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Exactly what is "Substance Abuse" – and how does it differ from "Substance Dependence? To begin with, I will present the clinical definitions and then examine and discuss some of the common indicators and consequences of taking these drugs on a regular basis. These are taken from The Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

There are accepted criteria that are used to determine "Abuse" and "Dependence."  I will present these in some detail as they represent the major warning signs that you should be aware of.

Some of the major criteria are;

Tolerance:  The body has a way of quickly adapting to most drugs that are taken. After a short period of time, the effects that you got from taking one pill – now requires two for the same effect. Soon three becomes four – then five – and at some point, injection is needed. I know some of you are thinking, "Oh – I would never touch a needle!" Really? Ask any of the kids or adults with needle marks on their arms if they ever thought they would use a needle. You will be surprised. Since most of the drugs that are abused have harmful effects on the body, this rapid escalation of intake caused by tolerance poses serious risks. We will discuss the effects of some of the more common abused drugs later in another article.  

In my experience, it was not unusual to see a teenager who started out taking one of his parent's Xanax to end up taking 30-40 pills a day! By the way, tolerance does not slowly build up over years, but literally happens in weeks and months. How far can tolerance go? It depends on the drug and the person. Basically it can continue until a major body system finally breaks down from the strain. I remember one 18 year old male that was on $500 of cocaine, $200 of heroin, Morphine injections if he could get them, 20-30 Oxycodone tablets, beer, pot, and 10 Xanax tablets – A DAY! He died of cardiac arrest before he could enroll in a treatment program.

Withdrawal:  The physical and emotional consequences of suddenly stopping the intake of abused drugs are usually devastating. These withdrawal symptoms are not imaginary, they are very real. Cardiac problems, severe muscle cramps, sweating, clinical depression, loss of body functions, headaches, and tremors – hallucinations - the list goes on. Sometimes withdrawal can be life-threatening.  

As one example, the body manufactures its own narcotic like drug called endorphins. Endorphins help keep us emotionally stable and relatively pain free. When the body senses the intake of massive amounts of narcotics, it shuts down its own manufacturing of endorphins. Then, when you suddenly discontinue the narcotics, not only do you not have the calming and other effects of the narcotic, but your endorphins are also depleted! This can result in suicidal levels of depression, physical and emotional pain. This is one of the main reasons physicians give low doses of other anti-depressant and calming drugs to opiate addicts during withdrawal. At some point "getting high" becomes almost secondary. Most opiate addicted individuals will tell you that they really do not get that "high" any more – they are just taking the drugs now in order to feel normal and avoid withdrawal! Telling someone with a serious addiction to "just quit" is a ridiculous thing to do. Most would quit if they could.

Taken in larger amounts and over a longer period of time than was intended:  I have never known a drug abuser or addict who ever thought they would end up where the drugs took them. In the beginning, everyone believes that they are different somehow, stronger, and that they can handle and control it. Most actually convince themselves that brief ventures like "only on weekends" really doesn't pose any risks. Do you know that there are documented cases with methamphetamine where literally one-time-addiction seems to have occurred! Think about that for a moment. Try it just one time – and you may be hooked! Does your teenager know facts like these?

Persistent desire and unsuccessful efforts to quit or limit drug use: This one is self-explanatory. Every addicted person either tries to quit frequently, or promises to do so. Most parents or spouses of addicts often hear, "I will never do it again...I promise!" The hard truth is that the vast majority of, addicts cannot quit and remain drug free for one year. Addiction is known for relapses and less than 7% successfully stay off drugs permanently once they have become addicted. Yes, I know that some people have quit the first time and never returned to drug abuse. Remember however, that these cases are extremely rare.

A great deal of time is spent obtaining, using, or recovering from the substance: Soon the pursuit of drugs begins to take over the life of the individual. Nothing becomes more important. Drugs are expensive and the pain of withdrawal is a powerful motivator. Avoiding reality also takes on a greater meaning as the drug life is actually a pretty miserable existence. It also becomes more difficult to recover from the recent use – harder to wake up – harder to go to school or work – you feel really lousy. Soon everything begins to revolve around drugs; drugs to help you get awake – drugs to help you go to sleep – drugs to help the tremors and headaches – drugs to help with the "crashes." These are some of the main reasons that most drug addicts use and abuse multiple drugs.

Important social or occupational activities are given up because of the drug use:  Drugs take over the life of the individual and become more important than family, job, school, or other responsibilities which suffer in major ways. The disengagement usually begins slowly and then rapidly escalates.  

The substance is used despite the knowledge of the problems being caused:  This is a really important one that usually separates out hard addiction from simple experimentation. Even though the person's life is in major disarray because of the drug use, and they know it, they continue to use the drug anyway.

Now that you have a basic understanding of the criteria, the definitions are;

A Substance Abuse  diagnosis is identified if any one of the criteria listed above is met within a 12 month period.

A Substance Dependence  (addiction) diagnosis is identified if any three of the criteria listed above are met within a 12 month period.

So – being arrested on New Year's Eve for driving under the influence of Lortab – and it doesn't happen again that year – would be classified as "abuse". Knowing that it is a problem (being in jail helps you figure that out) – and doing it over and over again that year would probably classify you as being "dependent."

You should realize that I have presented these criteria in a very basic way. The actual diagnosis is always a bit more complicated. For example, severe physical withdrawal is weighted more heavily toward a diagnosis of dependence than simple social isolation.

One additional issue that parents, teens, and users need to be aware of is "cutting". Almost no drug is sold on the street (especially heroin) in a pure form as they are extremely toxic and would probably – and do - kill the user. So drugs are often "cut" with another substance to make more of the product (more money) and/or to enhance the effect.  

In a study in Michigan that I was involved in, users were sent to "their most reliable dealer" to purchase a wide variety of drugs. The drugs were then sent to a police lab for analysis. 100% of the drugs were not what they were claimed to be – or were cut with dangerous chemicals. Common chemical additives that were found were formaldehyde, PCP, battery acid, baking soda, and various animal tranquilizers. Marijuana was almost always sprinkled with PCP.  

It should be obvious that a drug dealer is the last person that you should ever trust for delivering a safe product! These people would sell their own family poison if it would make money and help supply their own drug use. You may think that last statement is an exaggeration – it is not. I have seen it happen. There is an inherent risk every time you take an illegal drug – a risk that could cost you your life. There are companies now in foreign countries that make and sell to drug rings common pills (Lortab, Xanax, etc.) that are absolute duplicates of the real thing. The packaging, bottles – everything looks very real. Even a pharmacist cannot tell the difference. They must be sent to a lab to determine their authenticity. These drugs are cut with all manner of dangerous ingredients. Sadly, few teens ever think about this hard fact.

If your family member is still in the experimental or even the abuse stage, you have a chance at success using the techniques listed in my earlier columns on substance abuse.  

Once they reach the stage of actual dependence (addiction), you will need the direct help of a trained professional. Forget the self-help books and other garbage you see advertised at that point. I will not smooth this point over. Even with the help of a trained professional, a good treatment program, and a drug-savvy physician – it will still be a hard and difficult struggle for the entire family. Make no mistake about it, addicts will lie to you, they will steal from you, they will beg you to rescue them just one more time, they will try and make you feel guilty, and they will even sell themselves on the street if they need to. Oh yes they will if that's what it takes to get the drugs!  

Getting them to admit to the problem and take the first step toward treatment is often the most difficult task for the family. You may have to quit giving them money, bailing them out of jail, ignoring their stealing, making excuses for them at school, letting them lay around the house and not work or go to school. That is called "enabling" and only makes the bad situation worse and prolongs the agony for everyone. That's the "tough love" you often hear about. Sometimes it takes really hitting the bottom for them to recognize that maybe they need to change what they are doing! Sometimes you have to get out of the way (stop enabling) and let them hit that bottom.

As I wrote this column, I realized that there is some more information that probably should be presented. It would be helpful for you to know the basic effects of the various types of drugs to help you know what to look for - and to realize what may be going on with your child.

So there will be a Part 4 of this series next week where these major drug types and the more common symptoms of their use will be presented.

Although it may be just the adolescent that falls into the trap of drug use, it takes the efforts and commitment of the entire family to heal them.  

Now you should know why early recognition and intervention are so very important.  

About The Author
James is a Masters level Child Psychologist and Internationally Certified Alcohol and Drug Counselor who has worked with distressed families for 40 years. He is the author of the Seamus the Sheltie series of children's books that were designed to assist parents in discussing difficult issues with younger children. Both books have received multiple national awards from parenting organizations. Mr. Beverly has written and published articles on parenting in a variety of media.

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