The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 11: Substance Use ProblemsTable 11-4: Definitions of Substance Dependence and Abuse (continued)Important social, occasional, or recreational activities are given up or reducedbecause of substance use.26 picasThe substance use is continued despite knowledge of having a persistent or recurrentphysical or psychological problem that is likely to have been caused or exacerbated bythe substance• (e.g., current cocaine use despite recognition of cocaine-induced depression, orcontinued drinking despite recognition that an ulcer was made worse by alcoholconsumption).Substance Abuse:A maladaptive pattern of substance abuse, leading to clinically significant impairment ordistress, as manifested by one (or more) of the following, occurring within a twelve-monthperiod:Recurrent substance use resulting in a failure to fulfill major role obligations at work,school, or home:• repeated absences or poor work performance related to substance abuse,• substance abuse-related absence, suspension,• 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-relateddisorderly conduct.Continued substance use despite having persistent or recurrent social orinterpersonal problems caused or exacerbated by the effects of the substance• (e.g., arguments with spouse about consequences of intoxication,physical fights).The symptoms have never met the criteria for substance dependence forthis class of substance.Sources: Passik SD, Portenoy RK. Substance abuse issues in palliative care. In Berger AM, Portenoy RK, Weissman DE, eds. Principlesand Practice of Supportive Oncology, 1 st ed. Philadelphia: Lippincott-Raven Publishers, 1998; American Psychiatric Association.Diagnostic and Statistical Manual for Mental Disorders, 4 th ed. Washington, DC: American Psychiatric Association, 1994.258U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau