Module 6: Substance Abuse - Definitions Of Substance Use, Abuse & Dependency

DEFINITIONS OF SUBSTANCE USE, ABUSE AND DEPENDENCY:

The above diagram illustrates the different stages of substance use, namely experimentation or initial use, continued abuse, and addiction or dependence. It is important to realise that not everybody who uses a substance becomes addicted to it. However, all people who abuse substances will experience negative consequences as a result

Normal:

For a normal person, there are times in life when one feels happy. The feeling wears off after a while and one goes back to being normal. At other times, one may experience sadness, anger or conflict. These feelings also wear off after a while and one goes back to feeling fine. When one gets stuck with feeling down all the time, it could possibly be as a result of depression. In this case, medical assistance is required.

Experimentation/Initial Use:

When one decides to take drugs for the first time, one generally experiences good feelings. Once the effects of the drug wear off, one goes back to feeling normal. However, even at this stage there are risks involved in using drugs.

• There is a small risk of death, in the case of overdose or an allergic reaction to a substance like ecstasy.
• When drugged/drunk, you tend to do things you would not normally do – this relates specifically to high-risk sexual behaviour. There is therefore a greater risk of contracting sexually transmitted infections and HIV.
• There is the risk of injury due to accidents or acts of aggression brought on by the drugged/drunken state.
• Risk of addiction, some people may experience strong cravings after using a drug for the first time.

Continued Abuse:

Many people move from experimentation to regular use, for example using drugs every second week or only on weekends. This stage of substance use is generally classified as continued use/abuse of a substance. While people are still experiencing a pleasant ‘high’, this is generally followed by a ‘downer’ or hangover. This results in reduced ability during the first days of the working week or possibly absenteeism on these days. People at this stage are often unaware of the consequences of their drug use. The risks or consequences include those of the previous category with some additions:

• The most crucial consequence of continued drug use is the impact the drugs have on the individual’s psychological and emotional development. With continued drug use, the individual’s development is delayed and sometimes even stopped. This means that while someone is taking drugs, he/she is not learning how to deal with stress constructively, how to effectively problem-solve, etc. They are not having the normal developmental experiences that they should.
• Continued drug use generally causes a loss of the individual’s potential. They may still be able to perform adequately at work, but are not doing as well as they used to, or could do. The ability to make decisions is impaired, reasoning becomes clouded, a general lack of insight accompanies behaviour etc. There is a lost potential.
• Tolerance of the substance develops. An individual needs more of the substance to experience its effects. Thus more money is needed to support the growing habit.
• Interpersonal problems develop. There may be feelings of depression and depersonalisation as the individual’s reality changes.
• The risk of getting caught by family or the law increases as regular users often become careless in their attempts to hide their drugging.

Dependence/Addiction:

The move from abuse to addiction is very subtle and is generally characterised by the drug use becoming the primary motivating factor in a person’s life. Their lives now revolve around their drug use and acquiring drugs. Their health, future, relationships with friends, family and work colleagues, becomes secondary. They no longer experience much of a ‘high’ but need to take drugs just to function normally and prevent withdrawal symptoms. Denial is almost always present. It is important to note that addiction is generally regarded as a health issue as opposed to a moral one. It is an illness, and a person who is addicted will require treatment in order to get well, just as someone with cancer requires treatment to get well.

These stages of drug use should be viewed as a continuum rather than a step-by-step progression and demonstrate the changing role which drug use plays in a persons life.

Formal definitions of the different stages of substance use have also been produced. The DSM IV identifies three categories of substance use. These are:

• Problematic Substance Use.
• Substance Abuse.
• Substance Dependence.

Problematic substance use:

People may find that even small amounts of alcohol or other drugs can be problematic for them. They may not be abusing or dependent, but the alcohol and other drugs may impair their work, social interactions and/or daily living.

DSM IV Abuse:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifest by one or more of the following:

• Recurrent use resulting in failure to fulfill major obligations at work, school or home.
• Recurrent use in situations in which it is physically hazardous.
• Recurrent substance related legal problems.
• Continued abuse despite persistent or recurrent social or interpersonal problems cause or exacerbated by effects of the substance.
• The symptoms have never met Dependence (discussed below).

DSM IV Dependence:

A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifest by 3 or more of the following:

• Tolerance.
• Withdrawal.
• Substance taken in larger amounts or over longer periodS than intended.
• Persistent desire or unsuccessful efforts to cut down or control use.
• Great deal of time spent obtaining substance.
• Social, work, recreational activities given up or reduced.
• Continued use despite knowledge of physical or psychological problem due to substance.

Substance abuse may or may not be:

• With physiological dependence: - Evidence of tolerance or withdrawal.
• Without physiological dependence: - No evidence of tolerance or withdrawal.

The presence of physiological dependence may require a short period of detoxification. When a person has been taking drugs for a while and suddenly stop, their bodies require a period to adjust. During this period symptoms of withdrawal may include nausea, anxiety, paranoia, rapid mood swings etc. Withdrawal from heroin, alcohol and tranquillizers tend to be the most severe and generally require medical supervision.

It is important to note that withdrawal is not treatment as such, but something which needs to occur before treatment can commence. The psychological components to addiction take time to deal with, that is, learning to deal with life without drugs/alcohol.