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—Ms Thomson raises the issue that substance use cannot be distinguished from substance abuse merely on the basis of the drug or its dose. She is correct. A pilot or surgeon might consume an amount of alcohol that might be appropriate at a dinner party, yet dangerous before a flight or an operation. Likewise, the same applies to individuals taking certain medications, or persons with certain brain conditions or who are at an age that may cause impairment by amounts that would be benign for others. These and other complexities have contributed to the development of special training and specialty status in the field. Interested persons can contact the American Society of Addiction Medicine and the American Association of Psychiatrists in Alcoholism and the Addictions.I concur with Dr Ireland that on the basis of lifetime risk, alcohol abuse remains the major substance abuse within our profession. By
Westermeyer J. Substance Use and Abuse-Reply. JAMA. 1991;266(11):1513-1514. doi:10.1001/jama.1991.03470110058030