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.)
____________________________________________________________________________
Research
findings implicate that drug effects with specific areas of the brain and specific
neurotransmitters. Impaired control
(dependence) is thought to be caused by a neuro- chemical
dysfunction. This research has major
implications for intervention and treatment.
CONTINUUM
OF USE
SOCIAL ABUSE DEPENDENCE
(recreational
use) (experiences
problem) (impaired control-cannot
consistently stop)
THE REWARD CENTER – NEUROTRANMISSION
– NEUROTRANSMITTERS*
*Graphics
from National Institute on Drug Abuse: Mind Over
Matter Serotonin Endorphin Epenephrine Nor Epenephrine Dopamine GABA
