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What Are Substance Use Disorders?
The terms substance abuse, dependence and addiction are broad and can cause confusion as people interpret their meaning differently. It is important to look at terminology in order to better communicate the issues surrounding this health condition.
The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition's (1994) purpose is to clearly describe diagnostic categories in order to diagnose, communicate about, study, and treat mental disorders (p. xxvii). Additionally, the DSM-IV (1994) defines substance abuse, substance dependence and categorizes substance related disorders.
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Abuse
According to the DSM-IV (1994), substance abuse is a maladaptive pattern of substance use characterized by repeated and significant adverse consequences related to the repeated use of substances. Also, there may be repeated failure to fulfill major role obligations, repeated use in situations in which it is physically hazardous, cause multiple legal problems, and recurrent social and interpersonal problems (p. 182).
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Dependence
Substance dependence is described in the DSM- IV (1994) as a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior. Cognitive, behavioral, and physiological symptoms indicate that the individual continues use of the substance despite significant substance-related problems (p. 176).
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Addiction
Substance dependence is often called an addiction. Addiction is a disease that is characterized by compulsive behaviors, continued usage, and an inability to quit without treatment. Addiction is often misunderstood as a behavior that can be conquered if a desire to quit is strong enough (Close to Home, 1998). Science based research demonstrates how drugs modify brain functioning and has long-term impacts on the brain that may result in addiction.
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"Science has shown us that drug abuse is a preventable behavior and drug addiction is a treatable disease. Drug use is voluntary behavior, but drug addiction is not - addiction is a compulsive, uncontrollable drug-seeking and drug-use act. Alcohol, cocaine and heroin can all lead to addiction."
- Alan Leshner, Director The National Institute on Drug Abuse
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Addiction experts indicate there may be six identifiable stages (Figure 8-1) that occur, based on escalating use (Close to Home, 1998).
As a person progresses, or as the frequency and amount of substance abuse increases through each stage, there is a growing risk of physical, social, and psychological problems. However, some persons go directly from use to dependence. These problems (see Table 8-1) are manifested in a myriad of ways:
Currently, discussions around the country and in our community are being held on the appropriate terminology to be used. In our community, the term substance abuse is often used to describe abuse of substances, addictions, and the services provided. The phrase substance abuse often describes the use of illicit or illegal drugs, such as, marijuana, psychedelics, uppers, downers, club drugs, cocaine, crack, heroin, methamphetamines, etc. However, substance abuse also refers to the use of licit or legal substances, such as alcohol, tobacco, and prescription medications (see Appendix E for a profile of various drugs). There are differences between those who use and abuse substances and those who are addicted. Many professionals in the field advocate clarifying these terms in order to ensure that the seriousness and disease-nature of addiction is better communicated to the public.
For the purpose of this assessment, the term substance use disorders will be used in the widest context and it is recommended that our community continue to discuss and adopt specific terminology that will better communicate these issues to the public.
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Economic Impact
Each resident of Travis County pays the economic cost of substance abuse. It is estimated that alcohol and drug abuse, and dependence cost our community $1,001 per man, woman, and child for related health care, extra law enforcement, auto crashes, crime and lost productivity in the workplace (Horgan, 1993).
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In Travis County the economic impact of Substance Abuse is estimated at $723,061,000 a year.
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Multiply $1,000 by an estimated population in Travis County of 723,061 (Epigram Population and Mortality Data Analysis, Online); thus, in Travis County the annual economic impact is estimated at $723,061,000. As Travis County continues to grow, the importance of addressing the problems associated with substance use disorders becomes more critical.
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Description of Substance Abuse Home Page
Substance Abuse Home Page
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