Substance abuse and substance dependence are two related but distinct terms used to describe problematic patterns of substance use. In the DSM-5, substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following within a 12-month period:
Recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
On the other hand, substance dependence is characterized by a cluster of physiological, behavioral, and cognitive symptoms indicating that an individual continues to use a substance despite significant substance-related problems. Dependence involves both tolerance (needing more of the substance to achieve the same effects) and withdrawal symptoms (experiencing physical or psychological symptoms when attempting to quit or reduce use). The DSM-5 combines substance abuse and substance dependence into a single disorder called substance use disorder, which is defined by a problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by two or more of the following within a 12-month period:
Taking the substance in larger amounts or for longer than intended
Wanting to cut down or quit but being unable to do so
Spending a lot of time getting, using, or recovering from the effects of the substance
Craving or a strong desire or urge to use the substance
Continuing to use the substance despite the problems it causes in relationships or other areas of life
Giving up important activities in favor of substance use
Using the substance even when it is physically hazardous
Continuing to use the substance despite the knowledge of its negative effects on physical or mental health
Tolerance
Withdrawal.
