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Substance abuse Substance abuse is a pattern of continued harmful use of a mood altering substance, that results in adverse social consequences, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Substance abuse may lead to addiction or substance dependence. Medicaly, dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse, but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. Dependence involves physiological proceses while substance abuse reflects a complex interaction between the individual, the abused substance and society. "Substance abuse" is sometimes used as a synonym for "drug abuse," but this usage is not universaly agreed upon, the later term usualy including any use of illicit drugs even if such use does not meet the medical definition of abuse. Diagnosis The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association defines substance abuse as: * A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household) 2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) * B. The symptoms have never met the criteria for Substance Dependence for this class of substance. Statistics As of 1999, substance abuse in the U.S. was estimated to be responsible for 590,000 deaths and 40 million injuries and illnesses annually. The total economic costs have been estimated to be close to $428 billion. It is estimated that one fourth of Americans over the age of 15 have physiological dependence on at least one substance.
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