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What Are Substance Use Disorders?
The terms substance abuse, dependence and addiction are broad and can cause
confusion as people interpret their meaning differently. It is important
to look at terminology in order to better communicate the issues surrounding
this health condition.
The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition's (1994)
purpose is to clearly describe diagnostic categories in order to diagnose,
communicate about, study, and treat mental disorders (p. xxvii). Additionally,
the DSM-IV (1994) defines substance abuse, substance dependence and
categorizes substance related disorders.
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Abuse
According to the DSM-IV (1994), substance abuse is a maladaptive pattern
of substance use characterized by repeated and significant adverse consequences
related to the repeated use of substances. Also, there may be repeated failure
to fulfill major role obligations, repeated use in situations in which it
is physically hazardous, cause multiple legal problems, and recurrent social
and interpersonal problems (p. 182).
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Dependence
Substance dependence is described in the DSM- IV (1994) as a pattern
of repeated self-administration that usually results in tolerance, withdrawal,
and compulsive drug-taking behavior. Cognitive, behavioral, and physiological
symptoms indicate that the individual continues use of the substance despite
significant substance-related problems (p. 176).
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Addiction
Substance dependence is often called an addiction. Addiction is a
disease that is characterized by compulsive behaviors, continued usage,
and an inability to quit without treatment. Addiction is often misunderstood
as a behavior that can be conquered if a desire to quit is strong enough
(Close to Home, 1998). Science based research demonstrates how drugs
modify brain functioning and has long-term impacts on the brain that
may result in addiction.
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"Science has shown us that
drug abuse is a preventable behavior and drug addiction is a
treatable disease. Drug use is voluntary behavior, but drug addiction
is not - addiction is a compulsive, uncontrollable drug-seeking
and drug-use act. Alcohol, cocaine and heroin can all lead to
addiction."
- Alan Leshner, Director
The National Institute on Drug Abuse
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Addiction experts indicate there may be six identifiable stages (Figure
8-1) that occur, based on escalating use (Close to Home, 1998).
As a person progresses, or as the frequency and amount of substance abuse
increases through each stage, there is a growing risk of physical, social,
and psychological problems. However, some persons go directly from use to
dependence. These problems (see Table 8-1) are manifested in a myriad of
ways:
Currently, discussions around the country and in our community are being
held on the appropriate terminology to be used. In our community, the term
substance abuse is often used to describe abuse of substances, addictions,
and the services provided. The phrase substance abuse often describes the
use of illicit or illegal drugs, such as, marijuana, psychedelics, uppers,
downers, club drugs, cocaine, crack, heroin, methamphetamines, etc. However,
substance abuse also refers to the use of licit or legal substances, such
as alcohol, tobacco, and prescription medications (see Appendix E for a profile
of various drugs). There are differences between those who use and abuse
substances and those who are addicted. Many professionals in the field advocate
clarifying these terms in order to ensure that the seriousness and disease-nature
of addiction is better communicated to the public.
For the purpose of this assessment, the term substance use disorders will
be used in the widest context and it is recommended that our community continue
to discuss and adopt specific terminology that will better communicate these
issues to the public.
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Economic Impact
Each resident of Travis County pays the economic cost of substance
abuse. It is estimated that alcohol and drug abuse, and dependence
cost our community $1,001 per man, woman, and child for related health
care, extra law enforcement, auto crashes, crime and lost productivity
in the workplace (Horgan, 1993).
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In Travis County the economic impact
of Substance Abuse is estimated at $723,061,000 a year.
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Multiply $1,000 by an estimated population in Travis County of 723,061 (Epigram
Population and Mortality Data Analysis, Online); thus, in Travis County the
annual economic impact is estimated at $723,061,000. As Travis County continues
to grow, the importance of addressing the problems associated with substance
use disorders becomes more critical.
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