Addiction is a term widely used to indicate any type of excessive repetitive involvement with an activity or substance, and it is applied as readily to exercise, reading, and television viewing as to alcohol, cocaine, or heroin use. Such broad use of the term detracts from its technical value, and in this entry the term will be used to refer only to substance use. When considering problematic patterns of use, two distinct patterns, abuse and dependence, are described (American Psychiatric Association, 1994). Substance Abuse refers to life problems from substance use—use in situations in which it is physically dangerous, use interfering with occupational roles or with family and other social relationships, or use resulting in legal difficulties. In contrast, Substance Dependence is more syndromal. Physiological components of dependence may include tolerance—the need for increasing amounts of the substance to attain the same behavioral and subjective effects—or withdrawal, a physical syndrome activated by cessation of use of the substance. Behavioral components include using larger amounts of the substance over longer periods of times than intended; spending excessive amounts of time obtaining, using, and recovering from use of the substance; or using instead of engaging in other recreational and social pursuits. Psychological components include continued use despite knowledge of medical or psychological conditions caused or worsened by substance use, and desire or actual attempts to cut down or stop using the substance. Use of a range of substances, including alcohol, other sedative/hypnotic/anxi-olytic drugs, cocaine, other stimulants, heroin, cannabis, hallucinogens, inhalants, and nicotine, can lead to Substance Abuse or Dependence. A withdrawal syndrome is associated only with alcohol, sedative/hypnotic/anxiolytic drugs, heroin, and nicotine.
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