Substance use can have serious consequences. Drug users may experience infections, paranoid delusions, brain damage, nerve damage or sudden death, depending on which drug they are using.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) listed several substance disorders, including drug dependency and drug abuse. So what is the difference between these two substance disorders?
The DSM-IV-TR has drug abuse and drug dependency disorders for several types of drugs, including alcohol, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and sedatives. The manual included diagnostic criteria for a dependency on nicotine and polysubstance, but not abuse criteria.
A section for other (or unknown) substance-related disorders is also in the manual, which allows for a diagnosis of drug abuse or dependency for drugs not otherwise listed, such nitrous oxide and prescription medications. If a person meets criteria for a drug dependency for a specific drug, such as cocaine, she cannot be diagnosed with drug abuse of that class of drug.
To be diagnosed with a substance abuse disorder, the person must have “a maladaptive pattern of substance use leading to clinically significant impairment or distress” within a 12 month period with one or more of the symptoms, according to the DSM-IV-TR.
Signs include failure to perform responsibilities at home, work or school; legal issues related to the substance use; continuing to use the substance even though there have been interpersonal or social issues caused or made worse by the substance; and using the substance in physically hazardous situations.
With a substance dependency disorder, the person also has a maladaptive pattern of substance use within a 12 month period, but meets three or more of the criteria. Two of the criteria are tolerance and withdrawal.
With tolerance, the person either has a decreased effect when using the same amount of the drug, or she needs to use more of the drug to get the level of intoxication desired.
With withdrawal, the person takes the same or a related substance to either avoid or alleviate withdrawal symptoms; the DSM-IV-TR listed specific withdrawal syndromes for the different classes of drugs.
A person can meet criteria for a substance dependence disorder without symptoms of tolerance or withdrawal. This type of substance dependence is further classified as “without physiological dependence.”
For example, if a person uses amphetamines and meets three or more criteria that do not include tolerance and withdrawal (i.e., taking the amphetamine in larger amounts or over a longer time frame that intended; continuing to use amphetamines despite the drug causing physical or psychological problems; and giving up important recreational, social or occupational activities to use amphetamines), then the diagnosis would be “amphetamine dependence without physiological dependence.”
Other criteria for a substance dependency disorder include unsuccessful efforts or a persistent drug to either cut down on drug use or control it; and spending a large amount of time to get the drug, use it or recover from use.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision). Print. American Psychiatric Publications. 2000.
MedlinePlus Medical Encyclopedia. Drug Abuse. Web. 7 December 2011
MedlinePlus Medical Encyclopedia. Drug Dependence. Web. 7 December 2011
Reviewed December 8, 2011
by Michele Blacksberg RN
Edited by Jody Smith