BASIC PRINCIPLES

USE, PROBLEM USE AND DEPENDENCY

Not all substance use causes problems and only a small proportion of those who use substances become dependent on them. Illicit substance use is widespread amongst the general population with almost 50% of younger adults having used cannabis during their lifetime. Alcohol use is even more widespread, but only a minority of individuals will experience problems as a result. Both problem use and dependency may indicate the need for treatment, as may the particular risks or harms arising from the problem use or dependency.

Problems associated with substance misuse range from the biological (accidental overdose, viral infections, liver disease etc.) to the psychological (depression, psychosis) to the social (homelessness, deteriorating relationships, loss of work, financial problems, acquisitive crime).

The use of the term ‘dependence’ indicates the presence of a dependency syndrome as defined by the World Health Organisation (1981). This modern concept of dependence encompasses both the psycho-social and physical characteristics of addiction and includes a number of ‘symptoms’:

• A stereotyped pattern of substance use.
• Prioritisation of drug-seeking and using behaviour over other daily activity.
• Craving.
• Tolerance to the effects of substances.
• Withdrawal symptoms on cessation or reduction of substance use.

• Use of substances to prevent the occurrence of withdrawal symptoms.
• Persistence of substance misuse despite awareness of harm.
• Loss of control over the onset, termination and amount of substance use.
• Rapid reinstatement of the syndrome after a period of abstinence.

Not all of these symptoms need to be present to indicate the presence of a dependency syndrome, and it is often the case that an individual is dependent on a substance in the absence of a withdrawal syndrome. Equally, harm and dependency are not necessarily correlated, and some non-dependent substance misusers may suffer serious physical, psychological and social consequences of the misuse.

Next page .. PREVALENCE OF SUBSTANCE MISUSE

Alcohol Guidelines index

The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.