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Historical Context of Substance Use
Early Use of Opiates
• Opiates have been used since the early 17th century, with records
dating back to the Mayflower in 1620, where they were utilized to
alleviate symptoms of diseases such as cholera and smallpox.
• Bayer's promotion of heroin and aspirin in the late 19th century
highlights the historical normalization of opiate use for both adults
and children, reflecting societal attitudes towards pain management
at the time.
Legislative Milestones
• The Harrison Tax Act of 1914 marked the first significant federal
attempt to regulate drug use in the U.S., imposing taxes on opium
derivatives, which laid the groundwork for future drug legislation.
• By the 1920s, the medical community recognized the addictive
properties of opiates, shifting the perception of addiction from a moral
failing to a medical issue, although stigma persisted.
Definitions and Diagnostic Criteria
Substance Use Disorder (SUD)
• SUD is characterized by a maladaptive pattern of substance use
leading to significant impairment or distress in various aspects of life,
previously referred to as drug addiction.
• Key terms include dependence (psychological or physiological),
withdrawal, detoxification, and tolerance, which are essential for
understanding the complexities of substance use.
Diagnostic Criteria for Dependence and Abuse
• Dependence is defined by the presence of three or more criteria
within a 12-month period, including tolerance and withdrawal
symptoms.
• Abuse is identified by one or more criteria in a 12-month period, such