Drug Abuse

Definition and common characteristics of Drug Abuse

A simple definition of drug abuse is that it is the periodic maladaptive consumption of a drug or drugs that results in a variety of problems in different areas of one’s life.

A more specific and formal definition of drug abuse can be formulated using the Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Association, (DSM-IV, 1994).

However the terms “drug abuse” and “drug dependence” are not used in the DSM-IV or the other widely used classification system, the International Statistical Classification of Diseases (ICD). Instead the terms “substance abuse” and “substance dependence” are used.

The term substance in the DSM-IV not only includes psychoactive chemicals of abuse but also medications and toxins with psychoactive effects and includes the following 11 classes of chemicals: “alcohol, amphetamine or similarly acting sympathomimetics; cannabis; cocaine; hallucinogens; inhalants; nicotine; opioids; phencyclidine or similarly acting arylcyclohexylamines; sedatives, hypnotics, and anxiolytics”.

Using the DSM-IV criteria for substance abuse but applying it to the case where the substance is one of the illicit drugs described above, the diagnosis of drug abuse is made when one or more of the following occurs over a year:

  • Recurrent drug use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household)
  • Recurrent drug use in situations in which it is physically dangerous (e.g., driving a car or truck or train, operating machinery e.g. in a factory, while under the influence of substance)
  • Having drug-related legal problems (e.g., arrests for substance-related fights in which injury occur).
  • Continuing to use a drug despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of the drug (e.g. interpersonal difficulties leading to career problems including loss of job).

Drug abuse differs from drug dependence

Research has shown important differences between alcohol abuse and alcohol dependence (Hartford and Muthen, 2001) and it is reasonable to conclude that the same distinction between drug abuse and drug dependence.

For example in drug abuse, there is no significant psychological or physiological dependence whereas drug dependence and associated symptoms e.g. withdrawal symptoms, craving etc are characteristic of drug dependence. Also because of these differences in the nature of drug abuse and drug dependence, there are critical differences between the treatments of these two distinct conditions.

Prevalence

The lifetime prevalence for drug abuse was found to be 7.9% in a large epidemiological study carried out recently in the United States, making it a little more than half the lifetime prevalence of alcohol abuse which is just 13.2% (Kessler et al, 2005).

In contrast, drug dependence had a lifetime prevalence of just 3.0%. It is to be noted that for both alcohol and drugs, dependence is less than half as common as abuse.

Alcohol dependence and codependence (developmental trauma)

The presence of an addiction of some kind has long been held as a main secondary symptom of codependency. Other names for codependency are developmental trauma and complex PTSD.

There is indeed a lot of evidence that many individuals who abuse or become dependent to any substance be it alcohol or illicit drugs have often been exposed to previous trauma during their childhood or thereafter.

For example, a study of borderline personality disorder, a severe form of what many call codependence, in patients with recent deliberate self-harm in Hong Kong, found they were more likely to suffer from a current alcohol and substance use disorder Wong (2010).

Also, research by Boriskin (2008) found that 25 to 50 percent of clients with a substance use disorder also meet the conditions for a diagnosis of post traumatic stress disorder (PTSD). Hence there is strong reason to conclude that a person who experienced repeated or prolonged trauma during their childhood (and hence is likely codependent) is at greater risk of developing drug/alcohol abuse or dependence in adulthood.

Treatments available for drug abuse

Fortunately there are a number of effective treatments for drug abuse as listed below:

  • Prevention is considered the best way to deal with drug abuse and psychoeducation, either at the individual or the public health level, is the most important prevention strategy.
  • Since generally the introduction to drugs (and alcohol) starts in teenage years, or unfortunately even earlier, it is best to start education about drug abuse and dependence in school as soon as possible.
  • Of course this has to be done in a culturally sensitive and also in an age appropriate level. Since alcohol and some other drugs are often used in a non-problematic way in many cultures, care must be taken not to alienate children from their parents others who may use drugs socially etc but at the same time inform children of the potential for drug abuse and dependence.
  • Psychoeducation is also an important therapeutic intervention in the treatment of drug abuse.
  • Many psychotherapeutic modalities e.g. cognitive behavioural therapy are used to treat drug abuse with varying degrees of success.
  • As already discussed individuals who have been traumatized as children or adults have greater risk of developing a problem with alcohol/drug abuse or dependence. For these individuals, treatment should include a component aimed at the trauma because it has the advantage of working through the lingering effects of traumatization and therefore reducing or stopping completely alcohol/drug abuse or dependence (Boriskin, 2008).

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.) Washington, DC: Author.

Boriskin, J. A. (2008, March). Effective treatments of complex PTSD and addiction. Paper presented at the meeting of Addiction, Trauma, and Co-Occurring Disorders, San Diego.

Kessler, Ronald C., Berglund, Patricia, Demler, Olga, Jin, Robert, Merikangas, K. R., Walters, Ellen E., (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, Vol. 62(6), 593-602.

Harford, T. C., & Muthen, B. O. (2001). The dimensionality of alcohol abuse and dependence: A multivariate analysis of DSM-IV symptom items in the National Longitudinal Survey of Youth. Journal of Studies on Alcohol, 62, 150–157.

Wong, Hiu-Mei; Leung, Henry Chi-Ming; Chow, Lai-Yin; Kam, Wai-Kwo & Tang, Alan Ka-Lam. (2010) Prevalence of borderline personality disorder and its clinical correlates in Chinese patients with recent deliberate self-harm. Journal of Personality Disorders, 24(6), 800-811.


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