Editing Substance abuse (section)

==History==

===APA, AMA, and NCDA===

In 1966, the [[American Medical Association]]'s Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of 'medical supervision':
{{blockquote|...'use' refers to the proper place of stimulants in medical practice; 'misuse' applies to the physician's role in initiating a potentially dangerous course of therapy; and 'abuse' refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior.}}

In 1972, the American Psychiatric Association created a definition that used legality, social acceptability, and cultural familiarity as qualifying factors:
{{blockquote|...as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien.<ref>{{Cite report |title=The Treatment of Drug Abuse: Programs, Problems, Prospects |last1=Glasscote |first1=Raymond M. |last2=Sussex |first2=James N. |date=1972 |publisher=Joint Information Service of the [[American Psychiatric Association]] and the [[Mind (charity)|National Association for Mental Health]] |last3=Jaffe |first3=Jerome H. |last4=Ball |first4=John |last5=Brill |first5=Leon}}</ref>}}

In 1973, the [[National Commission on Marijuana and Drug Abuse]] stated:
<blockquote>...drug abuse may refer to any type of drug or chemical without regard to its pharmacologic actions. It is an eclectic concept having only one uniform connotation: societal disapproval. ... The Commission believes that the term drug abuse must be deleted from official pronouncements and public policy dialogue. The term has no functional utility and has become no more than an arbitrary codeword for that drug use which is presently considered wrong.<ref>{{Cite report |url=https://www.ojp.gov/ncjrs/virtual-library/abstracts/drug-use-america-problem-perspective |title=DRUG USE IN AMERICA - PROBLEM IN PERSPECTIVE |last=National Commission on Marihuana and Drug Abuse |date=March 1973 |page=13 |id=NCJ 9518 |author-link=Shafer Commission |archive-url=https://web.archive.org/web/20220923030953/https://www.ojp.gov/ncjrs/virtual-library/abstracts/drug-use-america-problem-perspective |archive-date=23 September 2022}}</ref></blockquote>

===DSM===
The first edition of the [[American Psychiatric Association]]'s [[Diagnostic and Statistical Manual of Mental Disorders]] (published in 1952) grouped alcohol and other drug abuse under "sociopathic personality disturbances", which were thought to be symptoms of deeper psychological disorders or moral weakness.<ref>{{Cite web |url=http://www.substancedrugabuse.com/tag/drug/ |title=Transformations: Substance Drug Abuse |access-date=2013-04-20 |archive-date=2012-11-01 |archive-url=https://web.archive.org/web/20121101103435/http://www.substancedrugabuse.com/tag/drug/ |url-status=dead }}</ref> The third edition, published in 1980, was the first to recognize substance abuse (including drug abuse) and [[substance dependence]] as conditions separate from substance abuse alone, bringing in social and cultural factors. The definition of dependence emphasised tolerance to drugs, and withdrawal from them as key components to diagnosis, whereas abuse was defined as "problematic use with social or occupational impairment" but without withdrawal or tolerance.

In 1987, the [[DSM-III]]R category "psychoactive substance abuse", which includes former concepts of drug abuse is defined as "a maladaptive pattern of use indicated by...continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous". It is a residual category, with dependence taking precedence when applicable. It was the first definition to give equal weight to behavioural and physiological factors in diagnosis. By 1988, the DSM-IV defined substance dependence as "a syndrome involving compulsive use, with or without tolerance and withdrawal"; whereas substance abuse is "problematic use without compulsive use, significant tolerance, or withdrawal". Substance abuse can be harmful to health and may even be deadly in certain scenarios. By 1994, the fourth edition of the DSM issued by the [[American Psychiatric Association]], the DSM-IV-TR, defined substance dependence as "when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed", along with criteria for the diagnosis.<ref name="DSM4">{{Cite book |url=https://www.worldcat.org/oclc/43483668 |title=Diagnostic and Statistical Manual of Mental Disorders : DSM-IV-TR. |date=2000 |publisher=[[American Psychiatric Association]] |isbn=9780890420249 |edition=4th TR |location=Washington, DC |oclc=43483668}}</ref>

The DSM-IV-TR defines substance abuse as:<ref name="fn_3">{{Cite book |last=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders : DSM-IV |title-link=Diagnostic and Statistical Manual of Mental Disorders |date=1994 |isbn=9780890420614 |edition=4th |volume=152 |location=Washington, DC |language=en |doi=10.1176/ajp.152.8.1228 |issn=0002-953X |oclc=29953039 |author-link=American Psychiatric Association}}</ref>

:*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:
::*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)
::*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)
::*Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
::*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)
:** the symptoms have never met the criteria for substance dependence for this class of substance

The fifth edition of the DSM ([[DSM-5]]), was released in 2013, and it revisited this terminology. The principal change was a transition from the abuse-dependence terminology. In the DSM-IV era, abuse was seen as an early form or less hazardous form of the disease characterized with the dependence criteria. However, the APA's ''dependence'' term does not mean that physiologic dependence is present but rather means that a disease state is present, one that most would likely refer to as an addicted state. Many involved recognize that the terminology has often led to confusion, both within the medical community and with the general public. The American Psychiatric Association requested input as to how the terminology of this illness should be altered as it moves forward with DSM-5 discussions.<ref>{{Cite journal|last1=Hasin|first1=Deborah S.|last2=O'Brien|first2=Charles P.|last3=Auriacombe|first3=Marc|last4=Borges|first4=Guilherme|last5=Bucholz|first5=Kathleen|last6=Budney|first6=Alan|last7=Compton|first7=Wilson M.|last8=Crowley|first8=Thomas|last9=Ling|first9=Walter|date=2013-08-01|title=DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale|journal=[[The American Journal of Psychiatry]] |volume=170|issue=8|pages=834–851|doi=10.1176/appi.ajp.2013.12060782|issn=0002-953X|pmc=3767415|pmid=23903334}}</ref> In the DSM-5, substance abuse and substance dependence have been merged into the category of [[substance use disorders]] and they no longer exist as individual concepts. While substance abuse and dependence were either present or not, substance use disorder has three levels of severity: mild, moderate and severe.<ref>{{Cite book |url=https://www.worldcat.org/oclc/830807378 |title=Diagnostic and Statistical Manual of Mental Disorders : DSM-5. |date=2013 |publisher=[[American Psychiatric Association]] |isbn=9780890425558 |edition=5th |location=Arlington, VA |language=en |issn=0950-4125 |oclc=830807378 |issue=3}}</ref>