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Substance Dependence: Definition, Treatment & Symptoms

Instructor: Ron Fritz
In this lesson, you will learn what substance dependence is, what it looks like, and how it is commonly treated. You will also learn the DSM-IV criteria that define substance dependence.

Introduction

Think about your favorite candy bar and imagine eating one; you've just demonstrated the concept of use. Now imagine eating so many candy bars that you get sick; you've just demonstrated what is called abuse. Finally, imagine eating so many candy bars that you are diagnosed with diabetes and then imagine you still continue to eat them; you've just demonstrated what is referred to as dependence. Substance dependence can be defined as continuing to use a substance even though negative consequences result from doing it.

Why are some people able to use drugs a few times and then walk away while others continue to use despite repeated marital problems, health problems, and sometimes even imprisonment? Why do some people continue to do the same behavior even when it causes them trouble? The answer is commonly referred to as addiction.

Jung Quote

Remember the first time you ever touched a flame? The fire was hot, it probably burned you, and you learned not to do it again (hopefully). For substance-dependent individuals, although they get burned, they are unable to stop themselves from sticking their hands in the fire again … and again … and again. Seems to defy common sense, doesn't it? That's because you got burned the first time you did it. What if the first time you put your hand in a flame it felt great instead of burning? You'd be more likely to try it again, right?

Dependence

Therein lies the problem with substance dependence: you're not dependent on the drug right away. Over time, you develop a tolerance until one day you barely receive any reward at all. You remember how good it used to feel and you keep trying to recapture that first high. You may even start noticing withdrawal effects when you stop using. You have become substance dependent.

Tolerance - Behaviorism teaches that the more times you do a behavior and receive a reward; the more likely you are to try it again. Even if the reward is eventually removed, you will still continue doing the behavior hoping that the reward will return. When someone uses alcohol or illegal drugs, their body is rewarded; they get 'high.' When the reward begins to diminish, the substance abuser increases the amount of alcohol or drugs they use to achieve the same level of reward. This is referred to as tolerance.

Withdrawal - Sometimes substance dependent individuals use alcohol or drugs long enough that they develop a physiological need for their drug of choice. When this happens, not using the substance can produce unpleasant effects such as vomiting, shakes, tremors, diarrhea, and hallucinations. The symptoms that result from not taking the substance are called withdrawal effects.

Using More - Buying a larger quantity of something because it is more economical with the intention of saving part of it for later makes good financial sense. When an alcoholic or drug user habitually does this and then ends up using more of the substance than he or she intended, it is often a sign of dependence. An example would be going to the local tavern to have one or two beers and then, ten drinks later, deciding it's finally time to go home.

Persistent Desire - Sometimes alcoholics and drug addicts have the best of intentions about quitting, however, after a period of abstinence they find themselves thinking more and more about using again. Finally, unable to resist their thoughts any longer, they succumb to the temptation and begin drinking or using again. The period of abstinence may last days, weeks, months, or may only last an hour or two. The common denominator is an overwhelming desire to use or drink again.

Excessive Time - When someone first starts drinking alcohol or using drugs, it is usually only on specific occasions and often for short periods of time. Eventually the substance use occupies more and more of the individual's life. At some point, the dependent person finds themselves spending a good portion of his or her day either looking for the substance (making a drug buy), using the substance (time spent getting drunk or high), or recovering from the effects of the substance use (sleeping it off).

Important Activities - One of the signs of substance dependence is when using the substance becomes more important to the individual than other activities that he or she used to consider important. Examples can include not spending as much time playing with the children because his or her time is now spent using, missing work because the person is hung-over or recovering from the effects of substance use, and no longer exercising because there is not enough time in the day to both use drugs and to exercise.

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