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If I Have a Problem,
What's the Solution?

The terms alcohol and drug abuse and dependence (addiction) are often used interchangeably, but they represent two quite different conditions. They also require two quite different remedies.

Alcohol/drug abuse is defined by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as follows:

A maladaptive pattern of alcohol or drug use leading to impairment or distress, presenting as one or more of the following over a 12-month period and symptoms have never met the criteria for chemical dependence:

  • Recurrent use leading to failure to fulfill obligations
  • Recurrent use that is physically hazardous
  • Recurrent alcohol- or drug-related legal problems
  • Continued use despite social/interpersonal problems

As such, abuse means intentional overuse of alcohol and/or drugs. It is often described as people making bad choices about the use of alcohol or drugs.

People abuse alcohol and/or drugs for many reasons, including peer pressure, immaturity, insecurity, habit, mental illness, life problems, ignorance, and poor coping skills.

Alcohol/drug dependence, on the other hand, is defined in the DSM-IV as:

A maladaptive pattern of alcohol or drug use, leading to impairment or distress, presenting as three or more of the following over a 12-month period:

  • Tolerance to the substance's actions
  • Withdrawal symptoms or use to avoid withdrawal symptoms
  • Substance is used more than intended
  • There is an apparent inability to control use
  • Effort is expended to obtain the substance
  • Alcohol or drug use continues despite negative consequences



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Dependence represents impaired control over the use of alcohol and/or drugs. Like abuse, it includes overuse, but overrides intention.

People become dependent on alcohol or drugs in response to a dysfunction in the brain's pleasure pathway that always involves neurobiology and often involves genetics.

The essential difference between abuse and dependence lies in control. Abusers can control their drinking and drug use whenever they choose. Dependents can control theirs on some occasions - perhaps even most - but not all. Their control is unpredictable.

The solution to avoiding the problems associated with abuse and dependence is different for each condition. Since abusers can control their use, their solution is consistent moderation. That may involve something as simple as setting limits and using will power to honor those limits. But it may involve more. For example, if someone is drinking excessively as a way to cope with grief and despair associated with the loss of a loved one, they may need to obtain counseling to learn more appropriate ways to cope with those feelings. Once the feelings are resolved, the "need" to self-medicate with alcohol fades away, and the alcohol abuse ends. Or if a person drinks a lot before and/or during social occasions to deal with low self-esteem and insecurity associated with being around people, they can get psychological help to feel better about themselves and become more confident in their ability to interact with others.

Alcoholics don't have the option of setting limits and sticking to them through will power. They may try many times to control their drinking, and will most likely succeed some of the time, but at least occasionally they will fail. They will drink more than they planned, and they will experience negative consequences associated with drinking. This is true even if they attend counseling to deal with problems and get help to develop positive self-esteem. Therefore, their only real solution is to abstain from alcohol and drugs and find recovery from dependence.

The following table provides a simplified use-abuse-dependence continuum that summarizes these differences:

USE

ABUSE

Addiction (Dependence)

Responsible use

Use to enhance the pleasure of normally pleasurable situations

No negative consequences or problems

No unpredictability

No limit setting needed or made

No one complains about use

Solution: none required
Possible reasons for transition from use to abuse:

Life problems

Poor coping skills

Peer pressure

Immaturity

Mental illness

Habit
Intentional overuse

Bad choices in cases of celebration, anxiety, despair, or ignorance

Negative consequences & problems

No unpredictability

Successful limit setting

Some complaints about use

Solution: moderation
Possible reasons for transition from abuse to dependence

Neurobiology

Brain chemistry

Genetic predisposition

Excessive use: Neuroadaptation
Impaired control over use

Loss of control caused by a dysfunction in the brain's pleasure pathway

Recycled negative consequences & problems

Unpredictability

Unsuccessful limit setting

Complaints about use

Solution: abstinence & recovery


A section on this web site named Where to Get Help provides numerous resources at UT, in Austin, in Texas, and on the Web for getting help with alcohol and drug abuse and dependence.
Click here to access that page:

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