Within the framework of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is redefined as a drug addiction, and can be diagnosed without the occurrence of a withdrawal syndrome.[6] It was described accordingly: "When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders."[7] In the DSM-5 (released in 2013), substance abuse and substance dependence have been merged into the category of substance use disorders and they no longer exist as individual diagnosis.[8]

Substance dependence, also known as drug dependence, is an adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use.[1][2] A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences.[1][2] An addictive drug is a drug which is both rewarding and reinforcing.[1] ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral addiction and drug addictions,[3][4][5] but not dependence.
However, your participation can make a big difference. Based on clinical experience, many health providers believe that support from friends and family members is important in overcoming alcohol problems. But friends and family may feel unsure about how best to provide the support needed. The groups for family and friends listed below under Resources may be a good starting point.
Inpatient treatment is a good choice for anyone who wants to focus completely on recovery without the stress or distractions of work, school, or social obligations. It allows for a thorough immersion in the recovery process and may be a good choice for people who have tried other treatments unsuccessfully. Inpatient treatment for alcohol rehabilitation may last anywhere from 30 days to six months or longer — recovery times depend on the needs of the individual.
An individual who suffers from both mental illness and alcoholism will need to undergo different treatment. Because alcohol withdrawal symptoms cause a person to experience some psychiatric stress, an alcoholic with mental health issues will find it much more difficult to resist turning to drink. The NIAAA believes the some self-help groups, such as Alcoholics Anonymous, are not effective when it comes to treating people with a dual-diagnosis of both alcoholism and mental illness. This is because these groups tend to specifically focus on the actual addiction itself, rather than any underlying psychological problems. Anti-depressants are improving all the time and it is believed that while a self-help group may not be useful for a dual-diagnosis individual by itself, if the individual is on the appropriate medication and receiving the appropriate psychological therapy it can prove to be just as effective as with other alcoholic individuals. Addiction Recovery: 12 Steps and Beyond (TTA Podcast 321)
People who misuse alcohol are often addicted to the act of drinking, as much as the alcohol itself. For that reason, you may need to learn skills and coping mechanisms to help you avoid alcohol once you leave a treatment center or return to familiar environments where the urge to drink may be stronger. Your doctor may refer you to a counselor or other treatment program to help you learn those skills and coping strategies. Inpatient Drug Rehab - What To Expect
This is an ongoing debate in the medical community, but it is generally agreed that there is no one cause for the development of addiction. According to the National Institute on Drug Abuse, contributing factors may include a genetic predisposition to develop addictive tendencies, an environment that is permissive of drug abuse, access to illicit substances, and certain developmental issues. The existence of a Dual Diagnosis is one of the biggest risk factors for the development of addiction. Heroin Withdrawal | First Week In
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