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Drug abuse has a wide range of definitions, all of them relating either to the misuse or overuse of a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect, or referring to any use of illegal drug in the absence of a required, yet practically impossible to get, license from a government authority (e.g., in the U.S. this is the DEA). Some of the most commonly abused drugs include alcohol, amphetamines, barbiturates, caffeine, cannabis, cocaine, methaqualone, nicotine, opium alkaloids, and minor tranquilizers. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction. Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. Public health definitions Diagram.PNG|thumb|right|400px|Source: http://www.cfdp.ca/bchoc.pdf A Public Health Approach to Drug Control in Canada, Health Officers Council of British Columbia, 2005 In recent decades, public health practitioners have attempted to look at drug abuse from a broader perspective than the individual, emphasising the role of society, culture and availability. Rather than accepting the loaded terms alcohol or drug "abuse," many public health professionals have adopted phrases such as "alcohol and drug problems" or "harmful/problematic use" of drugs. The Health Officers Council of British Columbia — in their 2005 policy discussion paper, A Public Health Approach to Drug Control in Canada — has adopted a public health model of psychoactive substance use that challenges the simplistic black-and-white construction of the binary (or complementary) antonyms "use" vs. "abuse". This model explicitly recognizes a spectrum of use, ranging from beneficial use to chronic dependence (see diagram to the right). Mass communication and vernacular usage The term "drug abuse" may be used in newspapers, television, etc. in an ambiguous, catch-all sense rather than as a medical or legal term, sometimes disapprovingly to refer to any drug use at all, particularly of illicit drugs. Medical definitions In the modern medical profession, the two most used diagnostic tools in the world, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD), no longer recognise 'drug abuse' as a current medical diagnosis. Instead, they have adopted substance abuse as a blanket term to include drug abuse and other things. However, other definitions differ; they may entail psychological or physical dependence, and may focus on treatment and prevention in terms of the social consequences of substance use. Historical positions of the American Psychiatric Association In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders referred to both alcohol and drug abuse as part of Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness . By the third edition, in the 1980s, drug abuse was grouped into 'substance abuse'. In 1972, the American Psychiatric Association created a definition that used legality, social acceptability, and even cultural familiarity as qualifying factors: …as a general rule, we reserve the term drug abuse to apply to the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien. Glasscote, R.M., Sussex, J.N., Jaffe, J.H., Ball, J., Brill, L. (1972). The Treatment of Drug Abuse: Programs, Problems, Prospects. Washington, D.C.: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health. Historical positions of the American Medical Association In 1966, the American Medical Association's Committee on Alcoholism and Addiction defined abuse of stimulants (amphetamines, primarily) in terms of "medical supervision": …"use" refers to the proper place of stimulants in medical practice; "misuse" applies to the physician's role in initiating a potentially dangerous course of therapy; and "abuse" refers to self-administration of these drugs without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance and abnormal behavior. Handbook on Drug and Alcohol Abuse The Handbook on Drug and Alcohol Abuse defines drug abuse as "nonmedical use of drugs, both drugs that have and those that do not have generally accepted medical value". Political and criminal justice definitions Most countries have legislation designed to criminalise some drug use. Usually however the legislative process is self-referential, defining abuse in terms of what is made illegal. The legislation concerns lists of drugs specified by the legislation. These drugs are often called illegal drugs but, generally, what is illegal is their unlicensed production, supply and possession. The drugs are also called controlled drugs or controlled substances. World Health Organization The World Health Organization (WHO), a public health agency comprised of delegates appointed by the governments of member nations, is considered by many to be a medical authority. Definitions found in WHO reports are often used as the basis for legislation at national, regional and local levels. The WHO also produces the ICD, a major diagnostic resource used by medical professionals worldwide. Although it consists largely of public health professionals, the WHO is an arm of the United Nations political body, and is therefore responsive to the needs of, demands from, and prevailing views among the UN member states that appoint WHO delegates. The manner in which the WHO has recognized and dealt with 'drug abuse' over the years reflects a continuing struggle to reconcile conflicting historical, political, social, cultural, and medical viewpoints. In its early reports, the WHO Expert Committee on Addiction-Producing Drugs used the terms 'abuse' and 'addiction' interchangeably. Beginning in 1950s, attempts were made to distinguish between scientific and emotionally-charged terminology. However, the term 'abuse' was still inserted into definitions of addiction and dependency. In 1957, while not explicitly saying that 'drug abuse' was synonymous with 'addiction', the committee first attempted to clarify existing definitions of addiction and habituation as had been in common parlance since at least 1931: Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society. Drug habituation (habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include (i) a desire (but not a compulsion) to continue taking the drug for the sense of improved well-being which it engenders; (ii) little or no tendency to increase the dose; (iii) some degree of psychic dependence on the effect of the drug, but absence of physical dependence and hence of an abstinence syndrome withdrawal, and (iv) detrimental effects, if any, primarily on the individual. In 1964, a new WHO committee found these definitions to be inadequate, and suggested using the blanket term 'drug dependence': The definition of addiction gained some acceptance, but confusion in the use of the terms addiction and habituation and misuse of the former continued. Further, the list of drugs abused increased in number and diversity. These difficulties have become increasingly apparent and various attempts have been made to find a term that could be applied to drug abuse generally. The component in common appears to be dependence, whether psychic or physical or both. Hence, use of the term 'drug dependence', with a modifying phase linking it to a particular drug type in order to differentiate one class of drugs from another, had been given most careful consideration. The Expert Committee recommends substitution of the term 'drug dependence' for the terms 'drug addiction' and 'drug habituation'. (emphasis added) This is believed to be the first reference to "medical need" as a factor in the distinction between use and abuse. , preferring instead to refer to the cluster of symptoms previously called 'drug abuse' as 'substance abuse'. In 1973, these statements and recent legislation based upon the term "dependence" rather than "addiction" or "abuse" were praised by President Richard M. Nixon's National Commission on Marihuana and Drug Abuse in its final report: The Commission applauds the much-belated attempt by the scientific community to sever its conceptual apparatus from the vocabulary of politics and emotion. "Addiction," like "narcotics" and "drug abuse," has a general connotation of evil, suggesting illicit ecstasy, guilt and sin. Because the public image is conditioned more by cultural perceptions than by medical ones, medically-precise meanings simply cannot be harmonized with common parlance. | |||||||
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