SNUD Committee Report
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The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association) defines substance abuse as “a maladaptive pattern of substance use, leading to clinically significant impairment or distress” as manifested by one or more of the following criteria occurring within a 12-month period: recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home; recurrent substance use in situations in which it is physically hazardous (e.g., driving or operating machinery); recurrent substance-related legal problems; and continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. The House of Commons Special Committee on Non-Medical Use of Drugs observed that the term substance abuse is widely used and that it has varying meaning to different people. It is sometimes used to refer to any use of a substance not necessarily causing harm to health or particularly to refer to any use of an illicit substance. In this report, the Committee prefers the term harmful use. However, when reporting evidence or referring to published documents, the report will respect the terminology used by the authors. According to the World Health Organization (WHO), addiction refers to the repeated use of a psychoactive substance or substances, to the extent that the user is periodically or chronically intoxicated, shows a compulsion to take the preferred substance, has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. In general terms, an individual suffering from an addiction has developed a tolerance to a substance as well as a dependence on a substance. In this report, the Committee prefers the term dependence. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association) defines substance dependence as “a maladaptive pattern of substance use, leading to clinically significant impairment or distress” as manifested by three or more of the following criteria occurring at any time in a one-year period: tolerance; withdrawal syndrome; consuming larger amounts or over a longer period; desire or unsuccessful efforts to cut down or control substance use; spending a great deal of time in activities to obtain the substance, use the substance, or recover from its effects; giving up or reducing important social, occupational or recreational activities because of substance use; and continued use despite awareness of physical or psychological problems likely associated with substance use. A vague term of diverse meaning. According to the WHO, in medicine, a drug refers to any substance with the potential to prevent or cure disease and enhance physical or mental welfare, and in pharmacology, to any chemical agent that alters the biochemical or physiological processes of tissues or organisms. However, the term drug is often used to refer specifically to illicit psychoactive substances. According to the WHO, harmful use refers to a pattern of psychoactive substance use that is causing damage to health: physical or mental. Harmful use commonly, but not invariably, has adverse social consequences; social consequences in themselves, however, are not sufficient to justify a diagnosis of harmful use. Illicit drug [drogue illicite] A psychoactive substance, the production, sale, possession or use of which is prohibited. In this report, the committee prefers the term illicit substance. LOW THRESHOLD SERVICES [services « à seuil bas » ou à accès élargi] According to the United Nations Office for Drug Control and Crime Prevention, services for drug users are known as low-threshold services when they are easily accessible by clients, and when abstinence is not a prerequisite for service provision. Often, such services work with clients on an anonymous basis. They are designed to attract future clients by offering, beside drug-related services, other services that respond to the immediate needs of clients, such as free or reasonably priced food, clothing or shelter. A synthetic opiate drug used in maintenance therapy for those dependent on opioids. According to the WHO, substance misuse refers to the use of substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription drugs. Some members of the Committee prefer the term “substance misuse” to the term “harmful use”. Psychoactive substance [substance PSYCHOATIVE] A substance that, when ingested, alters mental processes such as cognition or affect. This term is most neutral and includes a whole class of substances whether they are licit or illicit. In this report, the Committee prefers the use of the term psychoactive substance to the use of the term drug, which in common parlance usually refers to illicit substances. A need to consume increased amounts of a substance to achieve intoxication or desired effect, or noticeably diminished effect with continued use of the same amount of a substance. Withdrawal Syndrome [syndrome de sevrage] According to the WHO, withdrawal syndrome refers to a group of symptoms of variable clustering and degree of severity, which occur on cessation, or reduction of use of a psychoactive substance that has been taken repeatedly, usually for a prolonged period and/or in high doses. |