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.