This document discusses alcohol use disorder and its effects. It defines the criteria for substance abuse versus substance dependence based on the DSM-IV. Substance abuse involves recurrent substance use that causes failure to fulfill major roles, being physically hazardous, legal problems, or persistent social problems. Substance dependence involves tolerance, withdrawal symptoms, a persistent desire to use, unsuccessful efforts to cut down, spending a lot of time obtaining and using the substance, and continued use despite knowledge of harm. Two case examples are provided to distinguish between abuse and dependence diagnoses.

1. ALCOHOL
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2. William Shakespeare
O God, that men should put an enemy in
their mouth to steal away their brains!
That we should, with
joy, pleasance, revel, and
applause, transform ourselves into
beasts.

3. Epidemiology
• 20-40% hospital admissions
• Outpatient setting
• 100,000 deaths per year
• Alcoholics who continue drinking have a
shortened life-span of 15 years

4. Substance Abuse
• Recurrent substance use
resulting in:
– A failure to fulfill major
role
– Physically hazardous
– Legal Problems
– Persistent social problems

5. Substance Dependence
• Psychological dependence
• Physical dependence
– Tolerance:
– Withdrawal

6. Substance Dependence
Psychological craving

7. Substance Dependence Tolerance
A state in which a person no longer responds
to a drug as they did before, and a higher
dose is required to achieve the same effect.

8. Substance Dependence
Withdrawal
A period during which somebody addicted to a drug or other
addictive substance reduces their use or stops taking
it, causing the person to experience painful or
uncomfortable symptoms
OR
A person takes a similar substance in order to avoid
experiencing the effects described above.

9. Substance Dependence
– Unsuccessful efforts to
cut down
– Time spent obtaining
the substance
– Continued use despite
negative effects

10. DSM IV criteria for substance dependence
Three or more of the following occurring at any
time during the same 12 month period:
– Tolerance
– Withdrawal
– Substance taken in larger amounts over time
– Persistent desire and unsuccessful efforts to cut down or stop
– A lot of time and activities spent trying to get the drug
– Disturbance in social, occupational, or recreational functioning
– Continued use in spite of knowledge of the damage it is doing to
the user or others
(DSM-IV-TR, American Psychiatric Association, 2000.)

11. Substance Abuse
• Compare that to Substance Abuse
• Recurrent substance use resulting in:
• –A failure to fulfill major role
• –Physically hazardous
• –Legal Problems
• –Persistent social problems

12. Abuse or Dependence?
• Mrs. J is a principal of your local middle school. Her employees
often complain that she is late to work and have noticed that she is
no longer driving her car. Her neighbor is driving her to work. The
president of the PTA has angrily written to the supervisor that she
has only attend two of the five PTA meetings. What is her most
likely diagnosis?
• Mrs. L is the principal’s assistant. Her husband left her two years
ago and she has not adjusted to being a single mother or living
alone. She found that she could drink a glass of wine at night to
help her sleep after her husband left. Over time she has gradually
increased her consumption to four glasses. She was not able to
drink wine last night as she had to attend the PTA meeting because
of the principle’s absence. This morning, she has a headache, feels
nauseas and anxious. What is her most likely diagnosis?