Abuse of a chemical leading to a worsening condition or disease requiring clinical treatment, as evidenced by one or more of the following symptoms:
Periodic use of a chemical that makes it impossible to fulfill important social obligations, such as: study, work or manage a household (for example, systematic absences of work related to substance use, absenteeism, prolonged non-attendance children or household).
Periodic use of a chemical in situations where it is life threatening (for example, driving a car or working on a machine while intoxicated).
Periodic legal problems associated with substance use (for example, arrests for unlawful acts committed under the influence of a chemical).
Prolonged use of a chemical, despite constant or regular social or interpersonal problems caused or aggravated by this substance, for example, disputes with the spouse (s) about the consequences of intoxication, fights).
These criteria should not overlap with the criteria for determining dependence on a given chemical substance.
“Unlike others, he (a heroin addict) cannot find a job, make a career, engage in meaningful activities around which he could build his life. Instead, he relies on his habit in everything.”
Psychologist Isodor Chain
Drug tolerance and withdrawal
Among the criteria for dependency in the DSM-4 is tolerance. Another new term is abstinence syndrome. Abstinence is a disease caused by the discontinuation of drug use or its reduction after the body is so accustomed to the presence of the drug in it that can no longer function without it. Clearly defined withdrawal syndrome does not cause all drugs. Abstinence symptoms may be stronger or weaker depending on the individual characteristics and the duration of the drug. Psychological symptoms, such as irritability, depression, and persistent desire for a drug, are usually part of an abstinence syndrome. It depends on their presence or absence whether a person can stop using drugs for a while.
Impact of drug use, tolerance and withdrawal on behavior
In this introductory chapter, attention was drawn to tolerance and withdrawal because these are central problems in psychopharmacology. Without them, the study of the drug and the evaluation of its action are impossible. Detailed consideration of these issues can be found in the following chapters. Now it is important to note that tolerance and abstinence affect the nature of drug use. For example, if tolerance increases, then a person needs to consume an increasing amount of the drug to get the desired effect. This in turn leads to the fact that a person spends more time on the acquisition and use of drugs. In the end, an increase in the number and frequency of drug use leads to the emergence of new physical, social and other problems.
Similarly, withdrawal leads to continued drug use, and most often in high doses. Studies have shown that the desire to get rid of withdrawal symptoms is a powerful incentive for further use of the drug. Abstinence begins when the level of the drug in the blood falls. If a drug is taken at this point, the withdrawal symptoms will disappear. But they will reappear and cause a vicious circle: the use of a drug – withdrawal – again the use of a drug.
The study of the mechanisms of action of tolerance and abstinence is the basis of psychopharmacology, which is looking for incentives for human consumption (or other living beings) of drugs. In Chapter 5, devoted to the principles and methods of psychopharmacology, this issue will be considered in detail.
We have shown that prolonged drug use changes the very nature of this use. The DSM-4 criteria specifically stipulate this duration. Tolerance and abstinence not only lead to changes in the production and consumption of drugs, usually their result is a jumble of one effect on another – the effect of a snowball. In the end, they are added phenomena that fall under other criteria for the diagnosis of diseases caused by drug use.