Substance abuse vs substance dependence

Substance abuse can be generally thought of as a misuse of a substance but with no prominent physiological or psychological tolerance (needing more for the same effect) or withdrawal (negative symptoms when without the substance).

Substance Abuse (DSM IV Criteria)

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

  1. Recurrent substance use resulting in a failure to fulfill major obligations at work, school, or home
  2. Recurrent substance use in situations in which it is physically hazardous
  3. Recurrent substance-related legal problems
  4. Continued substance use despite having persistent social or interpersonal problems caused or worsened by the substance

B. Has never met the criteria for Substance Dependence for this class of substance.

Substance Dependence (DSM IV Criteria)

Substance dependence is sort of like the next step. It’s still affecting the person’s life (if not more) but now the person physiologically and/or psychologically needs the substance. You can’t count it as abuse if they have the symptoms of dependence.

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

  1. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect
    • Markedly diminished effect with continued use of the same amount of the substance
  2. Withdrawal, as manifested by any of the following:
    • The characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
    • The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  3. The substance is often taken in larger amounts or over a longer period than was intended
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use
  5. A great deal of time is spent in activities necessary to obtaining, using or recovering from the substance
  6. Important activities are given up or reduced because of substance use.
  7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Mnemonic for substance dependence: The 3 Cs
  1. Compulsive use
  2. Loss of Control
  3. Consequences of use

Note: for polysubstance dependence a person meets the criteria for dependence and is using 3 or more substances. There is no polysubstance abuse (it is assumed that if you’re using more than 3, you’re dependent).

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