WHO Lexicon of alcohol and drug terms

Definition: Abuse (drug, alcohol, chemical, substance, or psychoactive substance) A group of terms in wide use but of varying meaning. In DSM-IIIR*, “psychoactive substance abuse” is defined as “a maladaptive pattern of use indicated by …continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physically hazardous”. It is a residual category, with dependence taking precedence when applicable. The term “abuse” is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. Because of its ambiguity, the term is not used in ICD-I0 (except in the case of non-dependence-producing substances- see below); harmful use and hazardous use are the equivalent terms In WHO usage, although they usually relate only to effects on health and not to social consequences. ” Abuse” is also discouraged by the Office of Substance Abuse Prevention (OSAP, now CSAP – Center for Substance Abuse Prevention) in the USA, although terms such as “substance abuse” remain in wide use in North America to refer generally to problems of psychoactive substance use.

* Diagnostic and statistical manual of mental disorders, 3rd ed.(revised).Washington, DC, American Psychiatric Association,1987.

In other contexts, abuse has referred to non-medical or unsanctioned patterns of use, irrespective of consequences. Thus the definition published in 1969 by the WHO Expert Committee on Drug Dependence was “persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical practice”*(see, misuse drug or alcohol).

*WHO Expert Committee on Drug Dependence. Sixteenth report. Geneva, World Health Organization ,1969 (WHO Technical Report Series, No.407

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