What is Substance Use, Substance Abuse,
and Substance Dependence?

Overview:

A variety of models and criteria are used to determine substance use, intoxication, abuse, and dependence.  For example, depending on the position you take, using heroin once is enough to consider you a substance abuser.  In contrast, other models consider you an abuser only when the substance is causing a problem in your life.  While each model has its proponents, one model that has developed specific objective criteria that differentiates between use, abuse, and dependence is the DSM IV.  This section will examine variables that differentiate between these levels of use.

Goal:

This section is designed to expose you to diagnostic background information related to substance use, abuse, and dependence.  It is also designed to expose you to various diagnostic criteria in the DSM IV.

Objectives:

In this section you will learn about the use of the DSM IV, definitions of mental disorders, issues related to ICD-9-CM codes, ICD-10 codes and other aspects.  You will also review the DSM-IV classification codes related to mental disorders, and specifically differentiating between substance use, intoxication, abuse, and dependence.  Finally you will examine the criteria related to specific compounds that individuals may use.

Outcomes:

1. To learn about the diagnostic criteria found in the DSM IV.

2. To learn to differentiate between substance use, abuse, and dependence.

KSAs:

3.     Describe the behavioral, psychological, physical health, and social effects of psychoactive drugs, including alcohol and tobacco, on the consumer and significant others.

4.     Recognize the potential for substance abuse disorders to mimic a variety of medical and psychological disorders, and the potential for medical and psychological disorders to co-exist with addiction and substance abuse.

8.     Appreciate the value of an interdisciplinary approach to addiction treatment.

9.     Understand the established diagnostic criteria for substance dependence and abuse, and describe treatment modalities and placement criteria within the continuum of care.

18.     Understand diverse cultures and incorporate the relevant needs of culturally diverse groups, as well as people with disabilities, into clinical practice.

34.     Analyze and interpret the data to determine treatment recommendations.

102.     Describe warning signs, symptoms, and the course of substance use disorders.

Tasks:

1. Read the following pages in the DSM IV. Introduction, 708-09,793-850  Within the introduction section note the general information related to the process of developing the diagnostic criteria.  Note the process of incorporating the DSM criteria with the ICD-9-CM and ICD-10 criteria.  The general codes are listed in pages 793-850 along with information related to specific culture-bound syndromes. 

2. Read pages 1-24.  Pay special attention to the use of diagnostic codes, severity and course specifiers, frequently used criteria, criteria for substance-induced disorders and general information. 

3. Read pages 25-36.  This section relates to multiaxial assessment.  Note that a person may not be diagnosed on all of the axes, or may be diagnosed in all.  Pay special attention to the Axis IV (Psychosocial and Environmental Problems) and Axis V (Global Assessment of Functioning).  These are very important while assessing and diagnosing substance abusers using this model.  Finally, review the report forms for appropriate examples to report using the various Axis and Nonaxial formats.

4. Read pages 175-194.  Note the Specifiers and Course Specifiers that are associated with substance dependence and essential variables that indicate substance dependence.  Then review the criteria for substance dependence with, and without physical dependence.  Then examine the sections on substance abuse.  Note the differences between substance abuse and dependence.  Upon completion, examine the sections on substance intoxication and substance withdrawal.  Note the features of each aspect.  Then review the features associated with each diagnostic category; including recording procedures, age, gender, and cultural features, familial patterns, and differential diagnosis.  Finally, examine substance-induced mental disorders included elsewhere in the manual.  Note the number and the types of disorders.  These are not commonly discussed within the course of a substance abuse/dependence diagnosis. 

5. Read pages 194-274.  These pages describe the most common substance abuse disorders.  Note the similarities across the different compounds.  What are the criteria included for intoxication vs. abuse vs. dependence?  Again, note the features associated with each compound, patterns of use, etc.  Finally, note the criteria for withdrawal.  How are they similar or different?

6. Once you have completed the readings, complete the following assignment and send it to your instructor's e-mail address and share your thoughts with your classmates in the on-line discussion.  Pick any substance of abuse and develop a case study describing a client or making up a client.  Include in your discussion, aspects of the clients history, culture, and other aspects you believe would be relevant to a diagnosis.   Then develop a diagnosis of this client using the DSM IV criteria.  Make sure you include all relevant diagnostic attributes.   Finally, describe why you included each attribute.   Be thorough and complete.

Discussion