Alcohol and Drugs
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Substance Misuse & Dependency

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What is harmful use?


  • It is the harmful use of substances e.g. alcohol
  • It is drug use with serious physical, psychological or social consequences for the user and those around them.
  • Harm can be associated with acute intoxication and hazardous use e.g. binge drinking

Issues in defining misuse


  • There is a lack of clarity and consistency related to defining and understanding substance use e.g. compare alcohol/Class A drug use.
  • Terms acquire negative and stigmatizing connotations e.g. abuse, addict, addiction, therefore fall out of usage
  • Negative attitudes to substance misuse and people who misuse substances is identified as a potential barrier to working effectively with this group [Norman and Ryrie, 2004]

What is Dependence?


  • A strong desire or sense of compulsion to take the substance
  • Difficulties in controlling substance taking behaviour in terms of its onset, termination or levels of use.
  • Physiological withdrawal
  • Evidence of Tolerance. Increased doses in order to achieve effects originally produced by lower doses.
  • Progressive neglect of alternative pleasures or interests.
  • Persisting with substance use despite clear evidence of overtly harmful consequences. [ICD 10 1992]

Dependence is diagnosed if 3 or more have been present together during the previous year.

Reasons associated with substance misuse


Causes are multiple, varied and inter-related:

  • Biological; genetic predisposition and hereditary factors.
  • Personality/Psychological Factors.
  • Enjoyment.
  • Age.
  • Gender.
  • Curiosity.
  • Risk Taking.
  • Peer pressure.
  • Locus of Control, [Rotter 1966].
  • Availability and accessibility.
  • Social, Economic and Cultural, Environmental Factors.
  • Educational Disturbance.
  • Family Disruption.
  • Self-Medication.
  • To manage (negatively) ‘Stress’.

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