ol in the important North American markets (Pearson, 1992, p. 17). In contemporary North American society, the use of certain substances to modify mood or behavior under certain circumstances is generally regarded as normal and appropriate. Such use includes recreational drinking of alcohol, in which a majority of adults participate. Problems develop when maladaptive behavioral changes associated with the more or less regular use of psychoactive substances that affect the central nervous system appear. For all psychoactive substances, including alcohol, pathological use is categorized as either psychoactive substance dependence or the residual diagnosis psychoactive substance abuse. The essential feature of psychoactive substance dependence is an indication that a person has impaired control of psychoactive substance use and continues use of the substance despite adverse consequences. Substance dependence is conceptualized as having different degrees of severity mild, moderate, and severe.
Psychoactive substance abuse denotes maladaptive patterns of psychoactive substance use that have never met the criteria for dependence for that particular class of substance. The maladaptive pattern is indicated by either (1) continued use of the psychoactive substance despite knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem that is cause
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