The term "substance use disorder" (SUD) implies a continuum of use: from abstinence to at-risk use to abuse and dependence (Fig. 51-1). The majority of the general population, as well as family medicine patients, are "abstainers." The majority of users of illicit substances do not meet criteria for the diagnosis of abuse and dependency. This model of substance use is important for family medicine physicians to keep in mind as they talk with their patients about substance use issues. It highlights the key role played by screening for substance use and early intervention at the at-risk use level, before specialized treatment services are more likely needed. For illicit substances, unlike alcohol, no amount of use can be considered safe or healthy, in part because any use is illegal.

Box 51-1 lists the DSM IV diagnostic criteria for substance abuse and dependence. Of note, physical dependence alone does not make a diagnosis of substance abuse or dependence, nor does lack of physical dependence exclude the diagnoses.

Table 51-1 shows some common drug street names. Comprehensive lists can be found on the Office of National Drug Control Policy website, www.whitehousedrugpolicy.gov. Street names vary by region and user group. The most useful

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by:


One or more of the following, occurring in a 12-month period, and these symptoms have never met the criteria for Substance Dependence: Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home

Recurrent substance use in situations in which it is physically hazardous Recurrent substance-related legal problems

Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance


Three or more of the following, occurring in the same 12-month period:

Tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance

Withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance or the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms The substance is often taken in larger amounts or longer than intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

A great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects.

Important social, occupational, or recreational activities are given up or reduced because of substance use.

The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

*American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington, DC, APA, 2000.

Table 51-1 Common Drug Street Names

Street Names (NIDA website)


Candy, downers, sleeping pills, sticks, handlebars




Blow, bump, C, candy, coke, crack, flake, rock, snow


Captain Cody, school boy, pancakes and syrup


Robotripping, Robo, Triple C


Roofies, rope, rophies, forget-me pill, Mexican Valium

Flunitrazepam (Rohypnol)

Liquid ecstasy, Georgia home boy, grievous bodily harm


jjj^jj^^j Brown sugar, dope, H, horse, junk, skag, skunk, smack


K, special K, vitamin K, cat Valiums


Acid, blotter, boomers, cubes, microdot


••xiifcPä:' ÏÈKiWiîffM

Blunt, dope, ganja, grass, herb, joints, pot, reefer, weed


^ Adam, clarity, ecstasy, Eve, lover's speed, peace, X


Chalk, rank, crystal, fire, glass, go fast, ice, meth, speed


Skippy, vitamin R, the smart drug, R-ball


Oxy, OC, killer, vike

Oxycodone (Oxycontin), hydrocodone (Vicodin)

Angel dust, boat, hog, love boat, peace pill


NIDA, National Institute on Drug Abuse; GHB, y-hydroxybutyrate; LSD, lysergic acid diethylamide; MDMA, methylenedioxymethamphetamine; PCP, phencyclldine.

information is obtained on the local level, simply by asking patients what they call the drug they are using.

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