Substance Dependence

Dependence syndrome is defined in the International Classification of Disease and Health Problems 10th Version (ICD-10) as a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for an individual than other behaviors that once had greater value. The World Health Organization introduced the term dependence to replace the terms addiction or habituation which did not encompass the true disorder associated with a dependence on a substance.

Dependence syndrome is the condition that chronic substance addicts suffer from. Substance dependence is not the same as substance abuse. The two terms refer to separate health concerns. A person may binge on drugs or alcohol, consuming either in excess and causing significant harm to themselves but not be dependent on the substance. They will not experience the symptoms associated with tolerance and withdrawals when not using. Substance abuse covers a range of patterns of drinking or drug taking while dependence refers to a specific set of diagnostic criteria. This identification of clear and concise definitions is important to health professionals, policy makers, treatment providers and law enforcement.

Dependence syndrome is a psychiatric condition and a physiological problem that can occur regardless of the substance of choice. A person with a dependence may use alcohol but overcome this dependence and begin to abuse another substance. In some cases, dual drug dependence occurs such as an addiction to alcohol and cigarettes or alcohol and cocaine. The person suffering from dependence syndrome is unable to control their drug use.

Addiction is defined as a physical and psychological dependence on a mind-altering substance or as the compulsive us and dependence on a psychoactive substance. The World Health Organization defines addiction as a dependence syndrome and estimates that at least 15.3 million persons worldwide have drug use disorders. The term dependence is used by the WHO in replacement of addiction, although they are both considered the same condition. This syndrome is a cluster of physiological, behavioral and cognitive phenomena that develops after repeated substance use.

Clinical Diagnosis of Dependence

The first basic definition of alcohol dependence was published in 1976 by Griffith Edwards and Milton Gross. Edwards and Gross described the condition as a means of clarifying the clinical picture that a person with alcoholism may suffer from. Within the description, specific reference is made to patterns of consumption, personal and social factors and range in severity.

According to Edwards and Gross, alcohol dependence was defined by the following criteria:

* Narrowing of the drinking repertoire
* Salience of drink-seeking behavior
* Increased tolerance to alcohol
* Repeated withdrawal symptoms
* Relief or avoidance of withdrawal symptoms by further drinking
* Subjective awareness of compulsion to drink
* Reinstatement after abstinence

This definition was used as the basis for the Diagnostic and Statistical Manual (DSM) and International Classification of Disease and Health Problems (ICD) definitions of dependence syndrome and alcohol dependence.

According to the DSM-IV, the criteria for substance dependence includes:

* The individual has developed a tolerance for the substance.
* The user continues to abuse these substances despite obvious evidence that it is causing them harm.
* The individual experiences withdrawal symptoms when they stop taking the substance.
* The user finds it difficult to cut down on the amount they are using.
* Lack of control over the amount they consume.
* Loss of interest in other activities that they once enjoyed.
* Devoting increasing amounts of time to the substance abuse. This includes time spent obtaining the substance, time spent using it and time spent recovering from the effects.

If the individual experiences three or more of the above symptoms within a 12-month period then it indicates that they have become dependent. This diagnosis can assist health professionals in treating the condition appropriately.

Abuse vs Dependence

There are a number of key elements that define a person who abuses drugs or alcohol and those who are dependent on these substances. Substance abuse is characterized by people who engage in behaviors that are high risk, dangerous and generally are considered unsafe. A dependence on alcohol or drugs differs from this as the behaviors are linked to physical or mental need for the substance.

Drug or alcohol abuse is defined as drinking behaviors that have recurring negative impacts on an individual’s health, relationships and work. Substance abuse is often displayed as drinking in dangerous situations, binge drinking, legal issues associated with drinking, significant impact on work or education and a failure to meet responsibilities. However, substance abusers have some ability to limit or control their use of a drug or alcohol which is what defines them from a substance dependent individual. Drug and alcohol abusers can recover from their harmful abuse of substances through a relatively short stint of treatment. Many will seek out help on their own and have the resolve to get over their problems.

Dependence on drugs or alcohol is considered a chronic diseases. The symptoms of substance dependence are progressive and can be fatal. Dependency is characterized by cravings and an increased tolerance despite severe medical implications and an inability, physically and mentally, to stop drinking or using drugs. Individuals who are dependent on alcohol or a drug often require medical intervention to treat the symptoms of the disease of dependence. Long term, repeated treatment is often required as relapse is common. Like other diseases, addiction can affect people from any ethnic, cultural or socioeconomic background. Genetics, environment, childhood experiences, peers and trauma can play a significant role in the development of an addiction. Unfortunately in many societies drug dependence is still not recognized as a health problem and many people suffering from it are stigmatized and have no access to treatment and rehabilitation.