General Approaches to Substance and Polydrug Use Disorders
The definitions of substance abuse and dependence
are based on the dependence syndrome of Griffith Edwards (Edwards and Gross,
1976). Substance abuse is a maladaptive pattern of substance use leading to
significant adverse consequences manifested by psycho-social, medical, or legal
problems or use in situations in which it is physically hazardous that must
recur during a 12-month period. Since a diagnosis of substance dependence
preempts a diagnosis of abuse, tolerance, withdrawal and compulsive use are
generally not present in individuals with a diagnosis of substance abuse. Since
caffeine and nicotine generally do not cause psychosocial or legal problems and
since it is not physically hazardous to use caffeine and nicotine, a diagnosis
of abuse does not apply to these substances. The two abuse criteria focusing on
legal and interpersonal problems are not among the dependence criteria.
Substance intoxication is a reversible
substance-specific syndrome with maladaptive behavioral or psychological
changes developing during or shortly after using the substance. It does not
apply to nico-tine. Recent use can be documented by a history or toxicological
screening of body fluids (urine or blood). Different substances may produce
similar or identical syndromes and, in polydrug users, in-toxication may involve
a complex mixture of disturbed perceptions, judgment and behavior that can vary
in severity and duration accord-ing to the setting in which the substances were
taken. Physiological intoxication is not in and of itself necessarily
maladaptive and would not justify a diagnosis of the DSM-IV-TR category
substance intoxi-cation. For example, caffeine-induced tachycardia with no
maladap-tive behavior does not meet the criteria for substance intoxication.
Substance withdrawal is a syndrome due to cessation of, or reduc-tion in, heavy and prolonged substance use. It causes clinically significant impairment or distress and is usually associated with substance dependence. Most often the symptoms of withdrawal are the opposite of intoxication with that substance. The with-drawal syndrome usually lasts several days to 2 weeks.
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