Abuse and Dependence – Where Do You Fit?

This chapter has two main objectives. The first is to establish that three-quarters of all addicts recover on their own, or with minimal help. The second is to assure you that you are not powerless over your addiction. The men and women represented below weren’t powerless, and neither are you.

The evidence comes from published, peer-reviewed, scientific studies, and many of them are available to anyone with a computer. It would be impossible to present all of the studies supporting this contention in a book this size, so I’m providing some representative studies in this chapter, and many more in the appendix. These are multiple, repeatable, detailed studies, over several decades, documenting successful recoveries of men and women diagnosed with substance abuse or dependence, according to the guidelines of the American Psychiatric Association, (APA).

If we’re exploring “natural recovery,” it makes sense for us to begin by defining what it is that people are naturally recovering from. The APA publishes a reference volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. They release a new one every few years, and the current one is the DSM-IV. It is by no means a perfect document, but it represents a consensus view of the criteria for diagnosing the various disorders it covers.

We need a benchmark, a ruler, a set of criteria, so we’re all speaking the same language throughout the rest of the book. The DSM, as imperfect as it is, will at least provide that set of criteria. It separates people into three distinct, mutually exclusive categories’: no substance abuse disorder, substance abuse only, or substance dependence. The DSM treats substance abuse disorders as a continuum, (like a volume control), varying from no abuse to severe dependence, based upon the number and relative severity of the criteria that are present. The following is quoted from the DSM-IV:

DSM-IV Substance Abuse Criteria:Substance abuse is defined as a maladaptive 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:


DSM-IV Substance Dependence Criteria:Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:


  • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
  • Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use).
  • Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct).
  • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).
  • Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of substance.
  • Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  • The substance is often taken in larger amounts or over a longer period then intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  • A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  • Important social, occupational, or recreational activities are given up or reduced because of substance use.
  • The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance


Not all addicts display all of the criteria, not even the most severely addicted. For instance, although I exhibited almost all of the other criteria for substance dependence and abuse, I never had any legal problems related to my drinking, nor did I ever try to cut down or quit.

[i] American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183).


[i] American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183).

About the Author Pete Soderman

Pete is an author, blogger, and podcaster who makes his home in Ajijic, Jalisco, Mexico. His primary interest is in helping others recover from self-defeating behaviors.

Leave a Comment:

Ian Mason says February 3, 2011

Agreed, a more nuanced analysis of abuse/addiction is needed but I’m equally skeptical as regards the medical view of things. As a life-long depression sufferer I know that so many experts tend to push people into the the newest “trendy” catagories, often those where a new medication is being promoted. Take nothing without a good pinch of salt.

    Pete Soderman says February 3, 2011

    I agree. The important thing to be aware of, I’m afraid, is who paid for the study! In most peer-reviewed journals, the scientists whose names are on the studies divulge any conflicts they may have, and who funded the study. Oftentimes, you find in the “trendy” market, the studies are funded by the very drug companies who are promoting the drugs. Doing research for a book such as the one I’m doing, I pay close attention to who is paying for what. There are studies funded by portions of the treatment industry, for instance, whose results have been questioned by other researchers. As always, you have to “follow the money,” and determine who benefits by the determination of which “panel of experts.” By the way, the one phrase you ALWAYS have to be wary of in any drug commercial or article is “Emerging Science Suggests…” That is one of those meaningless phrases that is used to snag the credulous. Please feel free to subscribe to the blog via email if you haven’t already done so. Many of the tools I talk about later in the book will work just as well on depression as they do on drug dependence. Thanks for your comment!

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