Building A Community Here At Minnesota Altenatives

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I had an interesting discussion with someone yesterday who told me she thought I was unethical because I did not recommend abstinence for everyone who meets the criteria for substance dependence. I responded that I think it is very important to meet people where they are at, and I know many, many people who have met the criteria for substance dependence (outlined below) who have cut back, or given up certain substances and have been able to live full and productive lives without needing to be fully abstinent. At the same time I have met many people where abstinence is essential. Again, every person is unique with a unique set of circumstances, and I think expecting the same outcomes for everyone seems more unethical than treating each person as an individual.

 

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:

  1. 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 the substance.
  2. 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.
  3. The substance is often taken in larger amounts or over a longer period than intended.
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  7. 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 (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

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