Substance Abuse? Addiction? Or Dependence? Words matter

[Vocalek]

From: CLEI | DSM-IV Substance Abuse Criteria

A. DSM-IV Substance Abuse Criteria

Substance abuse is defined as 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 (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as 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 (for example, arguments with spouse about consequences of intoxication and physical fights).

Note: The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.

B. DSM-IV Substance Dependence Criteria ("Addiction")

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1. Tolerance, as defined by either of the following:
   (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
   Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
2. The substance is often taken in larger amounts or over a longer period than intended.
3. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
4. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
5. Important social, occupational, or recreational activities are given up or reduced because of substance use.
6. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current ....... use despite recognition of .......-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183)

Topics for Discussion:

1. How does your use of nicotine match the above definitions, and how does it differ?

• For substance abuse
• For addiction

2. If you were to roll back the clock to before the first laws against smoking were enacted, when 50% of all adults were smokers, which of the symptoms listed in the quotation above would NOT be a problem for you?

From:
http://addictionscience.net/b2evolution/blog1.php/2009/03/30/why-distinguishing-between-drug-dependen

Drug dependence, in contrast to the two terms described above, refers to a state where the individual is dependent upon the drug for normal physiological functioning. Abstinence from the drug produces withdrawal reactions which constitute the only evidence for dependence. Drug dependence can involve disturbances in general bodily (i.e., somatic) function such as vomiting, ........, sweating, and the resulting symptoms indicate a physical dependence syndrome which is usually specific for a given class of drug. Drug dependence can also involve disturbances in psychological functioning, such as inability to concentrate, anxiety, depression, and the resulting symptoms indicate a psychological dependence syndrome which often shares common features with other abused drugs. It is important to note that psychological dependence has a physiological basis and thus it is preferable to use the term physical dependence to refer to disturbances in somatic function to avoid confusion.

How well does definition the of dependence given above fit your use of nicotine?

 

[Anima]

[/LIST]Topics for Discussion:

1. How does your use of nicotine match the above definitions, and how does it differ?

• For substance abuse
• For addiction

Whilst smoking I met the criteria for addiction, but vaping doesn't land me on either list.

2. If you were to roll back the clock to before the first laws against smoking were enacted, when 50% of all adults were smokers, which of the symptoms listed would NOT be a problem for you?

No change.

I think the criteria for both "disorders" are taken from the DSM-IV and changes are going to be made in the DSM-V. Both are a load if you ask me. For example, in the DSM-V gambling addiction will be acknowledged, but it will be the only behavioral addiction. We all know that there are other behavioral addictions (e.g. sex, shopping, etc), so the manual is not comprehensive. It's basically a committee of shrinks yelling over each other in a room. The disorders change constantly.

 

[Vocalek]

Whilst smoking I met the criteria for addiction, but vaping doesn't land me on either list.



No change.

I think the criteria for both "disorders" are taken from the DSM-IV and changes are going to be made in the DSM-V. Both are a load if you ask me. For example, in the DSM-V gambling addiction will be acknowledged, but it will be the only behavioral addiction. We all know that there are other behavioral addictions (e.g. sex, shopping, etc), so the manual is not comprehensive. It's basically a committee of shrinks yelling over each other in a room. The disorders change constantly.

Yes, they were taken from the DSM-IV. I substituted a more exact listing for the first version I posted, which was taken from a drug treament center's site.

For me, A4 was only a problem after smoking started to become socially unacceptable (thanks to the propaganda capaign launched by the anti-tobacco movement.)

In terms of B, Tolerance existed, but was limited. I never got to a point where I needed more and more and more of nicotine, the way alcoholics will continue increasing the quantities they drink. I leveled out at a pack a day, where I would have stayed had I not followed the surgeon general's advice to switch to lights, at which point I smoked more to compensate for the lack of nicotine. If someone had been measuring my blood levels of nicotine, I believe they would have stayed fairly steady throughout my smoking history.

When I made an effort to cut down, I was able to cut down. However, I did not feel "normal" when I did so, until I started substituting other, safer (than smoking) sources of nicotine. B 5 was not a problem until smokers were turned into lepers thanks to the ANTZ.

I think my use of nicotine fits the paragraph defining physical dependence a lot better than it meets the DSM criterion for either drug abuser or for addict.