Substance Dependence and Use Disorder

Substance dependence

• Definition
  • physiologic addiction behaviors that include:
    • tolerance 
      • need to take larger amounts for the same desired effect
    • withdrawal
    • persistent desire or unsuccessful attempts to cut down
  • disturbance of life function
    • significant energy spent obtaining, using, or recovering from substance
    • impaired control over substance use (work, school, relationships suffer and time spent doing these activities is reduced)
• continued use in light of the problems caused by the drug

Substance use disorder

• Definition
  • less emphasis on biochemical addiction; one or more of the following:
    • impaired control over substance use (work, school, relationships suffer and there is failure to fulfill major obligations in these areas)
    • compulsive use (use in physically hazardous situations)
    • continued use despite harm
• recurrent substance-related legal problems

Stages in overcoming substance addiction

• Pre-contemplation – no acknowledgement of the problem
• Contemplation – acknowledgement of the problem, but not ready to make a change  
• Preparation/Determination – getting ready to change behavior 
• Action/Willpower – process of changing behavior
• Maintenance – maintaining the behavioral change
• Relapse – returning back to old behavior