Drugs and Alcohol

Many people use drugs and alcohol recreationally. However, the line between recreational use and habitual/addictive use is blurry. The National Institute on Drug Abuse defines drug addiction as a, "complex illness characterized by intense and, at times, uncontrollable drug crazing, along with compulsive drug seeking and use that persist even in the face of devastating consequences." However, not all substance use is addiction. Below is the spectrum of substance use, abuse, and addiction as published in a 1999 report to Congress:

Drug experimentation
The use of alcohol or illicit drugs at any time for experimentation. While in and of itself experimentation may not appear to be abusive, even a single episode of experimentation can result in harm to self or to others. For example, the use of alcohol or other drugs at all during pregnancy could result in harm to the fetus, the experimental use of alcohol or other drugs while driving can result in harm to the user as well as others, or a child may be injured when left unsupervised while a parent is intoxicated. Also, if experimental use continues or serves as a gateway to additional use, as often it does, patterns of alcohol and other drug abuse may develop.

Social use of drugs
Use of any drug or combination of drugs in social situations, or for social reasons. If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse. Social use of alcohol or other drugs often leads to further and elevated use.

Binge drinking
Heavy use of alcohol periodically. This can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others. For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence. The National Household Survey on Drug Abuse defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past 30 days.

Substance abuse
The characteristic feature of abuse is the presence of dysfunction related to the person's use of alcohol or other drugs. One standard definition (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes it as "the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning." Abuse may or may not involve physiologic dependence or tolerance. For example, use of substances in weekend binge patterns may not involve physiologic dependence; however, it may have adverse affects on a person's and possibly others' lives. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association is used across the medical and mental health fields for diagnosing both substance abuse and mental health disorders. According to the DSM-IV, substance abuse is "a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by" a variety of possible symptoms of impairment. Neglect of children is specifically listed as a potential symptom of substance abuse (American Psychiatric Association, 1994).

Addiction or Chemical Dependency
With continued use, many persons' use or abuse of alcohol or other drugs becomes addiction, a disease in which the substances have caused changes in a person's body, mind, and behavior. As a result of this disease, addicted persons are unable to control their use of substances, despite the bad things that happen when they use them. Addiction may be a chronic, relapsing disorder and if the disease process progresses, recovery becomes more difficult. Chemical dependency occurs most frequently in those who have a family history of the disease. Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a). The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms when the substance is not used).


National Resources
The Watershed
Substance Abuse and Mental Health Services Administration