2.2 Substance-related disorders

A Family Guide to Concurrent Disorders - Part I: What are concurrent disorders?

There is no clear line that indicates when substance use becomes a problem that is severe enough to need treatment. However, the DSM-IV includes substance-related disorders as one of the classes of mental health disorders. Many clinicians use the DSM’s diagnostic criteria for substance abuse and substance dependence to help screen and assess people for concurrent disorders.

Substance Abuse

People who abuse substances regularly may have ongoing serious problems without being dependent on the substance. Some of these problems are:

• inability to fulfil responsibilities (e.g., being absent from work, doing poorly in school or neglecting duties at home)
• dangerous use (e.g., using substances in physically dangerous situations, such as when driving a car)
• legal problems (e.g., being arrested for disorderly conduct following substance use)
• social and family problems (e.g., arguing with family members about being intoxicated).

If one or more of these problems has a significant impact on a person’s life, the person may be diagnosed with a substance abuse disorder.

Substance Dependence

People who are dependent on substances have major physical, mental and behaviour problems that can have serious effects on their lives. Some of the signs of substance dependence are:

• tolerance: the need to use larger and larger amounts of the substance to get the desired effect, such as intoxication
• withdrawal: having unpleasant symptoms if substance use stops; continued substance use with the same or similar drugs to avoid or reduce withdrawal symptoms
• desire to cut down or quit: many unsuccessful attempts to reduce or stop using the substance
• time investment: a great deal of time spent getting the substance, using it or recovering from its effects
• retreat from usual activities: giving up or reducing work, social or recreational activities, and withdrawing from family and friends to use the substance privately or to spend more time with friends who use substances
• ongoing use: substance use continues despite the negative effects.

If three or more of these problems are ongoing during a 12-month period, a person may be diagnosed with a substance dependence disorder.

A person does not need signs of tolerance or withdrawal to be dependent. For example, people who are dependent on marijuana show a pattern of compulsive use without any signs of tolerance or withdrawal. Compulsive use means people keep using substances in spite of the negative consequences, even though they want to stop and have tried to stop. Many people who are substance dependent also experience cravings. A craving is an urge or a longing for a substance.

Addiction

Addiction has been defined in many ways. Some of the technical definitions are similar to the way in which substance dependence is defined (see above). Most people use the term more broadly to refer to compulsive behaviours, including substance use, that cause problems. People persist with these behaviours in spite of strong negative consequences.

If we use this definition, addiction can be thought of as existing on a continuum. Substance abuse is a less severe form of addiction than substance dependence. Other forms of addictive behaviour include smoking, problem gambling and compulsive sexual behaviours.

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