Substance Dependence
Posted: Tue Feb 06, 2007 5:43 pm
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.
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.