Substance use is a complex issue with both medical and social implications. While often viewed as a moral or legal problem, it becomes a concern for healthcare professionals, including psychiatrists, when it leads to significant difficulties for the individual. Questions frequently arise about whether substance use disorders are genuine medical conditions or merely forms of deviant behavior. However, clinical evidence suggests that substance dependence should be recognized as both a chronic medical illness and a social problem. The shared underlying factors across various substances and the high prevalence of multiple dependencies indicate that substance dependence is a complex mental disorder with possible neurological foundations.
Categories of Substance-Related Disorders
There are two primary categories of substance-related disorders: Substance Abuse and Substance Dependence.
Substance Abuse
Substance abuse is characterized by a maladaptive pattern of substance use, leading to significant negative consequences. This occurs when an individual continues using a mind- or mood-altering substance despite the problems it causes. In other words, when substance use takes precedence over the harm it inflicts, the individual is considered to be abusing drugs.
Substance Dependence
Also referred to as "habituation" or compulsive use, substance dependence involves both psychological and physical reliance on a drug. This dependence is evident when substance use is prioritized over other behaviors that were once more important to the individual.
Psychological Dependence: The individual requires the drug to achieve a sense of well-being or optimal functioning.
Physical Dependence: The body adapts to long-term substance use, leading to withdrawal symptoms when the drug is discontinued.
Two key aspects of physical dependence are:
Tolerance: The need for increasing amounts of a substance to achieve the same effect.
Withdrawal Symptoms: A range of physical and psychological symptoms that appear when substance use is abruptly stopped.
The Scope of Substance Use Disorders
The dramatic rise in illegal drug use over recent decades has had profound societal implications. In the United States, for example, the percentage of individuals who reported using illegal drugs increased from less than 2% in the early 1960s to over a third of the population by 1985, according to the National Institute on Drug Abuse (NIDA).
Major Classes of Substances
Substance use disorders can involve various types of drugs, categorized into seven major classes:
Marijuana
Cocaine
Opiates (e.g., heroin, prescription painkillers)
Hallucinogens (e.g., LSD, psilocybin)
Inhalants
Sedative-Hypnotics (e.g., benzodiazepines, barbiturates)
Nicotine
Conclusion
Substance use disorders are multifaceted conditions that require a comprehensive understanding of their medical, psychological, and social dimensions. Recognizing the distinction between abuse and dependence is essential for effective intervention and treatment. Addressing substance use disorders requires a multidisciplinary approach that includes medical treatment, behavioral therapy, and social support systems.