does someone know that they have a substance problem?
answer of "yes" to any one of four simple questions
may indicate the presence of a substance problem. In
the past year:
you ever felt that you should cut down on your use of
people annoyed you by criticizing your use of the substance?
you ever felt bad or guilty about your use of the substance?
you ever used the substance first thing in the morning
to steady your nerves or get rid of a hangover?
are substance problems defined?
are two basic types of substance-use issues, "substance
abuse" and "substance dependence." Both
is substance abuse?
abuse is defined as one or more of the following having
occurred in the past 12 months:
to fulfill major role obligations at work, school, or
home because of recurrent substance use.
use of the substance in hazardous situations (for example,
driving or using machinery).
legal problems related to use of the substance.
use despite interpersonal or social problems.
is substance dependence?
dependence is defined as three or more of the following
having occurred in the past 12 months.
A need for markedly increased amounts of the substance
to achieve the desired effect, or experiencing diminished
effect with continued use of the same amount of the substance.
Experiencing withdrawal symptoms after stopping use of
the substance, or taking the same or a closely-related
substance to avoid withdrawal symptoms.
substance is often taken in larger amounts or over a
longer period than intended.
is a persistent desire or unsuccessful efforts to cut
down or control substance use.
great deal of time is spent in activities necessary to
obtain the substance.
social, occupational, or recreational activities are
given up or reduced because of substance use.
use is continued despite knowledge of experiencing physical
or psychological problems related to substance use.
do substance problems affect the course of therapy?
most cases, substance-use issues need to be addressed before
patients can make progress on other issues. Substance use
tends to distort a person's emotional life, either dulling
and flattening it, or causing intense, irrational grief,
rage or other substance-induced emotions. Since good therapy
deals with thoughts and feelings, it is difficult to make
progress when thoughts and feelings are being covered over
and distorted by substance use. In addition, many problems
in a patient's life may be caused by substance use itself,
though the patient may be unaware of the connection.
substance problems be treated?
Treatments differ depending on the substance or substances,
and the degree of dependence. Many substance users can be
treated on an outpatient basis. Outpatient treatment typically
involves therapy and participation in a self-help group such
as Alcoholics Anonymous. Serious substance dependence is
initially best treated in a hospital or other in-patient
setting. Frequently, the patient will need to undergo detoxification
under medical supervision. Completion of detoxification followed
by an in-patient program usually gives patients a good head
start and they can follow up with treatment on an outpatient
National Institute on Alcohol Abuse and Alcoholism
National Institute on Drug Abuse
Al-Anon and Alateen