Substance abuse
Classification and external resources
Comparison of the perceived harm for various psychoactive drugs from a poll among medical psychiatrists specialized in addiction treatment[1]
ICD-10 F10..1-F19..1
ICD-9 305
DiseasesDB 3961
MeSH D019966

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent.[2] The term "drug abuse" does not exclude dependency,[3] but is otherwise used in a similar manner in nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction.[4] Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions.


Substance abuse is a form of substance-related disorder.


Public health definitions

File:Spectrum Diagram.PNG


Public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasizing the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "substance and alcohol type problems" or "harmful/problematic use" of drugs.


Medical definitions

In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognize 'drug abuse' as a current medical diagnosis. Instead, DSM has adopted substance abuse[6] as a blanket term to include drug abuse and other things. ICD refrains from using either "substance abuse" or "drug abuse", instead using the term "harmful use" to cover physical or psychological harm to the user from use. Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) ). Its section Substance dependence begins with:


However, other definitions differ; they may entail psychological or physical dependence [6] , and may focus on treatment and prevention in terms of the social consequences of substance uses.

Drug misuse

Drug misuse is a term used commonly for prescription medications with clinical efficacy but abuse potential and known adverse effects linked to improper use, such as psychiatric medications with sedative, anxiolytic, analgesic, or stimulant properties. Prescription misuse has been variably and inconsistently defined based on drug prescription status, the uses that occur without a valid prescription, intentional use to achieve intoxicating effects, route of administration, co-ingestion with alcohol, and the presence or absence of abuse or dependence symptoms.[7][8] Tolerance relates to the pharmacological property of substances in which chronic use leads to a change in the central nervous system, meaning that more of the substance is needed in order to produce desired effects. Stopping or reducing the use of this substance would cause withdrawal symptoms to occur.[9]

As a value judgment

Philip Jenkins points out that there are two issues with the term "drug abuse". First, that constitutes a "drug" is debatable. For instance, GHB, a naturally occurring substance in the central nervous system is considered a drug, and is illegal in many countries, while nicotine is not officially considered a drug in most countries. Second, the word "abuse" implies a recognized standard of use for any substance. Drinking an occasional glass of wine is considered acceptable in many Western countries, while drinking several bottles is seen as an abuse. Strict temperance advocates, which may or may not be religiously motivated, would see drinking even one glass as an abuse, and some groups even condemn caffeine use in any quantity. Similarly, adopting the view that any (recreational) use of marijuana or amphetamines constitutes drug abuse implies that we have already decided that substance is harmful even in minute quantities.[10]

Signs and symptoms


There is a high rate of suicide in alcoholics and drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse.[12] In the USA approximately 30 percent of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.[13]






1 in 5 teenagers report having abused a prescription medication and over 2500 teenagers a day experiment with prescription medications taken from the home. The Massachusetts legislature just enacted a law that requires all Pharmacy's located within the Commonwealth to display, and offer for sale, medical lock boxes for home use and to place those products within 50 feet of the pharmacy counter. Products such as the RxDrugSAFE, a fingerprint recognition home medical safe, combats unauthorized access to prescription medications at home, thereby preventing abuse. This new law is the first such law enacted within the United States.


File:Drug use disorders world map - DALY - WHO2002.svg


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In 2009 in the United States about 20% of high school students have taken prescription drugs without a valid prescription.[17] And earlier in 2002, the World health Organization estimated that around 140 million people were alcohol dependent and another 400 million sufferd alcohol-related problems.[18]

File:Alcohol by Country.png

Total recorded alcohol per capita consumption (15+), in liters of pure alcohol[19]



In 1932, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors: Template:"[20]


In 1973 the National Commission on Marihuana and Drug Abuse stated:








DSM-IV-TR defines substance abuse as:[22]



Society and culture

Legal approaches






The UK Home Office estimated that the social and economic cost of drug abuse[25] to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.[26]


The Home Office has a recent history of taking a hard line on controlled drugs, including those with no known fatalities and even medical benefits,[28] in direct opposition to the scientific community.[29]


Treatment for binge drinking and other forms of substance abuse is critical for many around the world. Behavioral interventions and medications exist that have helped many people reduce, or discontinue, their substance abuse. From the applied behavior analysis literature, the behavioral psychology literature, and from randomized clinical trials, several evidenced based interventions have emerged:

It has been suggested that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious.[32]

See also


  1. Template:Cite pmid
  2. Template:DorlandsDict
  3. Template:DorlandsDict
  5. "Drug Trade". BBC News.
  6. 6.0 6.1 6.2 6.3 DSM-IV & DSM-IV-TR:Substance Dependence
  7. Barrett SP, Meisner JR, Stewart SH (November 2008). "What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations". Curr Drug Abuse Rev 1 (3): 255–62. doi:10.2174/1874473710801030255. PMID 19630724. http://www.bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf.
  8. McCabe SE, Boyd CJ, Teter CJ (June 2009). "Subtypes of non-medical prescription drug misuse". Drug Alcohol Depend 102 (1-3): 63–70. doi:10.1016/j.drugalcdep.2009.01.007. PMC 2975029. PMID 19278795.
  10. Philip Jenkins, Synthetic panics: the symbolic politics of designer drugs, NYU Press, 1999, ISBN 0814742440, pp. ix-x
  12. O'Connor, Rory; Sheehy, Noel (29 January 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33–36. ISBN 978-1-85433-290-5. http://books.google.com/?id=79hEYGdDA3oC.
  13. Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, Calif.: ABC-CLIO. pp. 122–123. ISBN 978-1-57607-708-5. http://books.google.com/?id=X0mxxfbIbp4C.
  14. Evans, Katie; Sullivan, Michael J. (1 March 2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 75–76. ISBN 978-1572304468. http://books.google.com/?id=lvUzR0obihEC.
  17. "CDC Newsroom Press Release June 3, 2010". http://www.cdc.gov/media/pressrel/2010/r100603.htm.
  19. Global Status Report on Alcohol 2004
  23. Copeman M (April 2003). "Drug supply and drug abuse". CMAJ 168 (9): 1113; author reply 1113. PMC 153673. PMID 12719309. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309.
  24. Wood E, Tyndall MW, Spittal PM, et al. (January 2003). "Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure". CMAJ 168 (2): 165–9. PMC 140425. PMID 12538544. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12538544.
  25. "NHS and Drug Abuse". National Health Service (NHS). March 22, 2010. http://www.nhs.uk/LiveWell/Drugs/Pages/Drugshome.aspx. Retrieved March 22, 2010.
  26. http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace
  27. Thornton, Mark. "The Economics of Prohibition". http://mises.org/story/2269.
  28. "Cannabis laws to be strengthened". BBC News. 2008-05-07. http://news.bbc.co.uk/1/hi/uk_politics/7386889.stm. Retrieved 2010-05-01.
  29. http://www.bbc.co.uk/blogs/thereporters/markeaston/2009/11/why_was_david_nutt_sacked.html
  31. Chambless et al., D.L. (1998). "An update on empirically validated therapies" (PDF). Clinical Psychology (American Psychological Association) 49: 5–14. http://www.apa.org/divisions/div12/est/newrpt.pdf. Retrieved 2008-03-24.

Further reading

External links

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