Psychologists use the term “Substance Dependence” instead of the more commonly used term “addiction” to describe when someone has a serious alcohol or drug problem.
For example, “Alcohol Dependence” refers to alcoholism, “Marijuana Dependence” refers to marijuana addiction, and “Cocaine Dependence” refers to cocaine addiction. The term “Polysubstance Dependence” is used when someone is dependent on more than one substance.
When someone is dependent on a substance, they perceive they do not have control over its use. In my practice, I counsel clients who are ready to either (1) give up alcohol or drug use entirely, or (2) explore the idea, and begin to take steps to change, depending on where the individual is in the “Stages of Change.” (Prochaska defined the “Five Stages of Change” as Precontemplation, Contemplation, Preparation, Action, and Maintenance).
Several of my clients have been successful in their efforts to completely give up alcohol or drugs, especially once they have discovered sufficient motivation to do so.
The following text, written in italics, is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), one of the diagnostic manuals used by mental health care professionals. Only a portion of the text printed in the DSM-IV-TR is presented in this blog.
Substance Dependence can be diagnosed when someone exhibits three or more of the following criteria.
1. tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve intoxication or the desired effect
(b) markedly diminished effect with continued use of the same amount of the substance
2. withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3. the substance is often taken in larger amounts or over a longer period than was intended
4. there is a persistent desire or unsuccessful attempts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of substance use
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
When I am working with a client to determine whether they have a problem with alcohol or drugs, I often focus our attention on the third criteria. For example, I will ask an individual who struggles with alcohol use whether they drink more than intended, over a longer period than intended.
Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta
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