Substance abuse

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Substance abuse
MedlinePlus 001945

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Also see Alcoholism and Drug addiction. Definitions of substance abuse vary and have changed over time. However, this is the most well known definition and the definition for which the term should be used.

Substance abuse refers to the use of substances when said use is causing detriment to the individual's physical health or causes the user legal, social, financial or other problems including endangering their lives or the lives of others. Substance abuse is not specific to illegal substances but people can also abuse legal substances which are bought or prescribed. Substance abuse is an old fashioned term for which the term problematic substance use is now more widely used.

Other terms

Other terms associated with substance abuse are substance use, substance misuse, problematic substance use, substance dependancy, substance addiction, drug use, drug abuse, drug dependancy, drug addiction, alcohol use, drinking, taking drugs, using drugs/substances, on a prescription, getting drunk, getting high, etc.

"Substance use" basically means the use of any substance. This substance could be legal or illegal. The substance could be used in any manner of different ways such as sniffing, inhaling, swallowing, drinking, smoking or injecting.

"Substance misuse" is a fairly modern term. It is used to mean the using of substances in a manner for which they were not intended. A good example of this would be using prescription medication differently to the way a doctor has directed. This could mean taking more tablets per hour than the doctor has directed or taking the substance into the body in a different way than directed by a doctor e.g injecting tablets rather than swallow as directed.

Substance use can become abuse or problematic use when it starts to cause the substance user medical, legal, social, economic etc. problems.

Some definitions of substance abuse

The disorder is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. There are on-going debates as to the exact distinctions between substance abuse and substance dependence, but current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use.[1]

Substance abuse may lead to addiction or substance dependence. Medically, physiologic dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. Dependence involves physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society. Substance abuse is determined by the amount of pills,[2]


In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness.

The third edition, in the 1980s, was the first to recognize substance abuse (including drug abuse) and substance dependence as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance.

In 1987 the DSM-IIIR category "psychoactive substance abuse", which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous". It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis.

By 1989, the DSM-IV defines substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal".

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association defines substance abuse as:[2]

  • A. A maladaptive pattern of substance use leading to clinically significant 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 fulfill 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 (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 fights)
  • B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

The fifth edition of the DSM, planned for release in 2010, is likely to have this terminology revisited yet again. Under consideration is a transition from the abuse/dependence terminology. At the moment, abuse is seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's 'dependence' term, as noted above, does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requests input as to how the terminology of this illness should be altered as it moves forward with DSM-V discussion.


  1. Pham-Kanter, Genevieve. (2001). "Substance abuse and dependence." The Gale Encyclopedia of Medicine. Second Edition. Jacqueline L. Longe, Ed. 5 vols. Farmington Hills, MI: Gale Group.
  2. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.

See also