Talk:Substance abuse

From Wikipedia, the free encyclopedia
Jump to: navigation, search
WikiProject Medicine / Psychiatry (Rated B-class, Mid-importance)
WikiProject icon This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 Mid  This article has been rated as Mid-importance on the project's importance scale.
Taskforce icon
This article is supported by the Psychiatry task force (marked as High-importance).
WikiProject Disability (Rated B-class, Low-importance)
WikiProject icon Substance abuse is within the scope of WikiProject Disability. For more information, visit the project page, where you can join the project and/or contribute to the discussion.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 Low  This article has been rated as Low-importance on the project's importance scale.

Suggested Addition on Special Populations[edit]

I have come up with an addition for this section addressing substance abuse in older adults and how they tend to transition into alcohol and prescription drug abuse. It discusses how this group (65+) is responsible for one-third of prescription drug sales and how these drugs can be abused. In addition, this group can be more susceptible to withdrawal symptoms and additional side-effects due to the mixing of alcohol and drugs. Any suggestions or problems? — Preceding unsigned comment added by Sankaria14 (talkcontribs) 22:34, 7 December 2014 (UTC)


why does the first sentence in the signs and symptoms paragraph say drug misuse instead of drug abuse? Is it because the definition of drug misuse is above it? I'm going to change it, if you have any problem with it go ahead and change it back but tell me why here (talk) 16:13, 12 August 2010 (UTC)

Responsible drug use[edit]

I'd like to make the following notes, though not sure what if any additions I can personally make above and beyond. More secificaly, my notes may be jurisdiction dependant.

1: The Majority of chemical drugs are not 'illegal' they are prohibited. for instance: Heroin is actually proscribed to some people, and not just for people who are dependant on it. 2: The misuse of drugs act [UK] (which came out of an international treaty) is based on 'misuse' being not of medical use, and so defines 'recreational' as not of medical use. Legal cases in the UK have been based on the idea of medical necessity, that is there was no suitable alternative available. and that serious harm would otherwise be caused. 3: I don't know anyone who's been coded this way for nicotine dependence, nor food dependence / abuse. —Preceding unsigned comment added by (talk) 19:34, 22 November 2010 (UTC)


Substance abuse is simply another euphemism for addiction. Tobacco for example has an 85% acquire rate which means for every 100 who smoke 1 cigarette will become dependent on tobacco. Ethanol is the active ingredient in beer, wine and spirits and the cessation rate is dismal at about 1 in 36.

This article smacks of prohibition when addiction should be recognized as a medical problem. Addiction is hard to treat, a jail cell is not treatment. My IQ >> 160 (talk) 01:23, 21 March 2011 (UTC)

Please use Wikipedia talk pages to improve the article. Are there verifiable and reliable sources to improve the article to show various points of view, while maintaining a neutral point of view? tedder (talk) 01:28, 21 March 2011 (UTC)

‘Substance’ use[edit]

The article’s use of ‘substance’ strikes me as bizarre
Does it represent denial that ethanol and nicotine are drugs, and generally muddled thinking about drug use by supposed authorities?
Or am I a substance abuser, within the meaning intended by the article, because air and water are substances?
Laurel Bush (talk) 14:43, 16 August 2011 (UTC)

"Substance" is usually shorthand for "psychoactive substance" or "drug", but casts a broader net because there are many people who abuse non-psychoactive substances (e.g., performance enhancing drugs)...In addition, "substance" is preferred by some over "drug" because the latter is more of a loaded term. While I have no idea if you abuse air or water, there is some discussion of this nomenclature in the article (though it could use more clarity) that would strongly suggest your possible issues with air and water, short of hyponatraemia or psychogenic polydipsia, aren't in the category of disorders discussed in the present article. — Scientizzle 16:25, 16 August 2011 (UTC)

Seems to me:

  • The article is really about drug abuse, meaning reckless or pathological use of a substance as a drug, and includes such use of substances which may not be recognised as drugs by drug and medicines control legislation, or in common discourse (with alcohol as an example of a substance which may be abused without being recognised as a drug)
  • ’Drug substance abuse’ might be a better article title, but would create, in my mind, a quandary as to what Drug substance should be or point to
  • The title should be Drug abuse (except Drug misuse might be better)

Laurel Bush (talk) 11:36, 24 August 2011 (UTC)

Drug misuse is a different concept than drug abuse (though I'm sure one could easily ID a demarcation problem between misuse and abuse), and more commonly associated with prescription drugs rather than illegal narcotics[1], so that would not be a good title. Substance abuse or Substance abuse disorder are the only proper titles based on the family of psychiatric disorders found in the DSM IV, in my opinion, and the former is simpler. — Scientizzle 14:00, 24 August 2011 (UTC)

Laurel Bush (talk) 09:35, 25 August 2011 (UTC)

I can certainly admit that my perspective of this topic has been formed in the United States and specifically influenced by NIDA. "Drug misuse" appears to have a different usage and meaning in the UK--completely synonymous with "drug abuse" rather than slightly I said above, the terms are unfortunately somewhat ambiguous. However, the title of this article should come from an evaluation of the most prominent and relevant sources. There are two distinct questions here: "substance" vs. "drug" and "abuse" vs. "misuse" vs. "use". The article presently uses "substance abuse" as the preferred term, but synonymizes (is this even a word?) it with "drug abuse" right in the opening sentence. To determine what the reliable, authoritative sources currently use as terminology. Here's what I've found thus far...
  • DSM[2]-"Substance-Related Disorders" and specific DSM coding for "abuse"
  • MeSH[3][4]-Synonymous use of "substance abuse" and "drug abuse"
  • ICD[5]-"Mental and behavioural disorders due to psychoactive substance use"
  • NICE[6]-"Drug Misuse"
  • Australian National Drug Strategy seems to prefer "abuse"[7] over "misuse"[8] and "drug abuse" generally
  • Royal College of General Practitioners[9]-"Substance misuse" & "drug misuse"(see also doi:10.1093/innovait/inq113 in which almosst every variation of "substance/drug misuse/abuse" is used almost interchangeably)
  • There's some good discussion of terminology by the WHO[10]

    misuse, drug or alcohol Use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. The term is preferred by some to abuse in the belief that it is less judgmental.


    abuse (drug, alcohol, chemical, substance, or psychoactive substance) A group of terms in wide use but of varying meaning. In DSM-IIIR, "psychoactive substance 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 physical1y hazardous". It is a residual category, with dependence taking precedence when applicable. The term "abuse" is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. Because of its ambiguity, the term is not used in ICD-10 (except in the case of non-dependence-producing substances- see below); harmful use and hazardous use are the equivalent terms In WHO usage, although they usually relate only to effects on health and not to social consequences. " Abuse" is also discouraged by the Office of Substance Abuse Prevention (OSAP, now CSAP - Center for Substance Abuse Prevention) in the USA, although terms such as "substance abuse" remain in wide use in North America to refer generally to problems of psychoactive substance use.

    In other contexts, abuse has referred to non-medical or unsanctioned patterns of use, irrespective of consequences. Thus the definition published in 1969 by the WHO Expert Committee on Drug Dependence was "persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice"

If anyone else wants to find more sources, I'd love to see them...
My take on what I've seen thus far is that "substance" & "drug" are widely and presently treated as synonymous and interchangeable, but the DSM & ICD use of substance over drug probably justifies substance being the preferred term over drug. That is, the way the opening sentence is structured right now is perfectly fine.
The question of "abuse" vs. "misuse" vs. "use" is a little trickier. It looks to me like there's a general abandonment of any distinction between misuse and abuse and the winds may be favoring the politically correct adoption of misuse over abuse. I think there's probably enough sourcing presented right here to adequately discuss the variations in terminology. Redirects for every major term, and bolded acknowledgment in the lede is probably warranted. — Scientizzle 15:02, 26 August 2011 (UTC)

I have read through some but not yet all of the material you have presented
It looks interesting

You say the winds may be favouring ‘misuse’ over ‘abuse’
I feel it blowing somewhat the other way in UK mass media, although my personal sense of English as a language is more comfortable with ‘misuse’ (with ‘abuse’ perhaps meaning deliberate or culpable misuse, and thus a category of misuse) Still, my local NHS board does continue to employ ‘substance misuse practitioners’, and has not rebranded them as ‘abuse practitioners’
Re ‘substance’ and ‘abuse’, I guess current DSM and ICD fashion must be respected, although I see use of ‘substance’ instead of ‘drug’ as denial, or pandering to denial, that ethyl alcohol and prescribed medicines are drugs
Or perhaps it is just that we are in an area littered with semantic traps (and perhaps the article should carry a warning to this effect)

I listed ‘Drug’ in Substance a while back

Laurel Bush (talk) 10:04, 29 August 2011 (UTC)

I have twigged
since writing the above
that substance abuse is usually code
or a morally prejudiced label
for intoxication
and that drug abuse is usally code for intoxication with 'drug'-stigmatised intoxicants
of which most are easily recognised as 'abuse'-stigmatised medicines
Reminds me of homosexuality used as a diagnosis
Laurel Bush (talk) 09:53, 27 October 2012 (UTC)

This article and the one on substance use disorder should not be merged. Substance use and substance use disorder are two different issues. Also, there are further differences between substance use, substance abuse, substance dependence, and substance withdrawal. So, again, these two are separate issues and the articles should not be merged. Daniellagreen (talk) 02:41, 20 February 2014 (UTC)

What about the third one, substance-related disorder? All seems the same to me. InedibleHulk (talk) 23:14, August 16, 2014 (UTC)

Less words please[edit]

I've just trimmed quite a bit, but this article still looks very much as if someone was paid "by the word" to pad it out. Keep it tight and on track people! Snori (talk) 18:25, 4 February 2015 (UTC)

DSM Updates[edit]

The DSM section of this article needs to be updated in that substance abuse is no longer a diagnosis according to DSM-5. Abuse and dependence have been merged as 'Substance Use Disorder.' The introduction should probably mention this with a wikilink to the Substance Use Disorder page. To the first paragraph a sentence such as:

According to the recently published DSM-5 substance abuse is no longer a specific diagnosis but under the category of Substance Use Disorder, combined with Substance Dependence.

I also suggest updating the DSM criteria for diagnosis. I do not have access to that information at the time of this edit. Ktwagner (talk) 12:57, 13 October 2015 (UTC)

@Ktwagner: Just came across your comment from 2 months ago. I agree. I'm going to post about it on WP:PSYCH first to see if there's already a general consensus about updating articles to the DSM-5 in a consistent way. If anyone sees message and wants to weigh in, I just posted about it on the talk page to the psych project. Permstrump (talk) 16:26, 15 December 2015 (UTC)


The last paragraph/phrase in that subsection (about risk for lungs when inhaling) looks odd. It is not in the same style than the rest. The whole section is not about harm but about special populations. The harm to lungs from aspiration/inhalation should IMHO be mentioned elsewhere. — MFH:Talk 00:43, 13 January 2016 (UTC)


Ref does not appear to support

Extended content

Scientist's began to study addiction in 1930, and concluded that addiction was a moral shortcoming and lack of willpower, developing a strong stigma towards what caused the addiction in the first place. Those conclusions influenced society’s view on addiction, but those conclusions are no longer valid because of groundbreaking information found by scientists in the past ten years that indicate addiction is a brain disease that affects both the brain and behavior.[1]

Doc James (talk · contribs · email) 07:13, 2 December 2015 (UTC)

what do you mean by "support"? what effect is opposed to what you expected/wanted? — MFH:Talk 00:43, 13 January 2016 (UTC)


I'm concerned about the following statement in the article as of 2016-05-24: "In 2013 drug use disorders resulted in 127,000 deaths up from 53,000 in 1990." I'm concerned about the following:
  1. Do these numbers refer to the entire world? I assume so, but it wasn't clear to me.
  2. I could not find those numbers in the article cited: GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604free to read. PMID 25530442. . I checked the article and could not find 127 (as in 127,000) nor 53 (as in 53,000) nor anything else quickly scanning that supported this statement. It may be there, but I didn't find it in the 5-10 minutes I spent skimming and searching.
Could someone please fix this verbiage and the citation?
Thanks, DavidMCEddy (talk) 18:44, 24 May 2016 (UTC)
I'm not seeing the numbers in the article or the figures either. Sizeofint (talk) 21:09, 24 May 2016 (UTC)

First graph is retarded[edit]

Most addictive drug is agreed by pharmacology authorities to be tobacco. Cannabis is not physically harmful at all. LSD is probably the least addictive substance that ever existed; it's practically impossible to form dependence even if one tries (due to tolerance etc). Amphetamine is infinitely more harmful than heroin. It's like it was randomly made by an idiot who has no knowledge at all about pharmacology. I won't remove it right now because I don't have the time to add the references to support my edit, but someone who has the time and the knowledge please look into this. — Preceding unsigned comment added by (talk) 07:53, 12 February 2016 (UTC)

I don't think we say LSD is addictive anywhere in this article. I agree this article needs improvement with reliable medical sources. Sizeofint (talk) 09:01, 12 February 2016 (UTC)
Thanks for the reply. I should clarify, I was only talking about the first graph. It seems completely full of errors — Preceding unsigned comment added by (talk) 12:57, 12 February 2016 (UTC)

Adding a section on Comorbidity[edit]

It is common for individuals that abuse or misuse drugs to have other psychological diagnoses. Depression, anxiety, and psychosis are all common comorbidities. However, it is difficult to determine if the substance abuse is a primary disorder or a result of the comorbid psychological disorder. Looking at family history, onset of the substance abuse and psychological disorder symptoms, and previous treatment, can all aid in determining the primary disorder.

Individuals who have a comorbid psychological disorder often have a poor prognosis.

Additionally, substance abuse may produce symptoms that lead to a false diagnosis. For this reason, it is important that an individual maintain abstinence for 2 weeks before a psychiatric diagnosis is made.


Good idea, Mattmcgarr, and thanks for getting something started! My suggestions are below. I tried to make it how it would look in article. I took out a lot of the stuff about the primary diagnosis because I think you misinterpreted the authors’ meaning. Let me know if you want me to expand on that. Permstrump (talk) 11:18, 9 March 2016 (UTC)

Dual diagnosis[edit]

Main article: Dual diagnosis

It is common for individuals that abuse or misuse drugs to have other psychological problems.[2] The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”[3]

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated.[2] Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However since the 1980’s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider.[3] Permstrump (talk) 11:18, 9 March 2016 (UTC)

Doc James, re: your recent edit, what do you think about "It is common for individuals that misuse drugs... or It is common for individuals with substance use disorders... to have other psychological problems."? The original wording was probably clunky, but the source is talking specifically about people with disordered use. I don't believe the statement applies to everyone who uses drugs/alcohol in general. PermStrump(talk) 04:11, 15 March 2016 (UTC)
I prefer "use". It is more factual. "Misuse" implies a judgement by someone. Many people who use drugs state they do so volitionally and can stop any time they wish. They deny they misuse them. Doc James (talk · contribs · email) 04:26, 15 March 2016 (UTC)
Even if the exact quote is, "symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol."? It's not that I'm so attached to the wording of that part of that one sentence, but I would have worried that it was misrepresentation of the source. If you think still think "use" is close enough compared to the direct quote, then I'll trust your opinion. I used that quote later in the same paragraph, so maybe that's qualification enough. PermStrump(talk) 04:32, 15 March 2016 (UTC)
Yes looking at sources such as this one [11] they do use "substance use disorder" so I guess we should stick with that. Doc James (talk · contribs · email) 04:37, 15 March 2016 (UTC)
    • ^ "Drugs, Brains, and Behavior: The Science of Addiction." National Institute of Drug Abuse (NHI). 1 July 2014. Web. 10 Nov. 2015.
    • ^ a b c Lingford-Hughes, A. R., Welch, S., Peters, L., & Nutt, D. J. (2012). BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. Journal of Psychopharmacology, 26(7), 899-952.
    • ^ a b Ashley L. Peterson, BSN, BScPharm, RN. Integrating Mental Health and Addictions Services to Improve Client Outcomes. Issues in Mental Health Nursing, 34:752–756, 2013.