Drug Abuse

Alcohol consumption above 30 g/day for men or 20 g/day for women is associated with increased mortality from all causes but on sumption below these concentrations is not associated with any health risks.

Consumption above 80 g/day for men or 60 g/day for women conveys a risk of one or more of the alcohol caused diseases such as cirrhosis or pancreatitis (see calculation of alcohol intake).

The increased mortality experienced between 30-80 g (20-60 g) is due to a wide variety of alcohol related problems such as hypertension, trauma etc. (See “secondary prevention”).

These are very safe drugs with low toxicity at therapeutic concentrations and safe use really consists of adhering to the indications and not continuing the drug for more than two months without clear evidence of continuing benefit.

Accepted indications

alcohol withdrawal
seizures
muscular spasm in cerebral palsy and spinal cord disease

Indications which are a matter of opinion

dysfunction anxiety
psychosis or depression and anxiety

Indications which are a matter of philosophy

short term insomnia
situational anxiety

Contraindications

“normal” anxiety
long term insomnia
alcohol/other drug dependence apart from withdrawal

For obvious reasons, the necessary data is not available.

The DSM-IV clinical criteria are equally applicable to all drugs. Three or more of the following should be present:

Tolerance
Withdrawal
Use of more or for longer than was intended
Persistent desire or unsuccessful efforts to cut down
Excess time is spent obtaining/using/recovering
Important social occupational or recreational activities given up because of substance use
Persistent use despite knowledge of a physical or psychological problem caused or exacerbated by the use

This is now the accepted term for alcohol/drug use which causes problems but is not dependent. The DSM-IV criteria are given below and only one need be present.

There is much less consistency in the diagnosis of “abuse” compared to “dependence”.