Abuse and dependence are often used interchangeably. However, there is a very clear distinction between the two. This activity will focus on the differences between abuse and dependence.


Review the Module Notes.

Read pages 175–183, 194–196: Substance Related Disorders in the Diagnostic and Statistical Manual of Mental Disorder–IV  Download Substance Related Disorders in the Diagnostic and Statistical Manual of Mental Disorder–IV.

Read pages 481–497 in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)  Download Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Things to think about as you prepare to participate in this discussion:


What is abuse?

What is dependence?

How can we tell the difference?

After completing the readings, follow the instructions below to participate in the discussion about abuse and dependence.


Begin by answering the following questions:


What do you personally see as the difference between abuse and dependence?

Now, based on the readings, imagine you are talking to a friend about your observations of their use or abuse.

How would you explain the differences between abuse and dependence so that a clear distinction is made?


Evaluation Criteria


Your initial post should be at least 250 words and must substantively integrate the assigned readings in the instructions with proper APA (Links to an external site.) style formatting.


For assistance with APA style formatting, visit the Library (Links to an external site.) or the Excelsior OWL (Links to an external site.).


Your initial post is due by Thursday at 11:59 PM EST. Your responses are due by Sunday at 11:59 PM EST.


After you have posted, read through the postings of your peers. Choose (at least) two of your peers’ posts to respond to. The posts you choose to respond to do not necessarily have to be classmates’ initial posts.


Each response to a peer should be (at least) approximately 100 words in length and should contribute to the discussion in progress. All responses to classmates should be substantive. That is, they should go beyond simple agreement or disagreement with classmates’ posts. Also, be sure that your responses are respectful, substantive, and consistent with the expectations for discussion, as stated by the prompt. Be sure to monitor and respond to feedback to your major thread post throughout the module. Be sure also to reply to your classmates’ postings and that your responses are within the designated due dates for this discussion activity. Please direct any questions you may have to your instructor.


See the Course Calendar for due dates for posts and responses.


Consult the Discussion Posting Guide for information about writing your discussion posts. It is recommended that you write your post in a document first. Check your work and correct any spelling or grammatical errors. When you are ready to make your initial post, click on “Reply.” Then copy/paste the text into the message field, and click “Post Reply.”


This is a “post first” discussion forum. You must submit your initial post before you can view other students’ posts.


To respond to a peer, click “Reply” beneath her or his post and continue as with an initial post.




This discussion will be graded using the discussion board rubric. Please review this rubric, located on the Rubrics page within the Start Here module of the course, prior to beginning your work to ensure your participation meets the criteria in place for this discussion. All discussions combined are worth 30% of your final course grade.


Chasing Heroin

Chasing Heroin




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Module 1: Module Notes: Introduction to Abuse or Dependence



Everyone is touched by addictive behavior in some way or another. Whether you have addictive behaviors, or a loved one or a member of your community, there is no escaping the impact and outcomes of addiction.


Addictive behavior is frequently related to the use of alcohol and drugs. Much of the research has been conducted with these substances as the target. Therefore, you will be relying on much of this information. However, addictive behavior also is evidenced in other ways.


In addition to alcohol and other drugs, addictions may surface in the areas of:











And the list goes on

Your exploration of addiction will encompass these areas. You are also free to investigate other addictions in the discussions and assignments as approved by your instructor.


Module 1: Module Notes: What is Addiction?



Addiction is a broad term. It covers a range of symptoms on a continuum. Although not a clinical term, it is used freely by many professionals and laypeople to describe one’s behavior as it relates to the overuse of a substance or action.


Addiction is a very complex disease, which impacts individuals, those around them, and the society at large. It is estimated that one in four families is directly impacted by alcohol and substance abuse alone.


Professionals in the field think of it as a chronic illness. Like other chronic illnesses, we attempt to manage the illness and expect that there may be relapses along the road to recovery.


Addiction involves out of control behavior. Addicts have lost control over what they are using or doing to the point where it is now creating harm in their life. We often look at five major life areas to determine the impact:


Social, family, or relationship impacts

Legal impacts

Financial impacts

Health impacts

School or work impacts

Addictions often start out as habits. A habit is often a choice, which one can choose to stop. Habits do not have psychological and physical attachments. Addiction involves the psychological and/or physical component in which the individual has lost the ability to control the behavior. Choice does not play a role in the addiction once the behavior has taken place.


Addictive behaviors impact people regardless of race, age, socioeconomic status, sex, sexual orientation, or gender identity. However, culture does play a role in the use of various addictive substances.



Module 1: Module Notes: Introduction to the Addiction Spectrum

When you are considering an individual’s use of a substance, such as alcohol or drugs (or any of the other addictive behaviors), we see the activity on a continuum.


On one end of the spectrum, there are individuals who simply do not use these substances. On the other end of the continuum would be those who are dependent or addicted to the behavior or substance.


In between there are other often forgotten categories.


Some people are in the experimentation phase. There are individuals who may use once or twice to see what the effect is.

Following this would be recreational users. These individuals use in a casual manner, but their usage is not excessive and does not interfere with their lives.

People who abuse the substance or behavior are those who are now experiencing difficulties as a result of their usage or behavior, but still continue to use the substance or behavior.

Those dependent on the behavior or substance come next, and are considered to be using in a manner that is out of control.

Abuse and dependence are explained in detail in the next screens and in your reading of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV).



Module 1: Module Notes: Substance Abuse and Substance Dependence

The term substance abuse has very different meanings for different people. Often, the definition of abuse may be influenced by the individual’s personal experiences. This creates a problem if each individual has a unique definition of abuse. When you add substance dependence to the mix, it can become even more complex.


As you move forward in this course, you will be using the terms substance abuse and substance dependence to describe the use of alcohol as well as other drugs. These drugs may or may not be prescribed. Alcohol abuse and dependence is often separated out, given its frequency. However, each substance has its unique characteristics and so from a clinical perspective, carries its own diagnosis. Grouping all these as substance abuse or substance dependence does not minimize the unique differences between substances. Behavioral addictions such as gambling and pornography follow the same continuums.


As described by Powell in Healthy Life, Mental Fitness Guide, we can define substance abuse as the repeated use of a substance even though it creates personal distress and problems. These problems may include:


Failure to fulfill work, school, and/or home obligations

Legal problems such as disorderly conduct and driving while intoxicated (DWI)

Physical harm that results from such things as falling, car accidents, etc.  (Powell, 2001)

Substance dependence is commonly known as addiction. Substance dependence is when individuals keep using a substance even though they have developed problems related to using it. Such problems may include:


Physical and emotional craving for the substance

Need for increased amounts of the substance to reach the desired effect

Withdrawal symptoms such as hand tremors, sweating, and agitation (Powell, 2001)

An individual can be abusing a substance without being dependent or addicted to it.




What Is substance abuse and dependence? (Links to an external site.) (n.d.) Retrieved from http://wweb.uta.edu/projects/sswtech/sapvc/community/what_is_substance_abuse.htm


Module 1: Module Notes: Historical Approach to Abuse or Dependence

The use of alcohol and other drugs has been documented for centuries. The purpose of these drugs has varied—frequently it has served religious purposes and other ceremonial functions. Throughout history, there have always been people who have abused substances with a subset becoming dependent on the substance.


For example, during the Civil War, morphine was used liberally by the Union Army as an aide in medical procedures. Frequently, the soldiers would become more and more reliant on morphine—in fact, it was so widespread that the dependence was commonly known as soldier’s disease. In the south, the Confederate Army was not as able to provide morphine in medical situations. Instead, they relied on large doses of whiskey to reduce the pain of amputation.


In general, little attention was paid to abuse and dependence. Abuse was often not acknowledged and dependence was seen more as a moral failure and lack of will power. In 1935, a group of individuals suffering from alcohol dependence came together to support one another and developed the twelve-step model known as Alcoholics Anonymous. In 1956, the American Medical Association first identified alcoholism as a disease requiring treatment.


Module 1: Module Notes: Diagnostic and Statistical Manual

The American Psychiatric Association publishes the Diagnostic and Statistical Manual (DSM). This manual describes behavioral health disorders and provides a common manner for professionals to identify these disorders. Substance abuse and dependence are included in this manual. Gambling disorder is also included.


A review of the revisions of the DSM over the years shows the changing perspective of alcohol and substance abuse. For example, in DSM-II, published in 1968, there were various alcohol and substance abuse-related diagnoses. However, at that time, the diagnostic criteria was not very specific and centered around identifying damage to physical health or social/personal functioning. These were not clearly defined, leaving it up to individual clinician’s interpretation. Episodic and habitual drinking were defined in part, based on the number of times per year one became intoxicated, with no real measure of intoxication.


In 1980, DSM-III was published. This revision brought a major change in the manner in which an individual was diagnosed. Criteria for clinical diagnoses related to alcohol and substance abuse became much more objective, meaning that there was greater consistency between clinicians in actually identifying abuse and dependence. DSM-IV, published in 1994, continued in this vein.



American Psychiatric Association (2013). Alcohol use disorders. In Diagnostic and Statistical Manual of Mental Disorders, (5th ed.), pp. 481–497, Arlington, VA. Retrieved from http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2557


Module 1: Module Notes: Definitions of Substance Abuse and Dependence

The clinical definition of substance abuse as defined by the American Psychiatric Association is as follows.


A maladaptive pattern of substance use leading to clinically significant (social, occupational, medical) impairment or distress, as manifested by one or more of the following in the same 12-months period:


Recurrent substance use resulting in a failure to fulfill major obligations at work, school, or home (e.g., repeated absences, or poor work performance related to substance use; substance related absences or expulsions from school)

Recurrent substance use in situations where it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by a substance)

Recurrent substance use resulting in legal problems (e.g., arrests for disorderly conduct related to substance abuse)

The individual continues to take the substance despite knowing that it is having a significant or worsening impact on social or interpersonal problems (e.g., drinking and knowing one’s health is being impacted)

The clinical definition of substance dependence is:

A destructive pattern of substance use leading to clinically significant (social, occupational, medical) impairment or distress, as manifested by three or more of the following in the same 12-month period:


There is a need for significant increased amounts of the substance to achieve intoxication, or significant diminished effect with continued use of the same amount of the substance

The individual suffers from withdrawal symptoms within several hours to a few days after a reduction in the amount of the substance taken over a prolonged period of time. Withdrawal is manifested by either of the following:

Sweating or pulse greater than 100, hand/body tremors, insomnia, nausea or vomiting, hallucinations or illusions, agitation, anxiety and/or seizures

The individual takes the substance to relieve or avoid the withdrawal symptoms

The substance is often taken in larger amounts over a longer period of time than was intended

The individual tries to cut down or quit taking the substance, but can’t

A great deal of time is spent in activities necessary to obtain the substance and/or to recover from its effects

Important social, occupational, or recreational activities are given up or reduced because of substance use

The individual continues to take the substance despite it having a significant or worsening impact on their psychological/physical condition.



Lack, C., 2020. Abnormal Psychology: An e-text! Retrieved from https://courses.lumenlearning.com/abnormalpsychology/chapter/substance-abuse-vs-substance-dependence/


Module 1: Module Notes: Alcohol (or Substance) Use Disorder

In 2013, the DSM-V was published. Several revisions have taken place from a clinical diagnostic perspective. However, the above descriptions remain true for the distinction between less and more intense behavior.


DSM-V now groups alcohol and substance abuse disorders on a continuum called Alcohol (or Substance) Use Disorder. A distinction is made between mild, moderate, and severe levels of use. Mild correlates well with the abuse category whereas severe correlates with the dependence category.


Viewing addictions on this type of scale better reflects the progression of the disorder. As we have learned a great deal more about the impact and progression of these disorders from brain imaging studies, we have identified the continuum model.


Many of the other behavioral addictions are not yet listed in the DSM. They are currently under study for inclusion. These include addictive behaviors such as Internet addiction.



American Psychiatric Association (2013). Alcohol use disorders. In Diagnostic and Statistical Manual of Mental Disorders, (5th ed.), pp. 481–497, Arlington, VA. Retrieved from http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=2557