Substance Abuse

Substance abuse has a substantial and reciprocal impact upon families. There are many definitions of substance abuse and dependence but two authoritative sources are the fourth edition of the Diagnostic and Statistical Manual (DSM-IV-TR) (American Psychiatric Association 1994), commonly used in the United States, and the tenth edition of the International Classification of Diseases (ICD-10) (World Health Organization 1992). The criteria for alcohol abuse in the DSM-IV-TR include drinking despite recurrent and significant adverse consequences due to alcohol use. A diagnosis of alcohol dependence emphasizes a set of psychological symptoms (e.g., craving); physiological signs (e.g., tolerance and withdrawal); and behavioral indicators (e.g., use of alcohol to relieve discomfort due to withdrawal). Unlike the DSM-IV-TR, the ICD-10 does not include a category alcohol abuse, but rather uses the term harmful use, created so that problems related to alcohol use would not be underreported. Harmful use implies use that causes physical or mental damage in the absence of dependence (National Institute on Alcohol Abuse and Alcoholism 1995).

One of the limitations of these classifications (particularly with the DSM-IV-TR) is the lack of attention to cultural variations in the diagnosis of substance abuse (Tang and Bigby 1996). Around the world, substance use and abuse take on different meaning and importance. For example, there are different cultural norms about the legal drinking age. The legal age for purchasing alcohol in many European countries is sixteen years (in Denmark it is fifteen) (Eurocare 2001). Among indigenous groups, alcohol and other drugs may be integrated parts of tribal and community existence (Charles et al. 1994) where conventional definitions of abuse and dependence may be not be held. The definitions of substance abuse used in this entry tend to reflect the conventions of the nonindigenous cultures of North America because most of the research cited tends to use the DSM in its various editions. However, to maximize a cross-cultural perspective, multicultural and international studies are also referenced.

The emphasis in this entry is on reporting the evidence base for understanding substance abuse and the family. Popular but evidence-limited notions of the cause, effect, or treatment of substance abuse will not be included.