Substance Abuse and Dependence

Background

Counseling for alcohol and drug problems can be distinguished from exploratory psychotherapy in its direct focus on attaining abstinence and problem solving around situations that can trigger a relapse or impede recovery. Historically, substance abuse counseling has been the preferred approach in community treatment programs in residential and outpatient settings. In addition, in most treatment settings, the emphasis on a disease model of alcoholism or addiction leads to a counseling approach rather than psychotherapy. Individuals with alcoholism or drug dependence tend to benefit from guidance, assistance with recovery-oriented decision making, and support for their capacity to cope with stressful events that can lead to relapse.

Key Terms and Concepts

Many terms are used to describe alcoholism and other substance related disorders. Some use substance misuse as a general term for the unhealthy or harmful use of substances. Substance misuse can include use of alcohol or other drugs with negative consequences to individuals' social, psychological, and physical well-being.

Substance abuse, the most widely used term, has both general and specific meanings. In general usage, substance abuse is the catch-all term that is used in governmental department titles and federal grant programs to describe programs and services dealing with illicit drug use and alcohol misuse or abuse. More precisely, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) divides substance misuse into two main classifications: substance abuse and substance dependence. Substance [Page 894]abuse is a diagnosis having four criteria, at least one of which must be met within a 12-month period: (1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home; (2) recurrent use in situations in which it is physically hazardous such as driving an automobile; (3) recurrent substance-related legal problems; and (4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substances. In addition, individuals cannot have ever met the criteria for substance dependence for the particular class of substances.

Substance dependence is a more serious problem related to substance use. The term chemical dependency is often used to mean substance dependence and is used more often than substance dependence in Alcoholics Anonymous-oriented programs. Others use the term addiction or addictive disease to describe substance dependence, although addiction can include compulsive behaviors other than substance use, as in sexual addiction or gambling addiction.

Individuals diagnosed with substance dependence must meet at least three of the following DSM-IV-TR criteria within a 12-month period: (1) tolerance as defined by either increased use for the desired effect or diminished effect from the same amount; (2) withdrawal when the substance is abruptly stopped or the individual uses the substance to stave off withdrawal symptoms; (3) often taking the substance in larger amounts or for longer periods than intended; (4) desire to reduce use or failed effort to reduce use; (5) spending excessive time procuring the substance; (6) giving up social, occupational, or recreational activities because of substance use; and (7) continuing to use the substance in spite of negative emotional or physical consequences.

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