Substance Use, Abuse, Dependence Continuum, and Principles of Effec | Page 2

Appendix E:
Substance Use, Abuse, Dependence Continuum, and
Principles of Effective Treatment
Alcohol and drug use occurs along a continuum, and not everyone who uses substances abuses or is
dependent on them. Levels of use are generally identified as use, abuse, and dependence.
The table on the next page summarizes the differences between substance use, abuse, and dependence,
and it highlights implications for risk to children based on a parent’s use, abuse, or dependence on
alcohol or other drugs. The information regarding clinical criteria included on the table is from the
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
(American Psychiatric Association, 1994).
Additional information regarding the types of risks to children based on parental substance abuse
disorders can be found in Understanding Substance Abuse and Facilitating Recovery: A Guide for Child
Welfare Workers available on line at www.ncsacw.samhsa.gov (Beshears, Yeh, & Young, 2004).
The box shown after this chart provides the National Institute on Drug Abuse (NIDA) researched-based
basic principles of substance use disorder treatment process (NIDA, 1999). Child welfare and court staff
should incorporate these principles into training curricula.

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