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Substance dependence - pt. has a problem
Substance abuse - the pt's problem got them in big trouble

Example:
Mr X drinks every night when he goes home from work. His tolerance for alcohol has increased so much that he is embarrassed to buy all his alcohol at one store, so he goes to two. He has tried to quit a couple of times, but he felt so much worse when he stopped drinking that he kept coming back to it. He used to be part of an amateur bowling league, but he kept getting drunk and falling asleep instead of going, so he quit the league...
Dx: Substance Dependence

...Mr X also has a drink or two in the morning, just to take the edge off. Once he almost got in a car accident backing out of his driveway without looking. He was reported at work for intoxication and threatened with termination. He was unable to stop drinking, and after his second warning he was fired.
Dx: Substance Abuse

hope that helps!
 
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