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Definition of Substance Abuse

chronic alcoholic according to asam guidelines

The American Society of Addiction Medicine (ASAM) has defined a standard of care for substance abuse that is based on applying the most appropriate intensity of treatment based on an individual’s support needs.

A recent study from Addiction verifies that this is an appropriate approach to treatment, as more severe levels of addiction respond better to higher-intensity treatment, while less severe substance abuse issues respond more to lower levels of treatment.

The ASAM guidelines, in turn, are based on the organization’s specific understanding of substance abuse and addiction. Entry to the lowest level of treatment is based on applying the definition through assessment of the individual’s degree of substance use. If substance abuse is not determined to be present, treatment is not relevant. However, there still may be tendencies toward substance abuse that call for a level of care that is below a treatment service, but still designed to intervene in substance use before abuse or addiction can develop. In order to make this determination, it is important to have a clear definition of what constitutes substance abuse or addiction, and what does not, so the appropriate intervention can be applied.

ASAM’s Definitions of Substance Abuse and Addiction

According to ASAM, addiction is a chronic disorder that affects the reward, motivation, and memory functions of the brain based on use of substances that have a psychoactive effect. Specifically, addiction results in an inability to control substance use or abstain from using drugs or alcohol. This results in changes in behavior and emotional response to stimuli related to substance use, including:

  • Inability to abstain from drug use consistently
  • Impaired control of other behaviors
  • Cravings for the substance of abuse
  • Decrease in ability to recognize the personal problems that have arisen with drug abuse
  • Dysfunction in emotional responses to situations

As with other chronic disorders, addiction cannot be cured, and it includes the potential to relapse. This means that one of the functions of treatment is to manage the symptoms of the disorder to the degree that the relapse risk is mitigated. ASAM’s placement criteria are intended to provide people with the treatment intensity most appropriate for the individual’s level of substance abuse or addiction, and motivation or readiness for change.

Still, not all substance abuse is addiction. When a person’s substance use is of concern but has not yet resulted in a substance abuse disorder diagnosis, it is still possible to provide intervention to prevent further development of substance abuse and the potential for addiction. While this is not explicitly considered to be treatment, this intervention is a part of ASAM’s continuum of care.

Early Intervention for Substance Abuse

According to the ASAM Continuum, there is a level of care designated at Level 0.5, called early intervention. This type of intervention is provided for those who are at risk of developing problems related to substance use or for those who are not yet able to be diagnosed with a substance use disorder, for one reason or another.

Information from the Association for Addiction Professionals defines this level of care as providing tools for assessment to help determine whether addiction is actually present, or offering education about substance abuse that may help the individual make a decision to avoid continued substance abuse. Through this level of care, some instances of addiction may be able to be avoided before they start.

As a part of the continuum of care, this level can lead to stepping up care if the criteria for treatment do develop. For people who have the risk of developing substance abuse problems or addiction, continued observation and assessment can lead to the application of the appropriate level of treatment should the need arise.