Substance Dependence

Discussion group for those recovering from substance abuse. This is the place to talk about your struggles and success in regards to addiction.
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Mystery
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Substance Dependence

Post by Mystery »

For those that requested this, I'm sorry it's taken me this long to post. Been dealing with an overwhelming number of assignments for school on top of work, but I'm getting to it :).

Anyway, what I'm providing is a summary of the diagnostic criteria for both substance dependence and substance abuse (general, not substance specific, although the criteria are basically the same). First, one must rule out dependence in order to give a diagnosis (dx) or, in my case, a diagnostic impression of abuse. In other words, check for dependence first. If they meet those criteria, that's the dx they get, if they don't check the criteria for abuse, etc. This information is based on the criteria provided in the DSM-IV-TR. The DSM, of course, is the diagnostic and statistical manual of mental disorders, and is used widely throughout many mental health fields, including my own agency. So, here it is....



Substance Dependence:

Defined as a maladaptive pattern of substance abuse, manifested by 3 or more of the criteria within the same 12-month period.

1. Tolerance (either needing increasing amounts of a substance to obtain the desired effct or diminished effect with continued use)

2. Withdrwal (either presence of symptoms or taking a substance to avoid the symptoms)

Note: some make the mistake of believing that tolerance or W/D HAVE to be present in order for dependence to be present, but that's not the case entirely.

3. User uses more of a substance than was originally intended, or uses for a longer amount of time.

4. The user wants to cut down, but is unsuccessful in his/her efforts to cut down or control their use.

5. Lots of time is spent in substance-related activities (using it, looking for it, recovering from it, etc.)

6. Work/school activities, social functioning, or recreational activites are reduced or gone due to the use.

7. User continues to use a substance despite having physical or emotional problems as a result of using the substance.

Note: You can also extend the criteria to include with physiological or with psychological dependence



Substance Abuse:

Defined as a maladaptive pattern of substance use that leads to clinically significant impairment, manifested by 1 or more of the criteria within the same 12-month period.

1. Recurrant use of a substance that causes failure to fulfill normal obligations.

2. Continued use of substances when it is physically hazardous (driving a vehicle, etc.)

3. Presence of legal problems related to use of substance.

4. Continued use of the substance despite the presence of recurring social/personal problems that are made worse by the substance (such as fights with your family, etc.)

Another couple notes:

1. You'll notice it says within the same 12-month period. One determination we make is that it's the most recent 12-month period in which the client had access to drugs. (i.e. if they come to me after being released from 5 years in jail, we evaluate them based on the 12-months and prior time BEFORE their sentence, as that's ideally when they last had access to the drug )

2. We rule out substance dependence first because, of course, it's the most severe, but in addition, once you receive a dx of dependence it's (using this term loosely) permanent, therefore you have to be careful of how you label a client.
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Bryn Mawr
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Substance Dependence

Post by Bryn Mawr »

Mystery;541917 wrote: For those that requested this, I'm sorry it's taken me this long to post. Been dealing with an overwhelming number of assignments for school on top of work, but I'm getting to it :).

Anyway, what I'm providing is a summary of the diagnostic criteria for both substance dependence and substance abuse (general, not substance specific, although the criteria are basically the same). First, one must rule out dependence in order to give a diagnosis (dx) or, in my case, a diagnostic impression of abuse. In other words, check for dependence first. If they meet those criteria, that's the dx they get, if they don't check the criteria for abuse, etc. This information is based on the criteria provided in the DSM-IV-TR. The DSM, of course, is the diagnostic and statistical manual of mental disorders, and is used widely throughout many mental health fields, including my own agency. So, here it is....



Substance Dependence:

Defined as a maladaptive pattern of substance abuse, manifested by 3 or more of the criteria within the same 12-month period.

1. Tolerance (either needing increasing amounts of a substance to obtain the desired effct or diminished effect with continued use)

2. Withdrwal (either presence of symptoms or taking a substance to avoid the symptoms)

Note: some make the mistake of believing that tolerance or W/D HAVE to be present in order for dependence to be present, but that's not the case entirely.

3. User uses more of a substance than was originally intended, or uses for a longer amount of time.

4. The user wants to cut down, but is unsuccessful in his/her efforts to cut down or control their use.

5. Lots of time is spent in substance-related activities (using it, looking for it, recovering from it, etc.)

6. Work/school activities, social functioning, or recreational activites are reduced or gone due to the use.

7. User continues to use a substance despite having physical or emotional problems as a result of using the substance.

Note: You can also extend the criteria to include with physiological or with psychological dependence



Substance Abuse:

Defined as a maladaptive pattern of substance use that leads to clinically significant impairment, manifested by 1 or more of the criteria within the same 12-month period.

1. Recurrant use of a substance that causes failure to fulfill normal obligations.

2. Continued use of substances when it is physically hazardous (driving a vehicle, etc.)

3. Presence of legal problems related to use of substance.

4. Continued use of the substance despite the presence of recurring social/personal problems that are made worse by the substance (such as fights with your family, etc.)

Another couple notes:

1. You'll notice it says within the same 12-month period. One determination we make is that it's the most recent 12-month period in which the client had access to drugs. (i.e. if they come to me after being released from 5 years in jail, we evaluate them based on the 12-months and prior time BEFORE their sentence, as that's ideally when they last had access to the drug )

2. We rule out substance dependence first because, of course, it's the most severe, but in addition, once you receive a dx of dependence it's (using this term loosely) permanent, therefore you have to be careful of how you label a client.


Many thanks for that - I've only just come across it.

A useful set of definitions very well set out.
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Nomad
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Substance Dependence

Post by Nomad »

Its easy to stay sober when things are rolling easy. When you meet difficulties the urge to drink is tremendous. Help !
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Carl44
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Joined: Fri Sep 08, 2006 9:23 am

Substance Dependence

Post by Carl44 »

Nomad;544919 wrote: Its easy to stay sober when things are rolling easy. When you meet difficulties the urge to drink is tremendous. Help !




hey buddy i dont think people realise , how bad the urge to drink is , this week i've really had the urge to get totally wasted , i'm glad i never but all i think is i'm not going to drink right now if someone offers me a large jack Daniels , i have even had people line up three or four doubles on the bar , and say the old jimbo would of knocked them back , as if drinking made you more of a Man sorta thing , then i think i'm not going to drink today and really make up my mind to achieve just that , if i thought along the lines of i'm never going to drink again ... then the term falling of the wagon ... would come into mind ... saying no to one drink at a time is do able,,,as is saying one day at a time not drinking ,but never again just seems so hard :-6
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Mystery
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Substance Dependence

Post by Mystery »

Nomad;544919 wrote: Its easy to stay sober when things are rolling easy. When you meet difficulties the urge to drink is tremendous. Help !


Help is only a phone call/keystroke away Nomad. Reaching out is always the best first step, and never pick up that first drink. The last time I had the urge to use was about 4 weeks ago. Was going through some really tough times with some financial matters, and it looked like I was going to be kicked out of school on top of some other things. I sat in my room obsessing over going out to use. But I didn't. I picked up the fone and called someone. That's, essentially what you've done. Is it something you can discuss, or is generic advice better?
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Nomad
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Substance Dependence

Post by Nomad »

The why's are irrelevant. I mean any given day it could be anything. I could always come up with a feeble reason.
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Carl44
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Substance Dependence

Post by Carl44 »

Nomad;544981 wrote: The why's are irrelevant. I mean any given day it could be anything. I could always come up with a feeble reason.


your not alone there mate , if i'm happy i want to drink , if i'm sad i want to drink more , if i'm not happy or sad i'll want a drink coz i'm bored :-5 :-5



but so far this year i've stayed on track , but it is very very hard
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Mystery
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Substance Dependence

Post by Mystery »

Nomad;544981 wrote: The why's are irrelevant. I mean any given day it could be anything. I could always come up with a feeble reason.


You know what's weird? When I first began this journey the good days were hardest for me. It's like the problems gave me something to work on, so I wasn't sitting around idly.

Any alcoholic can create a reason. Heck, I broke a toenail, I need a fix...I dropped a plate on the floor and it broke, perhaps I should wash away the turmoil...etc, etc. Thing to do is seek out other options. Have activities you like, friends that care, a good book to read. Generally, if one can overcome that initial urge, it'll go away. Just depends on how big as to how long that takes, but nothing's worth losing the serenity and peace of sobriety. :-6
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Mystery
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Substance Dependence

Post by Mystery »

jimbo;544985 wrote: your not alone there mate , if i'm happy i want to drink , if i'm sad i want to drink more , if i'm not happy or sad i'll want a drink coz i'm bored :-5 :-5



but so far this year i've stayed on track , but it is very very hard


Kudos to you jimbo :-6 That's absolutely terrific!

I don't remember anyone ever telling me it was going to be easy, but they did tell me it was simple. They also told me, as an addict/alcoholic, we can complicate the hell out of darn near everything.
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Nomad
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Substance Dependence

Post by Nomad »

So sobriety is supposed to be peaceful then ?....ok maybe I missed that part. :wah:
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Mystery
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Substance Dependence

Post by Mystery »

Nomad;544992 wrote: So sobriety is supposed to be peaceful then ?....ok maybe I missed that part. :wah:


Nah, you're just going through one of those bumps in the road. Can ya really sit there and tell me you've not known peace since giving it up? ;)
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Nomad
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Substance Dependence

Post by Nomad »

Mystery;544997 wrote: Nah, you're just going through one of those bumps in the road. Can ya really sit there and tell me you've not known peace since giving it up? ;)




Well I was fairly peaceful passed out on the couch too. :D
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Mystery
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Substance Dependence

Post by Mystery »

Nomad;544999 wrote: Well I was fairly peaceful passed out on the couch too. :D


:wah: Yes, but it's the waking up part that stops that.
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Nomad
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Substance Dependence

Post by Nomad »

Mystery;545003 wrote: :wah: Yes, but it's the waking up part that stops that.




Right. Thats why I stayed drunk. I didnt just fall off the rutebaga truck !
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