SUBSTANCE ABUSE

Substance Abuse

Substance Abuse in UK and Tanzania

Substance abuse is a disorder with neurobiological, social, and psychological influences. It is characterised by a pattern of maladaptive behaviors that develop as a consequence of the reinforcing effects of a drug that promotes continued use. Drug abuse and dependence have both direct and indirect impacts on individual health and also lead to social costs including those associated with drug-related crime. Although dependence is often a chronic, relapsing condition that accounts for a large public health burden, a large proportion of those with drug dependence remit even without treatment. This entry reviews the diagnoses of substance abuse and dependence, examines individual and environmental risk factors, discusses the individual and social costs of abuse and dependence, and considers options for the prevention and treatment of substance abuse and dependence.

Diagnoses of Drug Abuse and Dependence

Objective criteria to diagnose dependence can be found in the Diagnostic and Statistical Manual of Mental Disorders, published by the British Psychiatric Association, and the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organisation.

Dependence is diagnosed if at least three of the following problems are present: the user is tolerant to the substance (needs to use more to achieve the same effect or the same amount of substance leads to diminishing effect), experiences withdrawal (exhibits withdrawal symptoms or uses the substance to relieve those symptoms), needs to take larger amounts or for a longer time, wants or unsuccessfully tries to control his or her use, spends most of his or her time getting or using the substance or recovering from its use, gives up important activities to use the substance, or continues to use even with the knowledge that he or she has health problems related to substance use. Maladaptive use that does not meet the criteria for dependence is called abuse. Diagnostic criteria for abuse include failing to fulfill obligations at work, school, or home; recurrent use in physically hazardous situations; recurrent legal problems; or continued use despite serious social or interpersonal problems.

Although abuse and dependence are considered as distinct diagnostic entities, there is considerable overlap between these disorders; abuse of drugs usually involves using a large quantity of one or more substances, and regular use often, though not always, leads to dependence. On the other hand, a minority of those who are dependent do not show symptoms of abuse. In addition, it is more difficult to treat the abuse of those people who are highly dependent than those who are not as dependent. Research suggests that drug dependence changes not only the brain chemicals but also the brain structures, and the more dependent a person is, the more difficult it is to reverse the brain into a nondependent stage.

Distribution of Substance Abuse in the Population

Substance abuse is not distributed randomly in the population. Prevalence of dependence is highest among people aged 18 to 54 years, especially among young adults. The extent to which minorities are affected by dependence varies by drugs, region, and ...