Focusing on what exactly can be called harmful use of drugs or use associated with harmful effects for a person taking drugs, or for other people. The research on the cost of health care uses the terms “drug abuse” and “alcohol abuse.” However, as already noted, different people put different meanings in the concept of “abuse”. This problem greatly complicates cooperation in the study of drug use. The lack of standard definitions slows down the growth of scientific knowledge. If we cannot figure out what it is that we want to study, it is hardly possible to move forward.
In the United States and other countries, people responsible for health care have solved the problem of definitions by developing diagnostic systems. The diagnosis is based on a group of symptoms, indicated in one word. This gives us an advantage. For example, if two doctors talk about pneumonia, while using a single diagnostic system, each of them clearly understands what the other means by the word “pneumonia”. He means above all a certain group of symptoms. A similar diagnostic system can be created for mental illness. In the US, the organization responsible for creating such a system is the American Psychiatric Association (ARA). Since the beginning of the 50s. The association publishes official diagnostic systems for various mental illnesses or disorders: Diagnostic and Statistical Manual (DSM). In the light of new research, these systems are reviewed from time to time. The latest version of the official diagnostic system was released in May 1994 and is called the DSM-IV. It has a section on chemical use disorders (that is, alcohol and other drugs), which contains definitions of chemical dependency and chemical abuse.
Table 1-1 gives the criteria for making a diagnosis of chemical dependence and abuse according to DSM-4. It is necessary to comment on these criteria. Basically, each criterion is applicable to the definition of dependence and abuse of any drugs and non-medical drug groups. Another important observation is that dependence and abuse are different diagnoses. It is impossible to make one person diagnoses of dependence on a chemical substance and its abuse at the same time, although it is possible to combine diagnoses for different substances.
In terms of dependence, criteria 3–6 define what is called a drug habit. Its essence is that the main thing in human life is the consumption and purchase of drugs, while all other aspects of life are ignored, or much less attention is paid to them. A man uses drugs, despite the risk. He cannot stop using drugs or shorten it for any significant amount of time, even if he wants to. This phenomenon is called loss of control.
The first 2 criteria of dependence introduce two terms: tolerance and abstinence. Next, we analyze them in more detail. In the DSM-4 diagnostic system, a dependency diagnosis can be made based on one of these criteria, or without them. For a more accurate diagnosis, at least 3 of the 7 criteria are needed.
When discussing the definition of addiction given in DSM, you need to consider a widely used term: psychological addiction. Like many other terms related to drugs, a different meaning can be put into the concept of psychological dependence. Most often, psychological dependence is an emotional state characterized by a sense of urgency towards the drug, either to gain an effect associated with its use or to relieve negative feelings associated with its abuse. As you can see, this is a narrower, but less detailed definition than that given in the DSM-4, and it focuses on the desire to use a drug in order to change its psychological state or avoid unpleasant sensations.
In the criteria for the abuse of chemicals, negative events in various spheres of life (family, social, professional) related to the use of chemicals are of prime importance. In relation to abuse, 4 criteria are given, and to make a diagnosis, it suffices to reveal one of them.
These criteria, which are based on the latest developments in the field of disorders associated with the use of chemicals, remove part of the problem of the scientific study of this topic. These are clear descriptive criteria. Of course, they are not perfect and will be refined as scientific knowledge grows.