The use of alcohol and other drugs is a multifaceted phenomenon, varying with the individual’s level of use and the dysfunction experienced as a result of that use. In brief, the four stages of addiction to alcohol and other drugs are experimentation, social/regular use, problem/risky use, and finally, dependence.
Stage 1: Drug Experimentation
Drug experimentation is defined as the use of alcohol or illicit/mood-altering drugs at any time for experimentation. While in and of itself experimentation may not appear to be abusive, even a single episode of experimentation can result in substantial harm to self or to others. Examples of potentially harmful experimentation include using any alcohol or other drugs during pregnancy, which could result in harm to the fetus; experimental use of alcohol or drugs while driving, which could result in serious harm to the user as well as others; children may be injured when left unsupervised while a parent is intoxicated. Also, if experimental use continues or serves as a gateway to additional use (as it often does), patterns of alcohol/ drug abuse may develop.
Stage 2: Social Drug Use, Regular Use
Social drug use is the use of any drug or combination of drugs in social situations, or for social reasons. If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse. Social use of alcohol or other drugs often leads to further and elevated use.
Alternatively, those with strong tendencies to isolate themselves socially may move from experimentation to regular use in the absence of social situations.
Stage 3: Problem Use, Risky Use
Examples of problem use or risky use of drugs and/or alcohol include binge drinking and drug abuse.
Binge drinking is heavy use of alcohol periodically. This can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others. For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence. The National Household Survey On Drug Abuse (NHSDA) defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past thirty days.
The characteristic feature of substance abuse is the presence of dysfunction related to the person’s use of alcohol or other drugs. HHS (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes substance abuse as “the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning.” Substance abuse may or may not involve physiologic dependence or tolerance. For example, use of substances in weekend binge patterns may not involve physiologic dependence; however, it may have adverse affects on a person’s and possibly others’ lives.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association is used across the medical and mental health fields for diagnosing both substance abuse and mental health disorders. According to the DSM-IV, substance abuse is “a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by” a variety of possible symptoms of impairment. Neglect of children is specifically listed as a potential symptom of substance abuse (American Psychiatric Association, 1994).
Stage 4: Addiction, Chemical Dependency
With continued use, many persons’ use or abuse of alcohol or other drugs becomes addiction: a disease in which the substances have caused changes in body, mind, and behavior. As a result of this disease, addicted people are unable to control their use of substances despite the negative consequences that occur as a result. Addiction may be a chronic, relapsing disorder and as the disease process progresses, recovery becomes increasingly difficult. Chemical dependency occurs most frequently in those who have a family history of the disease. Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a). The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms that occur when the substance is not used).
The American Society of Addiction Medicine (ASAM) describes drug dependence as having two possible components:
Psychological dependence centers on the user’s need of a drug to reach a level of functioning or feeling of well-being. Due to the subjective nature of this term, it is not very useful in making a diagnosis. Physical dependence, however, refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of alcohol or other drug use. Tolerance, dependence, and withdrawal develop differently depending on the particular substance (HHS/SAMHSA, 1994).
Source: A Report to Congress on Substance Abuse and Child Protection, April 1999