Substance abuse and dependence
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Substance abuse and dependence
- Among psychoactive substances, alcohol is the most used, essentially by young people, showing higher values when compared to illicit substances.
- It is noteworthy to make the distinction between abusing drugs and alcohol and being dependant on them.
- It is not so difficult to cross the line separating them, being extremely important that the progression into dependency is stopped before serious problems appear.
An individual with at least three of these criteria is diagnosed as ‘dependent‘ (WHO, ICD-10).
A definitive diagnosis of dependence can only be made if three or more of the following criteria have been displayed at some point in the last 12 months:
- Strong desire or sense of compulsion to consume the substance;
- Difficulties in controlling substance use, in terms of onset, termination and levels of consumption;
- State of physiological withdrawal when substance use has ceased or been reduced, as evidenced by the withdrawal syndrome or when the same substance (or similar) is used to alleviate or prevent withdrawal symptoms;
- Evidence of tolerance, such that increasing doses of psychoactive substance are required to achieve effects originally produced with lower doses;
- Progressive abandonment of alternative pleasures and interests in favor of psychoactive substance use; or increased amount of time required to obtain or to consume the substance as well as recover from its effects;
- Persistence in the substance use, despite clear evidence of harmful consequences such as: liver damage caused by excessive alcoholic drinking, depressed moods following periods of substance abuse, cognitive functioning impairment associated with the substance. In this case, an effort should be made to determine if the user was really aware of the nature and extent of the damage.