risky substance use behaviors.
§ Age 21 was selected because of the cultural marker
of adulthood in the U.S., including the minimum
legal drinking age, although research documents the
continued development of the brain (and consequent
vulnerability to the effects of addictive substances)
into the mid-twenties.The notion of critical periods, so integral to the
development of language or musical skills, is
relevant to the development of addiction as
well. It is clear from my work in addiction
medicine that use of addictive substances is
like a traumatic brain injury to a young person.
Any use by young people before brain
development is complete equals risky use.^161--Mark S. Gold, MD
University of Florida College of Medicine and
McKnight Brain Institute
Departments of Psychiatry, Neuroscience,
Anesthesiology, Community Health &
Family Medicine
Chairman, Department of Psychiatry