Substance Use Continuum

A--|--B--|--C--|--D--|--E

A

Zone A: The person does not use substances in a predictable, regular fashion. When use does occur, it is at a modest to moderate level with no negative consequences resulting from the use.
B

Zone B: The person is a pattern substance user, i.e., uses in a predictable consistent manner. However, there are no negative consequences resulting from using. Within this zone are those who remain pattern substance users for life (e.g., two beers every Friday night, etc) and those just passing through on their way to problem use.
C

Zone C: Problem substance user. The substance use is typically to intoxication. The person’s substance use, including the after-effects, has caused at least one negative life consequence or prevented an intended activity.
D

Zone D: Psychological dependence. The lack of physical withdrawal symptoms following a period of heavy use, when no substance use occurs again for over 48 hours distinguishes this person from having a physical dependence. However, an expressed craving for the substance, along with restlessness and agitation on being without the substance, can appear similar.
E

Zone E: Physical dependence in addition to psychological dependence. Physical withdrawal symptoms that may include tremors, sweating and nausea, anxiety are likely to follow cessation of substance use and to persist for several days. In more extreme forms of withdrawal, hallucinations, significant agitation and even seizures may be present

Using alcohol consumption as an example to evaluate placement along the continuum

A

Zone A: The person does not use alcohol in a predictable, regular fashion. A “social drinker” at irregular intervals, not drinking to excess and not experiencing any consequences due to their drinking behavior.
B

Zone B: The person is a pattern drinker, e.g., 2 beers every Friday night, a brandy before bed, drinking every time one gets together with a certain individual, a drink after fighting with a partner. There are no negative consequences resulting from drinking.
C

Zone C: The drinking is to the point of intoxication and causing life consequences, e.g. broke plans, missed class or work because of drinking or its after-effects, drove a car or motorcycle intoxicated, not able to do homework or study for a test due to intoxication, got into fights, acted bad or did mean things, caused shame or embarrassment to someone, lost a job
D

Zone D: A pattern of consistent life consequences and psychological dependence, e.g. left a party because there was no alcohol, kept drinking when you promised yourself not to, had a drink before or instead of breakfast, wanted to stop drinking but couldn’t
E

Zone E: Physical dependence e.g. had the shakes, fits, seizures, DTs or “seen or heard things that were not really there” when you were coming off a period of drinking or after you stopped drinking. Had withdrawal symptoms, that is, felt sick because you stopped or cut down on drinking.