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Both Barrels:
The Devastating Comorbidity of Anxiety Disorders and Substance Abuse

(Released May 2012)

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  by J. Erick Sinkhorn  

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Substance Abuse

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The meaning of the term "substance abuse" can vary somewhat, depending on how and by whom it is applied. For example, a legal or social definition may take into account a broader set of effects and criteria than a purely medical interpretation. The latter specifically distinguishes between the infrequent or incidental use of a substance and an abusive habit that may result in dependence.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines substance abuse as:

A 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.
  • Recurrent substance use in situations in which it is physically hazardous.
  • Recurrent substance-related legal problems.
  • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (American Psychiatric Association, DSM-IV-TRM)
Spectrum of substance use
A Public Health Approach to Drug Control in Canada Health Officers Council of British Columbia, October 2005

It is no exaggeration to say the substance abuse rates are at epidemic proportions in the United States. According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health, 23.5 million Americans aged 12 or older required treatment for a drug or alcohol abuse problem in 2009 ("Treatment Statistics," NIDA). The National Institute on Alcohol Abuse and Alcoholism reports that nearly 14 million Americans, or 1 in every 13 adults, abuse alcohol or are alcoholics. Several million more are in danger of developing drinking problems as a result of their risky drinking patterns ("One in Four Children," NIAAA).

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