Substance Abuse and Addiction: Terminology and Diagnosis
9.1 Introduction There is a long-established link between substance (anything that can alter an individual’s cognition or mood) use and criminal behavior (Bradford, Greenberg, & Motayne, 1992; Tonry & Wilson, 1990). However, as we will explore in this chapter, it is important to note that there is no single substance use–crime relationship. In some instances, substance use precedes the criminal behavior. In other instances, the criminal behavior precedes the substance use. And sometimes both the substance use and the criminal behavior occur around the same time.
In addition, substances also differ in their criminogenic qualities (crime-causing potential). For example, a substance like marijuana is less criminogenic compared to a substance like heroin. However, in specific individual cases, and under certain situational conditions, mari- juana can be a highly criminogenic substance.
Substance abuse, in all its forms, impacts an enormous number of people, as well as their friends and families. Understanding the nature and extent of substance abuse allows us to make connections between substance abuse and criminal behavior.
9.2 Substance Abuse and Addiction: Terminology and Diagnosis Professionals and practitioners in a variety of fields—including psychology, criminal justice, health care, politics, and law—have tried to clarify terminology and concepts in an effort to improve public policy, professional standards, and patient care related to substance abuse (the hazardous or harmful use of substances) and addiction. As discussed in Chapter 2, in the field of psychology, the primary system that is used to diagnose mental disorders—including substance abuse and addiction—is the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the DSM-5, which was published in 2013, the American Psychiatric Association rec- ommends that the term abuse be discontinued in favor of a more informative and less stigma- tizing term. However, the term substance abuse remains the most common term in use today, especially by state and federal governments as well as researchers in the field. We’ll refer to both abuse and use throughout this chapter, using the terms interchangeably.
The DSM-5 instead characterizes substance use disorders (patterns of symptoms resulting from the use of a substance that an individual continues to take despite experiencing prob- lems as a result of the substance use) as existing on a continuum from mild (two or three symptoms) to moderate (four or five symptoms) to severe (six or more symptoms). Each specific substance is addressed as a substance use disorder (e.g., alcohol use disorder, opioid use disorder), but nearly all are diagnosed based on the same overarching criteria.
Listed below are the criteria for substance use disorder according to the DSM-5.
1. Taking the substance in larger amounts or for longer than you’re meant to. 2. Wanting to cut down or stop using the substance but not managing to. 3. Spending a lot of time getting, using, or recovering from use of the substance. 4. Cravings and urges to use the substance.
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Section 9.3 Why Do People Use Drugs?
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships. 7. Giving up important social, occupational, or recreational activities because of sub-
stance use. 8. Using substances again and again, even when it puts you in danger. 9. Continuing to use, even when you know you have a physical or psychological prob-
lem that could have been caused or made worse by the substance. 10. Needing more of the substance to get the effect you want (tolerance). 11. Development of withdrawal symptoms, which can be relieved by taking more of the