The difference between use and abuse
Alcohol or drug abuse differs from alcohol or drug use in terms of the amount of use but more importantly in terms of risks incurred by the user. [Alcohol of course is just another drug albeit a legal / decriminalized one in most countries] With alcohol or other drug use it is understood that there is a degree of risk / damage incurred by the user but this risk is minimized and controlled. So many people choose to drink alcohol occasionally and in moderation, nevertheless understanding that ANY alcohol use is correlated with an increase in both morbidity (illness period / infirmity often preceding death) and mortality (the age at which they will die decreases), as well as risk of addiction. Equally, some people choose to use illegal drugs such as methamphetamines, cocaine or heroin on an infrequent basis and in a relatively “safe” location (for example some friends who go away for the occasional weekend together a couple of times a year and use Ecstasy or cocaine in a remote location and without any need for transportation). Again, this increases the risk of immediate death as it does both morbidity and mortality risk, but the use of the drug is occasional and low intensity and the situation is at least somewhat controlled. The same is true for many of the across counter and prescription drugs that we use, but again when they are prescribed or used occasionally for reasons they were designed for we are generally prepared to take the slight increase in risk for the alleviation of symptoms or mitigation of other risks that they come with. Someone who is afraid of flying might use a prescribed benzodiazepine twice a year when they go on holiday, or someone with pain might use one of the many drugs containing codeine (an opiate) to obtain relief from an occasional severe headache or sinus infection.
Reasons for abuse
In the older versions of the psychiatric diagnostic manuals e.g. DSM-IV a clear distinction was made between drug / alcohol use and drug / alcohol abuse. Drug / alcohol abuse is seen as occurring when someone is using alcohol / drugs frequently and/or intensely (bingeing) for a protracted but finite period of time, often related to something happening in their life and thus also incurring damages / potential damages from their using. It can be a “life phase” such as students often drinking too much for a period or smoking significant amounts of cannabis and often practicing risky behaviours over and above this. Examples of this might include drinking and driving, not studying for a test or practicing unsafe sexual practices where they would normally have been more responsible. Equally, drug / alcohol abuse might occur after a significant event in the form of a maladjusted coping response. So it is not uncommon for someone going through divorce to increase their alcohol consumption or increase their Ritelin use beyond their script, generally with functional risks incurred such as poorer sleep, increased health risks, poorer work performance, and/or inebriated driving. In general alcohol / drug abuse, while high risk and sometimes fatal is a phase that can last weeks to years but that the drug abuser ultimately finds their way out of, generally because of a shift in life circumstance. The student smoking cannabis daily gets a job and thus might cut back dramatically so that they can perform at a level similar to their colleagues, or the divorcee meets someone new and thus settles into the joys of a new romance embracing more “socially acceptable” consumption levels and behaviours surrounding alcohol use.
The third category of alcohol / drug use is called alcohol / drug dependence (addiction) and is described here.
In the psychiatric Diagnostic and Statistical Manual 5 (DSM-V) all maladaptive drug / alcohol use problems are (perhaps unhelpfully) thrown together under Drug Use Disorder (eg. Cocaine Use Disorder or Alcohol Use Disorder). Each of these alcohol or drug use disorders is a Prescribed Minimum Benefits (PMB) condition in South Africa, which means that if you are on a medical aid then (and irrespective of the quality of your medical aid plan) they need to grant you 12 outpatient psychotherapy sessions (at their normal rate).
There are four relevant categories pertaining to Alcohol and Drug Abuse:
