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Substance use and abuse can sometimes be tricky to identify, especially in the early stages. But recognizing the signs early can make a huge difference in getting the help and support that’s needed. So, I’m curious What do you think are the essential steps for identifying substance use?
What are some of the signs or behaviors that you’ve found helpful in noticing early on? Or if you’ve ever been in a situation where you had to identify substance use, what steps did you take?
Hey @katelynmartins, thanks so much for bringing your expertise to the OHDSI community! I always like to start with defining the target clinical idea, and the terminology in this field can be confusing. Maybe beginning with these definitions can help us identify early indicators in data and clinical practice. What do you think?
Use Simply the act of consuming a substance in a typical or prescribed manner, without significant cravings or harm. Examples: Taking an opioid pain medication exactly as prescribed for a short time; occasionally smoking a cigarette without cravings or life disruptions.
Dependence A state of tolerance (needing more for the same effect) and withdrawal if usage stops. Physical dependence alone doesn’t necessarily indicate a Substance Use Disorder (SUD) if there’s no harm or social disruption. Examples: Long-term prescribed benzodiazepine use with withdrawal symptoms (e.g., anxiety, insomnia) if doses are reduced or skipped; near-daily cannabis use leading to irritability or poor sleep if the user doesn’t smoke, yet they’re still functioning reasonably well in daily life.
Abuse (older DSM-IV term) Repetitive use leading to harmful consequences—previously differentiated from “dependence” but now folded into SUD in DSM-5. Examples: Regularly taking extra opioid pills and neglecting work or family responsibilities, yet not necessarily showing withdrawal or tolerance; recurrent binge drinking that causes personal or legal problems but may not include classic withdrawal symptoms.
Misuse Using a substance in a way that deviates from its intended or prescribed use. Examples: Taking higher doses of opioids than prescribed, using someone else’s prescription, escalating alcohol intake beyond typical patterns (e.g., frequent binge drinking).
Disorder (SUD) A pattern of uncontrolled substance use leading to significant impairment or distress, typically meeting ≥2 diagnostic criteria (e.g., craving, inability to cut down, withdrawal). Examples: An individual on opioids who craves them, repeatedly fails to cut down, continues despite health or occupational issues, and experiences withdrawal when stopping; heavy alcohol use that escalates to daily drinking, strong cravings, social conflicts, and withdrawal—indicating an Alcohol Use Disorder.
Can you share your perspective on how you clinically distinguish these nuances, and especially in the context of identifying early warning signs. Are there specific markers or behaviors you’ve found helpful in clarifying when someone is shifting from simple “use” into “misuse” or a more serious “disorder”? Sometimes it maybe useful to consider “Overdose Risk” as an early warning sign (e.g., escalating doses, using potent substances like fentanyl) and differentiate between “Physical Dependence from Legitimate Therapy” vs. “Prescription Drug Misuse”.
Looking forward to hearing your thoughts!