Management of substance abuse

Abuse (drug, alcohol, chemical, substance or psychoactive substance)

Definition

A group of terms in wide use but of varying meaning. In DSM-IV, 'psychoactive substance abuse' is defined as a 'maladaptive pattern of use indicated by ... continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physically hazardous'. It is a residual category, with dependence taking precendence when applicable. The term 'abuse' is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. Because of its ambiguity, the term is not used in ICD-10 (except in the case of non-dependence-producing substances); harmful use and hazardous use are the equivalent terms in WHO usage, although they usually relate only to effects on health and not to social consequences. In other contexts, abuse has referred to non-medical or unsanctioned patterns of use, irrespective of consequences. Thus the definition published in 1969 by the WHO Expert Committee on Drug Dependence was 'persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice'.

Psychoactive substance misuse

Use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. The term is preferred by some to abuse in the belief that it is less judgemental.

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