Randall Eiger LCSW
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Substance Abuse FAQ


Q:  How does someone know that they have a substance problem?

An answer of "yes" to any one of four simple questions may indicate the presence of a substance problem. In the past year:

  • Have you ever felt that you should cut down on your use of the substance?
  • Have people annoyed you by criticizing your use of the substance?
  • Have you ever felt bad or guilty about your use of the substance?
  • Have you ever used the substance first thing in the morning to steady your nerves or get rid of a hangover?
Q: How are substance problems defined?

There are two basic types of substance-use issues, "substance abuse" and "substance dependence." Both are serious.


What is substance abuse?


Substance abuse is defined as one or more of the following having occurred in the past 12 months:

  • Failure to fulfill major role obligations at work, school, or home because of recurrent substance use.
  • Recurrent use of the substance in hazardous situations (for example, driving or using machinery).
  • Recurrent legal problems related to use of the substance.
  • Continued use despite interpersonal or social problems.
Q: What is substance dependence?

Substance dependence is defined as three or more of the following having occurred in the past 12 months.

  • Tolerance. 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.
  • Withdrawal. Experiencing withdrawal symptoms after stopping use of the substance, or taking the same or a closely-related substance to avoid withdrawal symptoms.
  • The substance is often taken in larger amounts or over a longer period than intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  • A great deal of time is spent in activities necessary to obtain the substance.
  • Important social, occupational, or recreational activities are given up or reduced because of substance use.
  • Substance use is continued despite knowledge of experiencing physical or psychological problems related to substance use.
Q: How do substance problems affect the course of therapy?
A: In 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.
Q: Can substance problems be treated?
A: Yes. 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 basis.

Helpful links:

National Institute on Alcohol Abuse and Alcoholism
Alcoholics Anonymous
National Institute on Drug Abuse
Narcotics Anonymous
Al-Anon and Alateen