Difference between substance dependence and substance abuse?

U

Unregistered

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I'm a little foggy about the difference between substance dependence and substance abuse. If someone took a narcotic substance for 15 years because of a medical condition and then came off of it after the condition was resolved, that seems to me like that person would have been dependent on that substance for 15 years, and that would be substance dependence?
 
"a little foggy" heehee

I'll bet you dollars to doughnuts that you'll get many many many referrals to Dr. Bruce.
 
The FAA book version of the answer to your question may be found here (you'll have to follow the various links for the full story). Beyond that, talk it over with your AME (or Dr. Bruce Chien) before you sign your medical application. You can reach Bruce either on the AOPA Forums or via his website.
 
I depend on chocolate. However I don't abuse it. I don't eat multiple dark chocolate bars every day, I limit to at most 1 a day. In fact some days, I don't have any dark chocolate bars, altho I will have a cup of hot chocolate in the evening. And perhaps some Hersey's syrup in milk in the morning along with my CocoaPops. I stopped snorting cocoa powder years ago and have never mainlined Ubet's chocolate no matter what my cousin says.
 
Dependence:
-- Normal Breathing (necessary to sustain life/completing daily activities)

Abuse:
-- Hyperventilating (getting high/dizzy & loosing 100% control from overuse)

.
 
"substance dependence" and "substance abuse" are defined in FAR 67.107
 
oldShar said:
Dependence:
-- Normal Breathing (necessary to sustain life/completing daily activities)

Abuse:
-- Hyperventilating (getting high/dizzy & loosing 100% control from overuse.
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Add also "Addiction." Ask a group of people if any are addicted to recreational drugs ... then discuss withdrawal symptoms for smokers or coffee drinkers when they go without their drug of choice for a day or two.
 
midlifeflyer said:
"substance dependence" and "substance abuse" are defined in FAR 67.107
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Thanks for the point-out.

Note that 67.107 covers First Class. It's also defined for Second and Third in 67.207/307, and I quote the language from 67.307 for "substance dependence":
(ii) “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by—
(A) Increased tolerance;
(B ) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.
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...and "substance abuse":
(b) No substance abuse within the preceding 2 years defined as:
(1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;
(2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or
(3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—
(i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
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Unregistered said:
I'm a little foggy about the difference between substance dependence and substance abuse. If someone took a narcotic substance for 15 years because of a medical condition and then came off of it after the condition was resolved, that seems to me like that person would have been dependent on that substance for 15 years, and that would be substance dependence?
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Outcome.

If you can't quit, you're dependent. If it also causes you a problem, it's abuse.
 
I sure hope they never take the caffeine exception out.....
 
A more general (non-FAA distinction):

Substance dependence may be intentional or unintentional and may or may not be comorbid with substance abuse. An example of unintentional substance dependence not comorbid with substance abuse would be a person who is prescribed a narcotic for physical pain, which later become ineffective (tolerance), difficult to stop taking without withdrawal symptoms, physically or otherwise harmful to the person's health, or taken in excess of prescribed dosages for the sole purpose of alleviating the intractable pain because lower dosages have become ineffective.

An example of intentional substance dependence would be when a person becomes dependent on a drug for which he or she never had a legitimate medical need (or after the need has passed) knowing that dependence was a possible outcome.

Substance abuse is intentional and may or may not be comorbid with substance dependence. It also may have originated in a lawful medical use, but later become abuse. Substance abuse includes the use of substances in violation of law, the misuse of substances for other than medically-legitimate reasons (including when a previous medical reason no longer exists), or any intentional use of substances that has adverse effects on the individual's well-being or functioning in any sphere (health, family, work, legal, etc.).

Substance dependence is not a requirement of substance abuse, but the two may (or may not) be comorbid. A person who ingests psilocybin mushrooms with his old college buddies "for old times' sake" once a year is a substance abuser because the illegal use of psilocybin has the adverse effect of making that person subject to arrest and prosecution (along with other possible dangers of consuming hallucinogens). But absent elements of tolerance, withdrawal, etc., that use would not meet the diagnostic criteria for substance dependence.

Neither is all substance abuse illegal. A person who drinks so much in the privacy of his own home that he can't hold a job is not violating any laws, but he is a substance abuser.

Rich
(Erstwhile CASAC)
 
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Ron Levy said:
Thanks for the point-out.

Note that 67.107 covers First Class. It's also defined for Second and Third in 67.207/307, and I quote the language from 67.307 for "substance dependence":
...and "substance abuse":
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I take note that electronic cigarettes, which contain no tobacco, are not included in the "dependence" exclusion....
 
I have a similar issue and am thinking about my 8500 form.. If this was used for medical purposes does box 18n get a Y or N? I would think it would get a NO because it doesn't fall under the FAA's definition of substance abuse or dependence.
 
The difference, probably more money for one.
 
Unregistered said:
I have a similar issue and am thinking about my 8500 form.. If this was used for medical purposes does box 18n get a Y or N? I would think it would get a NO because it doesn't fall under the FAA's definition of substance abuse or dependence.
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I would suggest that you report actual diagnoses, but not look for conditions that aren't there.

If the drug was used under a doctor's supervision to treat a medical problem, it was acceptably effective at prescribed dosages, you neither misused it not had an unusually difficult time titrating off of it, and you were never diagnosed or treated for a drug dependency or drug abuse, then the answer is No.

The doctor visits, underlying diagnoses, treatments, and so forth do need to be reported, however.

You may want to consult with someone like Dr. Bruce for the best way to frame these responses and what, if any paperwork to obtain from the treating physician(s) in order to speed the process along. It may be one of those cases where a slip of paper can mean the difference between an in-office issue or months of waiting.

Rich
 
Unregistered said:
I'm a little foggy about the difference between substance dependence and substance abuse. If someone took a narcotic substance for 15 years because of a medical condition and then came off of it after the condition was resolved, that seems to me like that person would have been dependent on that substance for 15 years, and that would be substance dependence?
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Your scenario is rather unlikely.
 
Unregistered said:
I'm a little foggy about the difference between substance dependence and substance abuse. If someone took a narcotic substance for 15 years because of a medical condition and then came off of it after the condition was resolved, that seems to me like that person would have been dependent on that substance for 15 years, and that would be substance dependence?
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You can abuse without being dependent.

You can be dependent without abusing.

Both can occur with the first use.

Some people can use a substance for years and never develop dependence.
 
i took narcotic pain releiver for several years due to a knee injury - i was offered a job with the FAA and took those meds up until the job was offered , is this considered dependency? if so , should i report it? i paid an consultant service to explain the situation and the Dr on staff told me clearly i would be disqualified but leftseat.com has advised that as long as im off the meds for 90 days and i can get a favorable evaluation from a HIMS addiction specialist then i should be ok? please help
 
Does the FAA also define what falls under the "substance" category?
I am highly dependent on dihydrogen monoxide. Heavily. Badly. If I skip it even one day, I experience dry mouth, headaches, cravings, you name it. The withdrawal doesn't feel good.
I am so dependent that if I don't have it for several days, I am likely to die. For realz.

But I do NOT abuse it. I am merely dependent.
Will the big bad FAA bear take my license? :(
 
Lou, just add some sweet tea molecules, ease yourself into a comfy chair, and let your worries drift away
 
Concerned112211 said:
i took narcotic pain releiver for several years due to a knee injury - i was offered a job with the FAA and took those meds up until the job was offered , is this considered dependency? if so , should i report it? i paid an consultant service to explain the situation and the Dr on staff told me clearly i would be disqualified but leftseat.com has advised that as long as im off the meds for 90 days and i can get a favorable evaluation from a HIMS addiction specialist then i should be ok? please help
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The real and correct answer to your question needs to come from a very experienced AME like Dr. Bruce Chien. Especially if you have done something that has put your medical certification status in jeopardy.

None of regular airmen us here are qualified to answer the "what I should do to fix this" question.
 
BigBadLou said:
Does the FAA also define what falls under the "substance" category?
I am highly dependent on dihydrogen monoxide. Heavily. Badly. If I skip it even one day, I experience dry mouth, headaches, cravings, you name it. The withdrawal doesn't feel good.
I am so dependent that if I don't have it for several days, I am likely to die. For realz.

But I do NOT abuse it. I am merely dependent.
Will the big bad FAA bear take my license? :(
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Yes. This is a very dangerous colorless and odorless chemical compound, also referred to by some as Dihydrogen Oxide, Hydrogen Hydroxide, Hydronium Hydroxide, or simply Hydric acid......:lol::lol::lol:

http://www.dhmo.org/facts.html
 
Concerned112211 said:
i took narcotic pain releiver for several years due to a knee injury - i was offered a job with the FAA and took those meds up until the job was offered , is this considered dependency? if so , should i report it? i paid an consultant service to explain the situation and the Dr on staff told me clearly i would be disqualified but leftseat.com has advised that as long as im off the meds for 90 days and i can get a favorable evaluation from a HIMS addiction specialist then i should be ok? please help
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I don't know about the FAA, but generally speaking, taking narcotic painkillers as prescribed for a valid medical reason definitely would not qualify as abuse. It might or might not qualify as dependency.

For example, a person who stops taking the medication and experiences only the expected short-term withdrawal symptoms would not be considered dependent (in general, I mean, not necessarily by FAA). A person who continues to experience cravings might be dependent depending on the frequency of cravings, intensity, and so forth. A person who submits to the cravings by scoring some heroin or Vicodin illegally definitely would be considered dependent.

As for the FAA view on the issue, I can't say. I would think that a HIMS AME should be able to tell whether or not someone who once took opiates for a physical problem has a continuing dependency on them; and I would think that if his or her finding were that the person is not dependent, that the previous lawful narcotics use should be a non-factor. But that's just a hunch. You'd need to talk to a HIMS AME to get an answer that actually means anything.

Rich
 
The FAA would demand a 90 days period of documented cessation (urine) and a statement an essay from the prescriber, as well as one form a board certified psychiatrist. Stockpiling has become all too common and FAA will have none of that.
 
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