Substance Use is primary a moral and a legal problem, and when it creates difficulties for the user or ceases to be entirely volitional it becomes the concern of all the helping professions, including psychiatry. Questions are often raised as to whether Substance Use disorders are genuine disorders or should rather be seen as a deviant behavior by people who deliberately indulge in an activity that causes them harm. However the clinical evidence suggests that substance dependence should be seen as both a chronic medical illness and a social problem. Common roots of dependence for a variety of substances and the high prevalence of multiple dependence also suggest that substance dependence should be viewed as a complex mental disorder with a possible basis in brain functioning.

There are 2 major categories of substance – related disorders, Substance Abuse and Substance Dependence. Substance Abuse is a maladaptive pattern of Substance Use manifested by recurrent and significant adverse consequences related to the repeated use of substances. Said in another way, when the continued use of a mind/mood altering substance means more to the individual then the problems caused by such use, the individual can be said to be abusing drugs.

Substance Dependence, also called “habituation” or compulsive use, connotes a psychological or physical need for the drug. It’s manifested by a behavioral pattern in which the use of a given drug is given a much higher priority then other behaviors that once had higher value. It implicates, psychological and physical dependence. Psychological dependence, centers on the user’s needing the drug in order to reach a maxi¬mum level of functioning or a feeling of well-being. Physical dependence indicates the body’s psychological adaptation to long-term use of the substance, with the development of symptoms when the drug is stopped or withdrawn. There are 2 important aspects to physical dependence; tolerance and withdrawal symptoms.

Tolerance is the need for higher and higher doses of the substance to achieve the same effect. Withdrawal symptoms is the appearance of symptoms when the drug is stopped quickly. It consists of a syndrome of mixtures of a wide variety of possible symptoms. The dramatic increase in illegal drug use over the last 25 years makes it hard to appreciate how extensively the problem has invaded our society. In the United States, experience with illegal drugs rose from 2% or less of the population in most areas in the early 1960’s, to more than a third of the population in 1985 according to household surveys by the National Institute on Drug Abuse (NIDA).

The drugs include seven major classes: marijuana, cocaine, opiates, hallucinogens, inhalants, sedative-hypnotics and nicotine.

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