Talk:Substance abuse

wat

why does the first sentence in the signs and symptoms paragraph say drug misuse instead of drug abuse? Is it because the definition of drug misuse is above it? I'm going to change it, if you have any problem with it go ahead and change it back but tell me why here 96.233.211.160 (talk) 16:13, 12 August 2010 (UTC)

Responsible drug use

I'd like to make the following notes, though not sure what if any additions I can personally make above and beyond. More secificaly, my notes may be jurisdiction dependant.

1: The Majority of chemical drugs are not 'illegal' they are prohibited. for instance: Heroin is actually proscribed to some people, and not just for people who are dependant on it. 2: The misuse of drugs act [UK] (which came out of an international treaty) is based on 'misuse' being not of medical use, and so defines 'recreational' as not of medical use. Legal cases in the UK have been based on the idea of medical necessity, that is there was no suitable alternative available. and that serious harm would otherwise be caused. 3: I don't know anyone who's been coded this way for nicotine dependence, nor food dependence / abuse. —Preceding unsigned comment added by 217.171.129.68 (talk) 19:34, 22 November 2010 (UTC)

Nonsense

Substance abuse is simply another euphemism for addiction. Tobacco for example has an 85% acquire rate which means for every 100 who smoke 1 cigarette will become dependent on tobacco. Ethanol is the active ingredient in beer, wine and spirits and the cessation rate is dismal at about 1 in 36.

This article smacks of prohibition when addiction should be recognized as a medical problem. Addiction is hard to treat, a jail cell is not treatment. My IQ >> 160 (talk) 01:23, 21 March 2011 (UTC)

Please use Wikipedia talk pages to improve the article. Are there verifiable and reliable sources to improve the article to show various points of view, while maintaining a neutral point of view? tedder (talk) 01:28, 21 March 2011 (UTC)

‘Substance’ use

The article’s use of ‘substance’ strikes me as bizarre
Does it represent denial that ethanol and nicotine are drugs, and generally muddled thinking about drug use by supposed authorities?
Or am I a substance abuser, within the meaning intended by the article, because air and water are substances?
Laurel Bush (talk) 14:43, 16 August 2011 (UTC)

"Substance" is usually shorthand for "psychoactive substance" or "drug", but casts a broader net because there are many people who abuse non-psychoactive substances (e.g., performance enhancing drugs)...In addition, "substance" is preferred by some over "drug" because the latter is more of a loaded term. While I have no idea if you abuse air or water, there is some discussion of this nomenclature in the article (though it could use more clarity) that would strongly suggest your possible issues with air and water, short of hyponatraemia or psychogenic polydipsia, aren't in the category of disorders discussed in the present article. — Scientizzle 16:25, 16 August 2011 (UTC)

Seems to me:

• The article is really about drug abuse, meaning reckless or pathological use of a substance as a drug, and includes such use of substances which may not be recognised as drugs by drug and medicines control legislation, or in common discourse (with alcohol as an example of a substance which may be abused without being recognised as a drug)
  
• ’Drug substance abuse’ might be a better article title, but would create, in my mind, a quandary as to what Drug substance should be or point to
  
• The title should be Drug abuse (except Drug misuse might be better)
  

Laurel Bush (talk) 11:36, 24 August 2011 (UTC)

Drug misuse is a different concept than drug abuse (though I'm sure one could easily ID a demarcation problem between misuse and abuse), and more commonly associated with prescription drugs rather than illegal narcotics[1], so that would not be a good title. Substance abuse or Substance abuse disorder are the only proper titles based on the family of psychiatric disorders found in the DSM IV, in my opinion, and the former is simpler. — Scientizzle 14:00, 24 August 2011 (UTC)

See http://www.legislation.gov.uk/ukpga/1971/38/contents
Laurel Bush (talk) 09:35, 25 August 2011 (UTC)

I can certainly admit that my perspective of this topic has been formed in the United States and specifically influenced by NIDA. "Drug misuse" appears to have a different usage and meaning in the UK--completely synonymous with "drug abuse" rather than slightly different...like I said above, the terms are unfortunately somewhat ambiguous. However, the title of this article should come from an evaluation of the most prominent and relevant sources. There are two distinct questions here: "substance" vs. "drug" and "abuse" vs. "misuse" vs. "use". The article presently uses "substance abuse" as the preferred term, but synonymizes (is this even a word?) it with "drug abuse" right in the opening sentence. To determine what the reliable, authoritative sources currently use as terminology. Here's what I've found thus far...

• DSM[2]-"Substance-Related Disorders" and specific DSM coding for "abuse"
• MeSH[3][4]-Synonymous use of "substance abuse" and "drug abuse"
• ICD[5]-"Mental and behavioural disorders due to psychoactive substance use"
• NICE[6]-"Drug Misuse"
• Australian National Drug Strategy seems to prefer "abuse"[7] over "misuse"[8] and "drug abuse" generally
• Royal College of General Practitioners[9]-"Substance misuse" & "drug misuse"(see also doi:10.1093/innovait/inq113 in which almosst every variation of "substance/drug misuse/abuse" is used almost interchangeably)
• There's some good discussion of terminology by the WHO[10]

  misuse, drug or alcohol Use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications. The term is preferred by some to abuse in the belief that it is less judgmental.

  and

  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 physical1y 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-10 (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.
  
  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"

If anyone else wants to find more sources, I'd love to see them...

My take on what I've seen thus far is that "substance" & "drug" are widely and presently treated as synonymous and interchangeable, but the DSM & ICD use of substance over drug probably justifies substance being the preferred term over drug. That is, the way the opening sentence is structured right now is perfectly fine.

The question of "abuse" vs. "misuse" vs. "use" is a little trickier. It looks to me like there's a general abandonment of any distinction between misuse and abuse and the winds may be favoring the politically correct adoption of misuse over abuse. I think there's probably enough sourcing presented right here to adequately discuss the variations in terminology. Redirects for every major term, and bolded acknowledgment in the lede is probably warranted. — Scientizzle 15:02, 26 August 2011 (UTC)

Thanks
I have read through some but not yet all of the material you have presented
It looks interesting

Meanwhile:
You say the winds may be favouring ‘misuse’ over ‘abuse’
I feel it blowing somewhat the other way in UK mass media, although my personal sense of English as a language is more comfortable with ‘misuse’ (with ‘abuse’ perhaps meaning deliberate or culpable misuse, and thus a category of misuse) Still, my local NHS board does continue to employ ‘substance misuse practitioners’, and has not rebranded them as ‘abuse practitioners’
Re ‘substance’ and ‘abuse’, I guess current DSM and ICD fashion must be respected, although I see use of ‘substance’ instead of ‘drug’ as denial, or pandering to denial, that ethyl alcohol and prescribed medicines are drugs
Or perhaps it is just that we are in an area littered with semantic traps (and perhaps the article should carry a warning to this effect)

I listed ‘Drug’ in Substance a while back

Laurel Bush (talk) 10:04, 29 August 2011 (UTC)

I have twigged
since writing the above
that substance abuse is usually code
or a morally prejudiced label
for intoxication
and that drug abuse is usally code for intoxication with 'drug'-stigmatised intoxicants
of which most are easily recognised as 'abuse'-stigmatised medicines
Reminds me of homosexuality used as a diagnosis
Laurel Bush (talk) 09:53, 27 October 2012 (UTC)

This article and the one on substance use disorder should not be merged. Substance use and substance use disorder are two different issues. Also, there are further differences between substance use, substance abuse, substance dependence, and substance withdrawal. So, again, these two are separate issues and the articles should not be merged. Daniellagreen (talk) 02:41, 20 February 2014 (UTC)

What about the third one, substance-related disorder? All seems the same to me. InedibleHulk (talk) 23:14, 16 August 2014 (UTC)

Suggested Addition on Special Populations

I have come up with an addition for this section addressing substance abuse in older adults and how they tend to transition into alcohol and prescription drug abuse. It discusses how this group (65+) is responsible for one-third of prescription drug sales and how these drugs can be abused. In addition, this group can be more susceptible to withdrawal symptoms and additional side-effects due to the mixing of alcohol and drugs. Any suggestions or problems? — Preceding unsigned comment added by Sankaria14 (talk • contribs) 22:34, 7 December 2014 (UTC)

Less words please

I've just trimmed quite a bit, but this article still looks very much as if someone was paid "by the word" to pad it out. Keep it tight and on track people! Snori (talk) 18:25, 4 February 2015 (UTC)

DSM Updates

The DSM section of this article needs to be updated in that substance abuse is no longer a diagnosis according to DSM-5. Abuse and dependence have been merged as 'Substance Use Disorder.' The introduction should probably mention this with a wikilink to the Substance Use Disorder page. To the first paragraph a sentence such as:

According to the recently published DSM-5 substance abuse is no longer a specific diagnosis but under the category of Substance Use Disorder, combined with Substance Dependence.

I also suggest updating the DSM criteria for diagnosis. I do not have access to that information at the time of this edit. Ktwagner (talk) 12:57, 13 October 2015 (UTC)

@Ktwagner: Just came across your comment from 2 months ago. I agree. I'm going to post about it on WP:PSYCH first to see if there's already a general consensus about updating articles to the DSM-5 in a consistent way. If anyone sees message and wants to weigh in, I just posted about it on the talk page to the psych project. Permstrump (talk) 16:26, 15 December 2015 (UTC)

Musicians

The last paragraph/phrase in that subsection (about risk for lungs when inhaling) looks odd. It is not in the same style than the rest. The whole section is not about harm but about special populations. The harm to lungs from aspiration/inhalation should IMHO be mentioned elsewhere. — MFH:Talk 00:43, 13 January 2016 (UTC)

Ref

Ref does not appear to support

Extended content

Scientist's began to study addiction in 1930, and concluded that addiction was a moral shortcoming and lack of willpower, developing a strong stigma towards what caused the addiction in the first place. Those conclusions influenced society’s view on addiction, but those conclusions are no longer valid because of groundbreaking information found by scientists in the past ten years that indicate addiction is a brain disease that affects both the brain and behavior.

Doc James (talk · contribs · email) 07:13, 2 December 2015 (UTC)

what do you mean by "support"? what effect is opposed to what you expected/wanted? — MFH:Talk 00:43, 13 January 2016 (UTC)

Numbers

I'm concerned about the following statement in the article as of 2016-05-24: "In 2013 drug use disorders resulted in 127,000 deaths up from 53,000 in 1990." I'm concerned about the following:

1. Do these numbers refer to the entire world? I assume so, but it wasn't clear to me.
2. I could not find those numbers in the article cited: GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. {{cite journal}}: |first1= has generic name (help)CS1 maint: numeric names: authors list (link). I checked the article and could not find 127 (as in 127,000) nor 53 (as in 53,000) nor anything else quickly scanning that supported this statement. It may be there, but I didn't find it in the 5-10 minutes I spent skimming and searching.

Could someone please fix this verbiage and the citation?

Thanks, DavidMCEddy (talk) 18:44, 24 May 2016 (UTC)

I'm not seeing the numbers in the article or the figures either. Sizeofint (talk) 21:09, 24 May 2016 (UTC)

First graph is retarded

Most addictive drug is agreed by pharmacology authorities to be tobacco. Cannabis is not physically harmful at all. LSD is probably the least addictive substance that ever existed; it's practically impossible to form dependence even if one tries (due to tolerance etc). Amphetamine is infinitely more harmful than heroin. It's like it was randomly made by an idiot who has no knowledge at all about pharmacology. I won't remove it right now because I don't have the time to add the references to support my edit, but someone who has the time and the knowledge please look into this. — Preceding unsigned comment added by 31.216.105.154 (talk) 07:53, 12 February 2016 (UTC)

I don't think we say LSD is addictive anywhere in this article. I agree this article needs improvement with reliable medical sources. Sizeofint (talk) 09:01, 12 February 2016 (UTC)

Thanks for the reply. I should clarify, I was only talking about the first graph. It seems completely full of errors — Preceding unsigned comment added by 31.216.105.154 (talk) 12:57, 12 February 2016 (UTC)

I suggest using a different word than 'retarded' and 'idiots'. It seems unprofessional to use that type of language and it can come off as offensive. With that being said you present very respectable information showing that the graph may not be the best fit and or accurate but when using such words it completely distracts from the purpose of the comment. Ashleymorris1 (talk) 02:11, 3 May 2022 (UTC)

Adding a section on Comorbidity

It is common for individuals that abuse or misuse drugs to have other psychological diagnoses. Depression, anxiety, and psychosis are all common comorbidities. However, it is difficult to determine if the substance abuse is a primary disorder or a result of the comorbid psychological disorder. Looking at family history, onset of the substance abuse and psychological disorder symptoms, and previous treatment, can all aid in determining the primary disorder.

Individuals who have a comorbid psychological disorder often have a poor prognosis.

Additionally, substance abuse may produce symptoms that lead to a false diagnosis. For this reason, it is important that an individual maintain abstinence for 2 weeks before a psychiatric diagnosis is made.

Good idea, Mattmcgarr, and thanks for getting something started! My suggestions are below. I tried to make it how it would look in article. I took out a lot of the stuff about the primary diagnosis because I think you misinterpreted the authors’ meaning. Let me know if you want me to expand on that. Permstrump (talk) 11:18, 9 March 2016 (UTC)

Dual diagnosis

Main article: Dual diagnosis

It is common for individuals that abuse or misuse drugs to have other psychological problems. The terms “dual diagnosis” or “co-occurring disorders,” refer to having a mental health and substance use disorder at the same time. According to the British Association for Psychopharmacology (BAP), “symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol.”

Individuals who have a comorbid psychological disorder often have a poor prognosis if either disorder is untreated. Historically most individuals with dual diagnosis either received treatment only for one of their disorders or they didn’t receive any treatment all. However since the 1980’s, there has been a push towards integrating mental health and addiction treatment. In this method, neither condition is considered primary and both are treated simultaneously by the same provider. Permstrump (talk) 11:18, 9 March 2016 (UTC)

Doc James, re: your recent edit, what do you think about "It is common for individuals that misuse drugs... or It is common for individuals with substance use disorders... to have other psychological problems."? The original wording was probably clunky, but the source is talking specifically about people with disordered use. I don't believe the statement applies to everyone who uses drugs/alcohol in general. PermStrump(talk) 04:11, 15 March 2016 (UTC)

I prefer "use". It is more factual. "Misuse" implies a judgement by someone. Many people who use drugs state they do so volitionally and can stop any time they wish. They deny they misuse them. Doc James (talk · contribs · email) 04:26, 15 March 2016 (UTC)

Even if the exact quote is, "symptoms of psychiatric disorders such as depression, anxiety and psychosis are the rule rather than the exception in patients misusing drugs and/or alcohol."? It's not that I'm so attached to the wording of that part of that one sentence, but I would have worried that it was misrepresentation of the source. If you think still think "use" is close enough compared to the direct quote, then I'll trust your opinion. I used that quote later in the same paragraph, so maybe that's qualification enough. PermStrump(talk) 04:32, 15 March 2016 (UTC)

Yes looking at sources such as this one [11] they do use "substance use disorder" so I guess we should stick with that. Doc James (talk · contribs · email) 04:37, 15 March 2016 (UTC)

References

Relevance of current epidemiology statistic regarding "illicit substances"

I'm working on an Esperanto translation of this article and find it important to raise this issue without getting into any sort of debate about drug abuse: I am unable to understand the relevance of the statistic about the number of people who use illicit substances. The diagnosis of substance abuse is independent of legality, and can include legal drugs like alcohol. If someone can justify the statistic, please feel free to. Jan sewi (talk) 18:07, 10 January 2017 (UTC)

A lot of the content in the epidemiology section seems more appropriate for recreational drug use. For the lead I think it is necessary since the source is discussing the proportion of illicit drug users that have substance-related problems. Sizeofint (talk) 18:15, 10 January 2017 (UTC)

This puts the condition into perspective. Doc James (talk · contribs · email) 10:37, 11 January 2017 (UTC)

It would be nice if it did put the condition into perspective, but it doesn't. Putting the condition into perspective would require statistics about the number of people who use both licit and illicit drugs. As it stands the number is arbitrary, because "licit" varies by jurisdiction. Jan sewi (talk) 13:00, 11 January 2017 (UTC)

Did you read the ref? It is by the UN. There are international agreements. Doc James (talk · contribs · email) 13:04, 11 January 2017 (UTC)

The ref does not include alcohol as an illicit substance, which makes it irrelevant to an article about substance abuse:

Annual prevalence of the use of alcohol is 42 per cent (the use of alcohol being legal in most countries), which is eight times higher than annual prevalence of illicit drug use (5.0 per cent).

So it's irrelevant according to the lead itself, which says alcohol is associated with substance abuse. It's also an atrocious underestimation of substance abuse according to the cited report. A relevant statistic is needed. Jan sewi (talk) 13:10, 11 January 2017 (UTC)

Adding further: in the body of the article, in the Classification section, it points out that the DSM-V even includes caffeine as a drug of abuse, which is not regulated in any way in most countries. I'm not claiming I agree with the inclusion of caffeine in this category, only that the topic of the article includes caffeine by definition, so illicit drug use statistics are not relevant to the topic.

If my objection is confusing to anyone, the issue is that "illicit" is a synonym of "illegal" or "prohibited," which has nothing to do with any medical concept of substance abuse. I should add also that my criticism does not involve the validity or invalidity of drug laws, it's only pointing out that statistics about the use of illicit drugs have nothing to do with substance abuse, which, according to current standard definitions, may include the abuse of alcohol or even caffeine. Does this make sense? Am I over-explaining myself? It's just hard for me to translate an article that gives conflicting messages. Jan sewi (talk) 10:59, 12 January 2017 (UTC)

If you have refs for use of legal substances and the frequency with which they result in substance abuse lets add them. This does not make the number who illegally use substances undue. Doc James (talk · contribs · email) 16:38, 12 January 2017 (UTC)

Possible Additions to the Society and Culture Section

Perhaps something could be said about how the cultural patterns of drug use are associated with the values, beliefs, and norms that a society assigns a drug. For example, the attitudes towards alcohol in the U.S., where the drinking age is 21, may influence behaviors of binge drinking in adolescence where as in some southern European countries, rates of binge drinking may be lower. Perhaps a different Wikipedia article altogether for this topic would be best. Courtlee214 (talk) —Preceding undated comment added 20:48, 26 January 2017 (UTC)

The photo

Dear @Doc James:, thanks for reaching out.

I think that photo has potential to mislead patients about the efficacy of psycho-stimulants which could hold back patients like ADHD to take medications they need. --It's gonna be awesome!✎Talk♬ 03:04, 5 October 2017 (UTC)

Yes psychostimulants work for ADHD but they are also drugs of abuse. Ketamine is also used for a lot of medication uses as are barbiturates and even cocaine occasionally.

Not seeing that as justification to remove the image. Doc James (talk · contribs · email) 03:08, 5 October 2017 (UTC)

However, if you're a patient or patient's parent seeing the picture saying either methylphenidate or amphetamine are rated close to other commonly-abused drugs that cause troubles in the society, would you still dare to or allow your child to take those drugs at a daily basis for treating ADHD or other medical indications such as narcolepsy, depression chronic pain, and obesity? At least, I think it's required to add more information along with the current photo description. Thanks! : ) --It's gonna be awesome!✎Talk♬ 03:38, 5 October 2017 (UTC)

And what about ketamine? I give it to kids all the time. Hopefully this will help parents keep better controls over their kids methylphenidate and realize that they could be selling it at school. Doc James (talk · contribs · email) 03:42, 5 October 2017 (UTC)

Perhaps cultures vary between countries to countries. My assumed context is very likely to show up in my country. Adapting this article to better reflect global views and culture is preferable to continuing the present version because it has been translated to other languages and caused unnecessary panic among parents here. By the way, are you a pediatric psychiatrist? : ) --It's gonna be awesome!✎Talk♬ 03:53, 5 October 2017 (UTC)

I found the recent photo update is more appropriate. I appreciate you all. : ) --It's gonna be awesome!✎Talk♬ 10:49, 5 October 2017 (UTC)

Have moved the other one to the body of the text. Doc James (talk · contribs · email) 18:04, 5 October 2017 (UTC)

Sure, maybe you've your reason. Have a nice day buddy. --It's gonna be awesome!✎Talk♬ 02:26, 7 October 2017 (UTC)

You too. Doc James (talk · contribs · email) 09:03, 7 October 2017 (UTC)

Comparison of risks

The consensus is to use the second image, File:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg.

Cunard (talk) 00:22, 4 December 2017 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

(first image) Rational harm assessment of drugs radar plot

(second image) Rational scale to assess the harm of drugs (mean physical harm and mean dependence)

Which of the two images should we use? Doc James (talk · contribs · email) 01:19, 30 October 2017 (UTC)

Support use of 1st

• Support since it conveys more information (social harm), although the graph is harder to read. I'm more inclined to support option 3 though: replace the charts with a sortable wikitable containing the numerical data contained in the image. Seppi333 (Insert 2¢) 01:54, 30 October 2017 (UTC)
  • Hum I guess that would not be that hard to make. Would not fit in an infobox though. Doc James (talk · contribs · email) 01:59, 30 October 2017 (UTC)
    • Added in the section below. Seppi333 (Insert 2¢) 20:08, 30 October 2017 (UTC)

Support use of 2nd

• Support second one With respect to these two graphs I find the second one much clearer. A few items: The second one has bigger words, The second one is intuitively laid out (more right and higher means more significant), The second one makes good use of color. Doc James (talk · contribs · email) 01:23, 30 October 2017 (UTC)
• support the second graph seems better overall--Ozzie10aaaa (talk) 11:17, 30 October 2017 (UTC)
• support Seems the clearer of the two. Attic Salt (talk) 15:19, 30 October 2017 (UTC)
• support This is better because it is a true 2D plot. The other is actually a pair of 1D plots in polar coordinates, and a sortable Wikitable would not be any sort of plot at all. Looie496 (talk) 20:45, 30 October 2017 (UTC)
• Support. I can actually read the words in the second one shown here, at the scale given, and interpret which substances are where on the scale. The first one is just some starry shapes with what look like words around them but are too small to be legible. Also, from a more technical point of view, the ordering around the star chart, and the line segments connecting one substance to the next one in the ordering, appears to convey very little useful information. So you're wasting bandwidth by not making the spatial information (positions of substances on the chart) tell the reader something. The second chart makes better use of its information channels, although its choice of colors could be better explained. —David Eppstein (talk) 06:20, 31 October 2017 (UTC)
• Support using this image provided that the table is also included since this image doesn't contain all the data from the source (social harm), a drug class comparison, or the aggregated harm rating. Seppi333 (Insert 2¢) 22:07, 31 October 2017 (UTC)

• Support. This is a much clearer representation at a glance in my opinion. Also, the first graph is an example of using a line graph when not appropriate - only the points are relevant, the line segments between them are not and only serve to clutter the graph.

Ashcanpete (talk) 17:47, 2 November 2017 (UTC)

• Second one - just more clearly understandable a format to me. Markbassett (talk) 20:12, 2 November 2017 (UTC)
• Support. Easier to interpret for me, and I suspect for almost all readers. (The reason's it's easier to interpret are explained above. It uses two dimensions to show two things, and does not clog the bandwidth with its near-meaningless ordering of the substances and totally meaningless line segments.) Maproom (talk) 08:02, 4 November 2017 (UTC)

Discussion

Why can't we keep using both? They're both in the article right now. WhatamIdoing (talk) 02:36, 30 October 2017 (UTC)

True. And which one do you think should go first? Doc James (talk · contribs · email) 02:40, 30 October 2017 (UTC)

I'm fine with keeping both. Sizeofint (talk) 03:18, 30 October 2017 (UTC)

Using both is okay. First No.2 (easier to read), then No.1, (more detailed). --A D Monroe III^(talk) 17:18, 30 October 2017 (UTC)

Yes so maybe 2 first and 1 second than? Doc James (talk · contribs · email) 19:06, 30 October 2017 (UTC)

Yeah, that's what I meant. Sorry. Amended my comment. --A D Monroe III^(talk) 19:26, 30 October 2017 (UTC)

The radar plot is just bizarre. There's nothing circular about the data. Maybe convert all pages using the radar plot to either the second graph or the table, then delete File:Rational_harm_assessment_of_drugs_radar_plot.svg and File:Rational_harm_assessment_of_drugs_radar_plot.png? Alsee (talk) 14:36, 25 November 2017 (UTC)

Table alternative

@Doc James and Sizeofint: See below. I've left-aligned the table on this page since the images take up too much space on the right at the moment. In the article, this table should be right-aligned.

Also, can someone please check to make sure that I didn't make a clerical error while copying the table values? I had to do this manually. Seppi333 (Insert 2¢) 19:56, 30 October 2017 (UTC)

I copy/pasted the data table below and the data table from File:Rational scale to assess the harm of drugs (mean physical harm and mean dependence).svg#Data into excel and computed the difference between the column values to double check the data I copied. There was only 1 erroneous value in the table (Heroin's social harm score - I copied its "other social harms" score instead of the "mean social harm" score). The rest of the data was likely copied correctly from the source, unless I and the person who created that data table made the same clerical error in the same cell under one of the three mean harm columns; that's rather unlikely. Seppi333 (Insert 2¢) 23:18, 31 October 2017 (UTC)

This could be good in addition to the images. Would a column for "total" be useful? Doc James (talk · contribs · email) 20:09, 30 October 2017 (UTC)

By total, do you mean the average of the of the 3 column values, or something else (e.g., the sum of those values)? Either would be fine I suppose. Seppi333 (Insert 2¢) 20:15, 30 October 2017 (UTC)

Yes one can either add the three or add the three and divide by three. More or less the same. Doc James (talk · contribs · email) 20:39, 30 October 2017 (UTC)

@Doc James: Alright. Should the table footer (the text beneath "Notes about the harm ratings") be collapsed or should the formatting be left as is? Seppi333 (Insert 2¢) 21:03, 30 October 2017 (UTC)

No strong feeling. Collapsed will be smaller. Doc James (talk · contribs · email) 21:07, 30 October 2017 (UTC)

Ok. I had to add another table around the wikitable since sorting a column when the footer is placed inside the wikitable sorts the footer along with the values under each heading (i.e., it looked pretty bad when it was sorted by any column). Seppi333 (Insert 2¢) 21:15, 30 October 2017 (UTC)

@Doc James: I've finished reformatting the table. I managed to get the footer to function correctly (i.e., not be sorted when sorting the columns) using only 1 wikitable, so there's no weird outside border in the current version. The table should be ready for the article now. Seppi333 (Insert 2¢) 21:55, 30 October 2017 (UTC)

Looks like a good addition to the images Doc James (talk · contribs · email) 22:40, 30 October 2017 (UTC)

Much more readable, and... well, visually dull? I think we can bring it back by adding color to each cell, yellow for under 1.00, orange for under 2.00, and (pale-ish) red for under 3.00, and maybe violet for (the single) 3.00 and above. I'm very tempted to immediately put it in myself so I can see it, but I thought I'd better ask first. --A D Monroe III^(talk) 00:27, 31 October 2017 (UTC)

I don't see any harm in adding it to see how it looks, especially since it can always be undone later. I think the sorting feature makes it a bit unnecessary to color code it though. Seppi333 (Insert 2¢) 00:42, 31 October 2017 (UTC)

Done. I kept the colors pale to maintain text contrast. --A D Monroe III^(talk) 04:14, 31 October 2017 (UTC)

That coloring scheme actually seems rather useful. Thanks for adding that. Seppi333 (Insert 2¢) 21:47, 31 October 2017 (UTC)

Rational scale to assess the harm of recreational drug use

Drug	Drug class	Physical harm	Dependence liability	Social harm	Total harm
Heroin	Opioid	2.78	3.00	2.54	2.77
Cocaine	CNS stimulant	2.33	2.39	2.17	2.30
Barbiturates	CNS depressant	2.23	2.01	2.00	2.08
Methadone	Opioid	1.86	2.08	1.87	1.94
Alcohol	CNS depressant	1.40	1.93	2.21	1.85
Ketamine	Dissociative anesthetic	2.00	1.54	1.69	1.74
Benzodiazepines	Benzodiazepine	1.63	1.83	1.65	1.70
Amphetamine	CNS stimulant	1.81	1.67	1.50	1.66
Tobacco	Tobacco	1.24	2.21	1.42	1.62
Buprenorphine	Opioid	1.60	1.64	1.49	1.58
Cannabis	Cannabinoid	0.99	1.51	1.50	1.33
Solvent drugs	Inhalant	1.28	1.01	1.52	1.27
4-MTA	Designer SSRA	1.44	1.30	1.06	1.27
LSD	Psychedelic	1.13	1.23	1.32	1.23
Methylphenidate	CNS stimulant	1.32	1.25	0.97	1.18
Anabolic steroids	Anabolic steroid	1.45	0.88	1.13	1.15
GHB	Neurotransmitter	0.86	1.19	1.30	1.12
Ecstasy	Empathogenic stimulant	1.05	1.13	1.09	1.09
Alkyl nitrites	Inhalant	0.93	0.87	0.97	0.92
Khat	CNS stimulant	0.50	1.04	0.85	0.80
Notes about the harm ratings The Physical harm, Dependence liability, and Social harm scores were each computed from the average of three distinct ratings. The highest possible harm rating for each rating scale is 3.0. Physical harm is the average rating of the scores for acute binge use, chronic use, and intravenous use. Dependence liability is the average rating of the scores for intensity of pleasure, psychological dependence, and physical dependence. Social harm is the average rating of the scores for drug intoxication, health-care costs, and other social harms. Total harm was computed as the average of the Physical harm, Dependence liability, and Social harm scores.

Section reflist

References

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The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The graph

This graph sould be removed from the lede, it just repeats the old anti-benzo prejudices. There's no evidence whagtsoever than benzos are at the same level of such extremely harmful drugs as alcohol, see also: [12].Miacek (talk) 21:31, 15 May 2018 (UTC)

What "anti benzo prejudice" do you speak about? Yah harm is definitely mid way on the spectrum in my experience. But we do not need my experience as we have a source. Doc James (talk · contribs · email) 23:41, 15 May 2018 (UTC)

As I pointed out, other estimates that put benzos' risk much lower do exist.Miacek (talk) 08:12, 16 May 2018 (UTC)

The graph came about from a large survey of a diverse range of experts. It is one of the most robust surveys done. That is why it is included in the article. There is no evidence of an "anti-benzo" bias. In fact, the lead author, Prof. David Nutt, is very much pro-benzos and closely tied with the manufacturers of benzodiazepine drugs.--Literaturegeek | T@1k? 14:29, 16 May 2018 (UTC)

Text

This needs to be converted to inline references Doc James (talk · contribs · email) 00:00, 31 August 2018 (UTC)

"St Louis Epidemic The overdose rate has risen in St Louis by 79 percent from 2010 to 2016 (Saint Louis County Department of Public Health, 2018). This increase could be explained by number of opioid prescription and quantity of pills issued to patients. Prescription Drug Monitoring Programs (PDMP) could directly influence the number of prescriptions written. Analysis was performed and determined that PDMP’s are not effective in reducing prescription rates unless physicians were required to access the program prior to writing the prescription (Ayres & Jalal, 2018). Additionally, Research has shown that patients receiving opioids to relieve chronic pain are 77 percent more likely to abuse drugs than those who do not (Banerjee et al., 2016). Education programs could be implemented to combat the overdoses as well. Historically, overdoses have decreased nine to 11 percent due to the Good Samaritan Laws that grant immunity to users that try and prevent an overdose (Ayres & Jalal, 2018). If citizens and more importantly, users, knew about law and other like it, the overall overdose rate could be positively impacted. Lastly, Naloxone has been available for many years but only to first responders and EMTs. Overdoses cost Missouri $12.6 billion annually (Missouri Department of Health, 2018). Research has shown, through the use of naloxone, overdose death rates decreased by 50 percent (Frank, Mateu-Gelabert, Guarino, Bennett, Wendel, Jessell, & Teper, 2015). The overdoses in St Louis continue to rise. By implementing PDMPs to monitoring prescriptions, educating the population about laws in place to combat overdoses and a cheaper more effective Naloxone prescription could reduce the number of drug related overdoses in the St Louis Area. References:

Ayres, I. & Jalal, A. (2018). Opioids, law & ethics. The Journal of Law, Medicine & Ethics, 46(2018), 387-403. doi:10.1177/1073110518782948

Banerjee, G., Edelman, E.J., Barry, D.T, Becker, W.C, Cerda, M., Crystal, S., Gaither, J.R., … Marshall, B.D. (2016). Non-medical use of prescription opioids is associated with heroin initiation among U.S. veteran: A prospective cohort study. Society for the Study of Addiction, 111(11), 2021-2031. doi:10.1111/add.13491 Frank, D., Mateu-Gelabert, P., Guarino, H., Bennett, A., Wendel, T., Jessell, L., & Teper, A. (26, January 2018).

High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users. International Journal of Drug Policy., 26(1), 84-91. doi: 10.1016/j.drugpo.2014.07.013 Missouri Department of Health. (2018). Good Samaritan law. Official Missouri State Website. Retrieved from: https://health.ml.gov/living/lpha/phnursing/goodsamaritan.php

Saint Louis County Department of Public Health. (June, 2018). Drug overdose deaths St. Louis County, Missouri. Retrieved from: https://www.stlouisco.com/Portals/8/docs/Health/Health%20Data/Drug_Poisoning_Profil e_Adapted_from_Heroin_Deaths_profile_2017_Final.pdf"

Outdated statement on cause

The current lede reads "The exact cause of substance abuse is not clear, with the two predominant theories being: either a genetic disposition which is learned from others, or a habit which if addiction develops, manifests itself as a chronic debilitating disease." with a citation to an obsolete ref. I suggest that it would be clearer to acknowledge that there is complex causation, with many genetic, epigenetic, and developmental factors. See for instance https://www.nature.com/articles/522S48a LeadSongDog come howl! 18:02, 2 January 2019 (UTC)

Substance "use"

There have been efforts, such as in the article on Ozzy Osbourne, to refer to substance use rather than abuse in an attempt to use more neutral and non-judgmental language. Should this now be renamed Substance use?--Egghead06 (talk) 15:46, 4 March 2021 (UTC)

Thank you for drawing attention to this important issue. I've actually reverted the phrase in Ozzy's article for consistency, but NIDA's guidance advises against the term "abuse" as it is stigmatizing language. Since Wikipedia values presenting information in as neutral a tone as possible, I think there is room for improvement here. I see proposals and discussion below on what to do. HussainHx (talk) 00:04, 2 October 2023 (UTC)

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Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:22, 17 January 2022 (UTC)

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"Illegal drug use" listed at Redirects for discussion

An editor has identified a potential problem with the redirect Illegal drug use and has thus listed it for discussion. This discussion will occur at Wikipedia:Redirects for discussion/Log/2022 May 11#Illegal drug use until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Sangdeboeuf (talk) 01:15, 11 May 2022 (UTC)

Requested move 17 July 2022

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved per consensus below. (closed by non-admin page mover) Extraordinary Writ (talk) 16:31, 24 July 2022 (UTC)

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Substance abuse → Substance addiction – I think the name of this page should be moved to 'Substance addiction'. I feel like the name 'Substance abuse' is biased and implies the person dependent on drugs has done something wrong by being addicted. Furthermore, my concerns are supported by a lot of sourced information already in the article which recommended avoiding the term 'abuse' in contexts like this. Renaming the article and replacing 'abuse' with 'addiction' in similar instances is a good idea from my perspective - not only preventing victim-blaming for people with drug addiction but also making the page neutral - considering the multiple paragraphs talking about criticisms of terms like 'substance abuse'. However, I'm also open to hearing different terms the article should be renamed to that also prevent victim-blaming. Someone might suggest a term better and more medically recommended than the one I've proposed. Stephanie921 (talk) 14:59, 17 July 2022 (UTC)

• Oppose - While I agree with some of the sentiments motivating the call for a move, I nonetheless oppose for two reasons. First, whether the substances are being "abused" or simply "used", addiction is not a prerequisite for doing so. Second, I am 99.9% sure that "substance abuse" is going to be the term most used by sources by an overwhelming margin. Primergrey (talk) 18:36, 17 July 2022 (UTC)
• Oppose. I agree that there can be abuse without addiction. Binge drinking is alcohol abuse, but can occur as a one-time event, without continuing alcohol addiction. And substance abuse is indeed the term most widely used, by far. Google hits: [13], 104M, versus [14], 6M. We also have a page on Substance use disorder. --Tryptofish (talk) 23:14, 17 July 2022 (UTC)
• Oppose per WP:COMMONNAME. Also, abuse and addiction are not the same thing. -- Necrothesp (talk) 09:56, 20 July 2022 (UTC)
• Oppose, while I appreciate the sentiment behind this RM, this isn't the common name and they aren't the same thing. You can abuse substances without being addicted to them, and it might also be possible to be addicted without abuse. Pikavoom ^Talk 10:39, 20 July 2022 (UTC)

Absolutely possible. Oxycontin anyone? Primergrey (talk) 17:28, 20 July 2022 (UTC)

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Merger Proposal with Substance Use Disorder

I noticed that previously there was a request to move this page to "substance addiction", which failed, but what I would suggest is that instead this article should be merged with the "substance use disorder" page. As noted in the article, the DSM-V does not use the terminology "substance abuse", neither does the WHO. Health Canada also recommends switching from "substance abuse" to "substance use disorder" (SUD) (see here), and the National Institute on Drug Abuse (NIDA) has been trying to change its name to the "National Institute on Drugs and Addiction" because it finds the language of abuse biased and stigmatizing. This page contains a lot of interesting information, but it is overall very confused.

It feels like a lot of workarounds have been written into the article in order to differentiate it from SUD. The article notes that substance abuse is a form of substance-related disorders, but there is no clarity as to how they are different throughout the article, and there are consistent slippages between substance use, abuse and substance use disorder. If this article is about substance use, then it should be about substance use, and would require major revisions to include things like history, culture etc. If it is about the term that was substance abuse, but now is substance use disorder it should be merged. For it to stay as it is, there should be a real definition of what classifies abuse in the article, and what differentiates it from use & SUD.

Merging, rather than moving (as described before) would allow for people to still search "substance abuse", they would just be sent to substance use disorder. A lot of the controversy that is on this page would still work really well on the substance use disorder page, as substance abuse is the historical term described. I think it would make the substance use disorder page more enriched by including a lot of the content that is currently here.

I am open to other proposals as well, or possible clarifications. ADrugResearcher (talk) 21:25, 25 October 2022 (UTC)

See Talk:Substance use disorder#Proposed_merge_of_Substance_abuse_into_Substance-related_disorder ADrugResearcher (t · c) buidhe 03:46, 5 September 2023 (UTC)

Requested move 2 October 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved. (non-admin closure) - 🔥𝑰𝒍𝒍𝒖𝒔𝒊𝒐𝒏 𝑭𝒍𝒂𝒎𝒆 (𝒕𝒂𝒍𝒌)🔥 13:38, 9 October 2023 (UTC)

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Substance abuse → Substance use and misuse – This is a great article, but it has a title with which the article itself seems to be unhappy. The problem is that “abuse” is a stigmatizing term, but up until now it has not been clear what was to be done. On 24 July 2022, it was decided that the article would not be moved to “substance addiction” because this article descibes risky use which is non-habitual in nature. There is also a recent yet seemingly inactive discussion about whether to merge substance abuse into substance use disorder, again misguided for the same reason (Talk:Substance use disorder).

Available editorial guidance is clear on this issue. Since 2017, the Associated Press Stylebook has advised authors and editors to avoid stigmatizing words such as “abuse” or “problem” and to instead use “risky,” “unhealthy,” “excessive,” “heavy,” or “misuse,” depending on context (link). Further, since 2021, the U.S. National Institute on Drug Abuse (NIDA) has advised against using the stigmatizing term “abuse.” NIDA has advised using the word “use” for non-legal drugs and “misuse” for the use of medically available drugs in a way which deviates from the prescriber’s explicit intent (link).

As written, this article pertains to the use of both legal and non-legal drugs, it mentions that the term “drug abuse” is not preferred, and it even has a section devoted to “drug misuse” which is consistent with NIDA’s recommendations. With the above in mind, I propose this article be moved to “Substance use and misuse.” HussainHx (talk) 01:01, 2 October 2023 (UTC)

I would support a move to "Substance misuse" but not to "...use and misuse". Since use in this context means "within the legal allowances" or something similar. Primergrey (talk) 01:19, 2 October 2023 (UTC)

Thank you for your comment. To clarify, "use" refers to non-legal drug use, whereas "misuse" refers to the use of prescribed drugs outside intended purpose. Both use and misuse are within this article's scope. HussainHx (talk) 19:47, 2 October 2023 (UTC)

"Substance use" refers to non-legal drug use? Is that a recent definition? Primergrey (talk) 22:11, 2 October 2023 (UTC)

CDC has used the term "substance use" to refer to the illicit use of alcohol, tobacco, and illicit drugs by children at least since their 2011 Monitoring the Future survey referenced in the article. More recently, NIDA’s 2021 style guidance explicitly recommended using the term "use" for illicit drugs. The use of legal drugs as prescribed is commonly referred to as "medication use" rather than "substance use," and alcohol and tobacco are usually specified and not referred to as "substances." As the article currently stands, there is just one paragraph which discusses the legal yet problematic use of alcohol, but that paragraph is arguably tangential to the article's topic and would be better moved to the article presently entitled "Alcohol abuse." Legal tobacco use is not discussed in any amount of depth in the present article, and it is covered by Tobacco smoking and Chewing tobacco. HussainHx (talk) 23:42, 2 October 2023 (UTC)

• Oppose per WP:COMMONNAME. "Substance abuse" is far more common than "substance misuse". See the Google Ngrams. Rreagan007 (talk) 04:15, 2 October 2023 (UTC)

  The point you raise relies on original research, so it may not be used as a point of consideration (Wikipedia:No original research). HussainHx (talk) 18:07, 2 October 2023 (UTC)

  Google Ngrams are very frequently used in RM discussions to determine what the most common name for a subject is. It is not considered a violation of WP:NOR to use them in this context. Rreagan007 (talk) 00:12, 3 October 2023 (UTC)

  Additionally, a sub-point of the guidance you cite advises using non-judgmental descriptive titles WP:NDESC. Substance use and misuse is common enough to be recognized. HussainHx (talk) 19:44, 2 October 2023 (UTC)

  I am not convinced that "misuse" is any more or less judgmental than "abuse". They appear to be interchangeable synonyms to me. "abuse: to use wrongly or improperly; misuse"[15] "misuse: wrong or improper use; misapplication"[16] Rreagan007 (talk) 00:14, 3 October 2023 (UTC)

  Thank you for clarifying the contextual appropriateness of Google Ngrams—I refer to that resource in the next paragraph to strengthen my case. First, though, please allow me to clarify in turn that "substance use" refers to the non-legal use of substances, such as when children consume alcohol, or when adults use heroin. On the other hand, "substance misuse" refers to the misapplication of prescription medications, such as when someone takes Xanax given to them by a friend, or when a patient attempts suicide by taking their own monthly supply all at once.

  Together, the terms "substance use" and "substance misuse" refer to what was once more commonly known as "substance abuse." According to Google Ngrams, the frequency of "substance abuse" was overtaken by "substance use" in 2019 (link). The term "substance abuse" has fallen out of favor, declining in frequency by nearly half between 2009 and 2019, while the terms "substance use" and "substance misuse" each more than doubled in frequency during the same period.

  Moreover, NIDA based their style guidance on research which showed that "the term 'abuse' was found to have a high association with negative judgments and punishment" (reference 7 at link). Surely, this form of evidence about the judgmentality of terms ranks above the subjective assessments of we Wikipedia editors. HussainHx (talk) 17:30, 3 October 2023 (UTC)

The medical community has a ton of reasons to want to distance themselves from negative judgements and punishment when it comes to substance abuse. Are we bound to assist them? Primergrey (talk) 20:05, 3 October 2023 (UTC)

This appears to be a loaded question based on skepticism toward the medical professions. The terminology advanced by both NIDA and the Associated Press, which according to Google Ngrams has overtaken the term "abuse" in commonality, is backed up by scientific research which says the term "abuse" is judgmental, and it is consistent with Wikipedia policy to use descriptive and non-judgmental terms WP:NDESC. HussainHx (talk) 20:25, 3 October 2023 (UTC)

I have a healthy skepticism towards a lot of things, but in Canada, where I live, everyone is free to go to one of the northern communities ravaged by Oxy and be cleansed of all their medical skepticism, which will be replaced by outright mistrust. Primergrey (talk) 21:07, 3 October 2023 (UTC)

The problem which you describe is covered in the articles entitled Opioid epidemic and Purdue Pharma, and while historic clinical contributions to substance misuse could be discussed in greater depth in the article at hand, Wikipedia editors are expected to maintain a neutral point of view, which involves treating scientific material in good faith that mainstream scientific points of view are valid (WP:NPOV). Since you are personally mistrustful of the medical professions, you are not able to engage with the material at hand in good faith. I suggest you recuse yourself from this discussion. HussainHx (talk) 21:46, 3 October 2023 (UTC)

For being mistrustful? I suspect I will not. Primergrey (talk) 01:35, 4 October 2023 (UTC)

• Oppose per WP:COMMONNAME. Agree with Rreagan007. The Herald (Benison) (talk) 12:10, 2 October 2023 (UTC)
• I don't see the purpose of this move, as I'm not sure misuse any less biased phrasing than the current title. However, if as some suggest the intended subject is "illegal drug use", the article should be renamed accordingly. (t · c) buidhe 23:44, 3 October 2023 (UTC)

Substance abuse is a much broader scope than illegal drug use. Excessive alcohol consumption or addiction to prescription medications are also labeled as substance abuse. Rreagan007 (talk) 07:51, 4 October 2023 (UTC)

Thanks for weighing in, Buidhe, and for your comment, Rreagan007. The article for alcohol abuse refers to alcohol as a "substance" only in the context of the non-legal use by adolescents. The misuse of prescription medications may or may not be legal depending on context—doubling or tripling up on one's prescribed Xanax in a non-habitual manner may deviate from prescribed use without crossing legal boundaries.

The term "misuse" was suggested by a Harvard professor of psychiatry in the concluding remarks of a scientific article published in 2010 which found that the term "abuse" was stigmatizing (link). NIDA references this article in their style guidance which informed my proposal (ref 7 in link).

However, based on the discussion which has unfolded, it seems my proposal is confusing because it uses the sub-term "substance misuse" to refer specifically to the misuse of prescription medications. While this is NIDA's guidance, I believe "medication misuse" is more clear.

With that in mind, an alternative option for adhering to both Non-Judgmental and Descriptive Titles WP:NDESC would be to move this article to "Substance use and medication misuse."

What are your thoughts? HussainHx (talk) 18:20, 4 October 2023 (UTC)

• Oppose, but I agree with the sentiment of your proposal, i.e., that "abuse" has stigmatizing connotations, at least in some contexts, e.g., "substance abuser". The term "substance abuse" was used for such a long time that thousands of important books and articles written over the last several decades use the term, and in the United States, we have the Substance Abuse and Mental Health Services Administration (SAMHSA).

I suggest concentrating on explaining the term within the article so that readers understand what it has meant historically and why it is no longer a recommended phrase for describing substance use disorders. (I see the two terms as being equivalent, although there is room for debate.) For example, the American Psychiatric Association eliminated substance abuse and substance dependence as distinct diagnoses in DSM-5 because the science did not support the distinction. Mark D Worthen PsyD (talk) [he/him] 16:24, 6 October 2023 (UTC)

• Oppose: per WP:COMMONNAME. The first sentence of the article literally reads, substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others; this is by definition what "abuse" means. Perceived "stigmatization" is not a good reason. For "substance use", see recreational drug use or self-medication. --WikiLinuz (talk) 19:00, 6 October 2023 (UTC)

References

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

• WikiLinuz The issue with that definition is that many reliable sources don't really distinguish between "abuse" by that definition and simply using a substance. For example, this 2023 review states that "more than 50% of abusers reporting at least one side effect" from androgen use. This presumes that some don't experience any adverse effects, yet are still considered to be "abusing" the drug. If two people use an illicit substance at the same dosage it's possible that one could experience harm and the other wouldn't. However, many types of research would not be able to elucidate whether a particular user is experiencing that harm and they tend to be lumped into "abuse". To me, this suggests that the term "abuse" is being used as a value judgement, which RS are free to make but is in contravention of WP:IMPARTIAL for us to repeat. (t · c) buidhe 22:20, 11 October 2023 (UTC)

  I'm not sure how "Substance misuse" is any less judgemental than "Substance abuse" in this context. The former assumes that an individual used it with/without intention to "abuse" it (meaning they may used it without sufficient knowledge), and the later assumes that the individual misused it intentionally to get high (example taking a week's worth of prescription stimulant medication in a day in binges). But I think WP:SUBJECT of this article is about the later category. A person may use a drug of abuse (controlled substances) without necessarily abusing it or using it in a harmful way (Responsible drug use). COMMONNAME still holds, since abuse (1,070,000) is used more commonly than misuse (18,200). Ngrams results are also consistent. --WikiLinuz (talk) 00:20, 12 October 2023 (UTC)

  I don't support misuse over abuse either, so Im not sure why that's your response. My comment is more in reference to the existence of the article. I am not sure it is possible based on the sources to draw a neat distinction between "responsible" use versus "misuse"/"abuse" and have a separate article focused on the latter. Philosophically, I think it is in more keeping with NPOV to treat both potential benefits and harms of drugs together. (I'm also opposed to "criticism of" articles). (t · c) buidhe 01:03, 12 October 2023 (UTC)

Not in the ICD

"The term ‘abuse’ is sometimes used disapprovingly to refer to any use at all, particularly of illicit drugs. The term is not used in ICD-10 because of its ambiguity and to avoid including social consequences in the definition of a diagnosis. Harmful use is the closest equivalent in ICD-10. 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’. The term drug use is often preferred as it is non-judgemental."

References

(t · c) buidhe 04:11, 9 December 2023 (UTC)

nicotine, cannabis, and THC

Why is nicotine not mentioned as one of the addictive chemicals in the introduction? Cannabis is also not considered a substance that has the likelihood to create an addiction. The statement should be changed from cannabis to THC. Even though THC is also not considered as highly of an addictive chemical, it is still more addictive than cannabis. Although nicotine may not be considered a drug in every country, it is still considered a stimulant and a problematic and addictive substance. Although there are many suicides associated with substance abuse, some of the wording should be changed to explain the difference in suicides and overdose. Also speaking about the increased risk factors of substance abuse, gun violence is an aspect that should be added to the possible risks as the National Institute of Health states that those involved in drug and alcohol abuse have an increased chance and percentage of being involved in gun violence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567686/

—-Sld99 (talk) 01:31, 15 May 2024 (UTC)