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Substance Abuse Criteria
drug abuse vs. drug dependence. Luna asks, “What kind of terminology might you find
in a patient’s record that would indicate abuse vs. dependence?” – I had to do my
little Google research, and for those that this is the first time on the call, the ongoing
joke out there especially in Facebook land is that I always say “Google it.” My niece
told me, “That’s what you’re going to raise your kids, aren’t you? You are going
to tell them, ‘Google it first.’” Yup! It’s amazing what you can find, so don’t
be afraid to use Google for medical coding research. Just type it in and you’ll be
amazed at what you’ll find. That’s how I found this.
I’ll go down to the footnote so you can see where this came from first. It came from
the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders:
DSM-IV. That’s an official manual that’s used. We don’t code from it, but it gives
us the definitions that we do use for coding. Before I go on, I just want to say as far
as what indicates abuse vs. dependence, the physician should really be documenting one
of those two words. You shouldn’t have to piece it together, but to understand what’s
behind the difference.
Here we go: Substance abuse is defined as maladaptive pattern of substance use leading
to clinically significant impairment or distress – that’s pretty much the same for abuse
vs. dependence. Here’s where the difference has come. They’re going to have one (or
more) of the following, occurring within a 12-month period: Recurrent substance use resulting
in failure to fulfill major role obligations at work, school, or home. The second bullet:
Recurrent substance use in situations in which is physical hazardous. Recurrent substance-related
legal problems. Continued substance use despite having persistent or recurrent social or interpersonal
problems.
They have a note here that the symptoms for abuse have never met the criteria for dependence
– so if they’ve ever met the criteria for dependence then that’s what you should
use. Now, according to this DSM-IV, a person can be abusing a substance or dependent on
a substance but not both at the same time. That makes sense.
Here’s a definition for dependence. So, everything was the same and they’re going
to have three or more of the following: Tolerance, as defined by either of the following: A need
for markedly increased amounts of the substance to achieve intoxication or the desired effect.
Withdrawal, they would go through with withdrawal if the substance was removed. The next bullet:
The substance is often taken in larger amounts or over a longer period than intended. There’s
a persistent desire or unsuccessful efforts to cut down or control it. And then, a great
deal of time is spent in activities necessary to obtain the substance, use it or recover
from it. Important social, occupational, or recreational activities are given up or reduced
because of it. The substance use is continued despite knowledge of having a persistent physical
or psychological problem, like, *** use having that ***-induced depression or
liver problems.
So that is the difference officially between abuse and dependence. So, dependence, three
or more of those bullets and the abuse was one or more of these bullets.
This will be on the answer sheet, but again, if you just Google substance abuse vs. dependence,
you will find pages like this. Again, coding wise, we really want the physician to tell
us, is it drug abuse or drug dependence?