PHMC - Policies

Addiction: Substance Abuse & Dependency

 

Effective Date: June 25, 2008

College Contact: Dr. Janet L. Wright, Assistant Registrar

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There are a number of differing definitions for the disease of addiction. Currently the most relevant ones in North America are those of the American Society for Addiction Medicine and the Canadian Society of Addiction Medicine who share a common agreed upon definition.

The only other definition is that of the World Health Organization (WHO). For legal purposes, the most widely recognized definitions are those of the DSM 4. The DSM does not contain a definition of Addiction per se, but rather gives definitions of Substance Abuse and Substance Dependence. The latter being the closest to a definition of Addiction.

CSAM and ASAM Definition of Addiction

A primary, chronic disease, characterized by impaired control over the use of a psychoactive substance and/or behaviour. Clinically, the manifestations occur along biological, psychological, sociological and spiritual dimensions.

Common features are change in mood, relief from negative emotions, provision of pleasure, pre-occupation with the use of substance(s) or ritualistic behaviour(s); and continued use of the substance(s) and/or engagement in behaviour(s) despite adverse physical, psychological and/or social consequences. Like other chronic diseases, it can be progressive, relapsing and fatal.

World Health Organization Definition of Addiction - Drug or Alcohol

Repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict):

  • is periodically or chronically intoxicated
  • shows a compulsion to take the preferred substance (or substances)
  • has great difficulty in voluntarily ceasing or modifying substance use
  • exhibits determination to obtain psychoactive substances by almost any means.

 

Typically, tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted. The life of the addict may be dominated by substance use to the virtual exclusion of all other activities and responsibilities. The term addiction also conveys the sense that such substance use has a detrimental effect on society, as well as on the individual; when applied to the use of alcohol, it is equivalent to alcoholism.

Addiction is a term of long-standing and variable usage. It is regarded by many as a discrete disease entity, a debilitating disorder rooted in the pharmacological effects of the drug, which is remorselessly progressive.

From the 1920s to the 1960s attempts were made to differentiate between addiction ; and "habituation", a less severe form of psychological adaptation. In the 1960s the World Health Organization recommended that both terms be abandoned in favour of dependence, which can exist in various degrees of severity. Addiction is not a diagnostic term in ICD-10, but continues to be very widely employed by professionals and the general public alike. See also: dependence; dependence syndrome

DSM definitions of Abuse and Dependence - Substance Abuse - a medical diagnosis, as specified in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV).

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 

  • recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) 
  • recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
  • recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 
  • continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

 

The symptoms have never met the criteria for Substance Dependence for this class of substance.

Substance Dependence - a medical diagnosis as specified the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV)

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 

  • tolerance, as defined by either of the following: 
  • a need for markedly increased amounts of the substance to achieve intoxication or desired effect 
  • markedly diminished effect with continued use of the same amount of the substance 
  • withdrawal, as manifested by either of the following: 
  • the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances) 
  • the same (or closely related0 substance is taken to relieve or avoid withdrawal symptoms 
  • the substance is often taken in larger amounts or over a longer period of time than was intended 
  • there is persistent desire or unsuccessful efforts to cut down or control substance use 
  • a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recovering from its effects 
  • important social, occupational, or recreational activities are given up or reduced because of substance use 
  • the substance use is continued despite knowledge of having a persistent of recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induce depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

 

The policy of the College of Physicians and Surgeons of Alberta will be to adhere to the DSM definition of Substance Dependence in mandating treatment to addicted physicians. This diagnosis should be included in any assessments performed for the CPSA. It is upon the diagnostic criteria of the DSM 4 that the diagnosis will be made and treatment and maintenance and monitoring programs mandated. 

                 

Contact

Dr. Susan Ulan, Assistant Registrar
780-969-4940 or 1-800-561-3899 ext. 4940 (in Alberta)
susan.ulan@cpsa.ab.ca