Date of this Version
Court Review, Volume 46, Issues 1-2, 24-29
Drug and alcohol use is a widespread and serious problem among pre-teens and adolescents in virtually all developed countries, and substance use disorders are among the most prevalent mental health problems in high-risk adolescents and young adults. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) specifies diagnostic criteria for two levels of substance use disorders —substance abuse and substance dependence. Substance abuse is defined by a period of at least 12 months of continued use of a specified substance in conjunction with negative consequences such as failure to fulfill life obligations (e.g., repeated absence or poor performance at work or at school, repeated suspensions or expulsions from school, neglect of children or household), legal problems (e.g., arrests for substance-related disorderly conduct), recurrent substance use in situations in which it is hazardous (e.g., driving a car while impaired), and/or other significant social problems (e.g., physical fights, arguments with romantic partners or parents related to intoxication). Substance dependence, the more serious of the two diagnoses, is marked by the development of tolerance for a particular substance (i.e., addiction or needing increased amounts to experience intoxication or desired effects) and/or withdrawal symptoms when not using the substance. Additional symptoms include spending a great deal of time on activities necessary to obtain the substance and/or recover from its effects, experiencing a persistent desire for the substance, and experiencing unsuccessful attempts to cut down and/or continuing to use despite the knowledge of the harmful effects. Unlike other diagnoses in the DSM-IV-TR, substance abuse and substance dependence do not require an age cut-off, which means that youth of any age can be diagnosed with these disorders.