The primary differences between drug abuse and drug dependence revolve around withdrawal and tolerance. Other distinctions exist as well. Most drug assessments such as the CAGE and the AA 20 assess whether someone has a problem with drugs or alcohol, but do not assess whether the problem is abuse or dependence. Knowing the criteria for diagnosis of these problems can help to understand the type and severity of the problem, and what kind of treatment is needed.
Drug Abuse
The Diagnostic and Statistical Manual of Mental Disorders, or DSM, describes drug abuse as a "maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances." A diagnosis of substance dependence supersedes a diagnosis of substance abuse, therefore if the criteria for substance dependence are met, then the additional diagnosis of substance abuse is not applied.
Drug Abuse Diagnostic Criteria
The DSM indicates that a clinical diagnosis of drug abuse requires that the person exhibit a "maladaptive pattern" of drug use causing significant impairment or distress. Beyond this, the person must exhibit only one additional criteria within one twelve-month period. These possible criteria include a failure to meet obligations at work, school, or within the family; recurrent drug use in situations where it is dangerous; multiple drug-related legal problems; and continued drug use despite ongoing social or interpersonal problems brought on by the drug use.
Drug Dependence
Drug dependence indicates symptoms that range from cognitive to behavioral to physiological. The use of drugs continues despite drug-related problems, according to the DSM. Dependence entails a pattern of use that results in tolerance, withdrawal upon cessation and compulsive drug-taking or drug-seeking behavior. The DSM adds that drug cravings accompany drug dependence.
Drug Dependence Diagnostic Criteria
Just as in drug abuse, a person with a drug dependence experiences similar counterproductive patterns of substance use which causes significant impairment or distress. To diagnose dependence, however, additional criteria must be met. These criteria include developing tolerance to the drug; experiencing withdrawal symptoms upon cessation of the drug; taking more of the drug than intended; unsuccessful attempts to cut down usage; spending a great deal of time obtaining the drug; foregoing important activities because of drug use; and continued use of the drug despite knowing its harmful effects.
Treatment
Treatment for both drug dependence and drug abuse may include psychotherapy, 12-step support groups, inpatient rehabilitation, medical detoxification, group therapy, outpatient drug treatment and therapeutic community living environments. CEO of the Haight Ashbury Free Clinic and Detox Center Darryl Inaba and colleague William Cohen examined the various treatment models and found that drug usage was reduced by 50 to 70 percent for all types of treatment studied including outpatient methadone programs, long-term residential treatment, short-term inpatient treatment and outpatient programs.
References
- "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision"; American Psychiatric Association; 2000.
- "Uppers, Downers, All-Arounders"; Darryl Inaba and William Cohen; 2000
