These slide shows an integration of two definitions as stated in the DSM IV; Diagnostic Statistical Manual of Mental Disorders.  Substance Dependence (SD) also known on common language as addiction is a more severe and long-term disorder (see red letters) and needs three or more criteria for a diagnosis (only one in white is needed for a diagnosis of Substance Abuse). 

In SD the patient should not expose to use any addictive substance without the risk of activating a compulsive use of it any time the rest of his life.  They should also learn to abstain of compulsive behaviors (as gambling, compulsive buying) and grow to a healthy life stile with healthy pleasures and support.  Any of these behavior problems may activate the craving and end in a relapse. In the case of substance abuse the patient may learn to reduce the use of the substance and use it with moderation but is at risk of developing SD if his abuse continue or increase.

Even when the patient with SD is totally abstinent for months or years of all addictive substances (SD in partial or in complete remission) they will show periodically for the rest of his life some symptoms of craving (desire for intoxication) and of brain neuropsychological problems (specially in the executive functions of the brain) such as :  irrational ideas (for example; my problem is easy and I only need will power and no other help), difficulty in impulse control, low frustration tolerance, intermittent partial amnesia, minimization and denial of their problem, stubbornness,  passivity, compulsive behaviors, emotional intolerance, episodes of antisocial behavior, difficulty in predicting possible consequences of their actions, periodic deterioration in life stile and many others.  This is complicated with the fact that the rule more than the exception as stated by multiple epidemiological studies is that the patients with SD have other co morbid (concurrent) mental disorders that may not being diagnosed or may be complicated with the active phase of SD.

That’s why:

1. SD patients not only need to quit all addictive substances and behaviors but also need scientific therapy and humane- spiritual support (without moral condemnation or punishment) to learn to compensate for all these neurobiological limitations.  These intermittent limitations endures the rest of their lives in residual manifestations if they attain total abstinence and are exacerbated to a more severe and probably dangerous level if they activate the disease and intoxicate with any addictive substance. 
2. This disease is confused with moral and will power problems even when the basis is a brain disorder; many people see them wrongly and in unfair way as bad immoral people.
3. These patients during the active disease, due to their brain disorder, usually are not willing to receive help that may imply any initial limitation or frustration of what they like to do.  At their best situation most of the patients with an active SD are ambivalent about receiving therapy. They usually present a cycle that at a moment is receptive and a few moments later are refusing and opposing the help). That is why a great number of patients with SD come for help and stay in help only if supported or pressured to do so by other family members or significant others.
4. The patients with the important help their supporting family members (or supporting concerned others) learn to share the treatment experience and later learn to share their endless recovery process passing throw different treatment and different recovery stages. 

All these brain and mental changes are in some way “contagious” and impact all the family members, specially the children, to the point of threatening their mental health, communication and life stile. 

That’s why:

5. The family members of a patient with active SD usually need help and also need to be active part of the treatment and share the recovery expediency.  But some of them do not want help and oversimplify the problem with a personalized view “my problem is him”. 
6. Some family members enter also in denial of the disease with irrational ideas (ideas based on false assumptions) similar to the ones that have the patients with SD ( for example: “if he quits he get cured and may learn to use with control at least the legal substances”). 
7. Some families with severe problems need family therapy at the same time that their member with active SD. Other family members present many dysfunctional interactions such as: co dependence, rigid ness, aggressiveness, lack of rules, punishment/ guilt interaction, overprotection, isolation, coalitions, power struggle games, inconsistency, prejudice and many other possibilities.  Some  have also active mental illness and need individual therapy at the same time of their family member with SD.
8. The recovery experience is a day-by-day work with learned relapse prevention tools, and a continuous share of all the processes with adequate and intelligent supervision and negotiation with the support family members. 
9. Is safer to talk of a recovery process than of a recovered person because the work of recovery is necessary every day to prevent relapses and to promote a continuous growth in health.  The levels of recovery are endless and this human growth is good medicine not only for patients and families with SD for all our society members.