Substance abuse is determined when someone develops a pattern of substance use that results in a clinically significant impairment to one’s life: work, school or home problems; hazardous behavior; legal problems; continued use despite social problems – and the criteria for substance dependence has not been met[i].
Substance dependence is determined when the criteria for substance abuse are met and the individual has three or more of the following manifestations: tolerance, withdrawal, increased quantities or duration; unsuccessful attempts to reduce or end usage; time-consuming efforts to obtain or for usage; missed important social/recreational activities; continued usage despite known detrimental affects[ii].
Drugs that are used or abused in a manner not intended
- -cocaine (including crack)
- – heroin
- – hallucinogens
- – inhalants
- – prescription-type psychotherapeutics used non-medically (pain relievers, tranquilizers, stimulants, and sedatives)
Alcohol is included in our discussion about substance abuse, though it is classified as a depressant.
Statistics on usage:
- – In a 2013 survey, an estimated 9.4% or 24.6 million Americans aged 12 or older had used an illicit drug during the previous month[iii].
- – Alcohol use was reported in 52% of the same survey respondents, aged 12 or older. Of those, 23%reported drinking five or more drinks on the same occasion during at least one day in the previous 30 before the survey; this is defined as binge drinking[iv].
- – Approximately 21.6 million, or 8.2%, of people 12 years and older are reported to have substance dependence or abuse, based on the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition)[v].
Addiction is a chronic disease. Unlike other chronic illnesses, people who have substance abuse problems are stigmatized[vi]. This is despite similarities to other illnesses:
- – Environmental and genetic causes (like heart disease, diabetes, cancer, asthma)
- – Lifestyle choices (similar to heart disease, diabetes, cancer)
- – Relapses occur (rates are similar to heart disease, diabetes, asthma)
Stigma manifests in many ways:
- – Stigma interferes with people getting treatment.
- – Some healthcare providers refuse to treat addicts.
- – Some drug manufacturers won’t try to develop new treatments for addicts.
Efforts to curb drug use have failed. The “War on Drugs” criminalized an illness, resulting in[vii]:
- – 60% of people test positive for illegal drugs when they are arrested
- – 80% of offenders abuse drugs or alcohol
- – 50% of people in jail or prison are clinically addicted
Once we take the stigma out of substance abuse we can change the focus from criminalization to treating people who have an addiction, and preventing others from developing one.
[i] Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.) 2 Definitions, Terms, and Classification Systems for Co-Occurring Disorders. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64184/
[iii] Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
[vi] National Institutes of Health, National Institute on Drug Abuse, http://archives.drugabuse.gov/about/welcome/aboutdrugabuse/chronicdisease/, Accessed 4/4/16.
[vii] National Council on Alcoholism and Drug Dependence, Inc., Alcohol, Drugs and Crime. https://ncadd.org/about-addiction/alcohol-drugs-and-crime, Accessed 4/4/16.