Use of alcohol and drugs falls within a range of disorders, from beneficial use to chronic dependence. According to the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), both substance abuse and substance dependance fall under the heading “substance use disorders.” Each issue carries with it its own set of diagnostic criteria. For the next edition of the manual (DSM-5), it has been suggested that these two disorders be combined into one “substance use disorder” category. When used in this context, the term “substance” refers to a chemical that has detrimental effects on a person’s physical or mental health. It should be noted that neither of these disorders is considered an “addiction”, at least according to the DSM.
A patient diagnosed with a “substance abuse” disorder typically experiences problems in social settings. For a true diagnosis, she exhibits a maladaptive pattern of use, which, in any given one year period, results in either a significant impairment of career, family or education obligations; use of substances in a physically dangerous situation; repeated legal problems as a result of the substance use; or continued use despite resulting social issues.
A patient diagnosed with a “substance dependence” disorder has bigger issues than mere social problems — by this point, the use has resulted in psychological and behavioral problems. For a true diagnosis, she exhibits a maladaptive pattern of use of at least three of the following in any one year period: tolerance (needing more and more of the substance to achieve the same effect); withdrawal; taking more of the substance or for longer than originally anticipated; a desire to stop but an inability to do so; obsession with obtaining or using the substance; sacrificing important life activities to get high; or continued use despite knowledge that it is causing significant problems.