The Thin Line Between Misuse and Addiction

What is the difference between substance abuse and addiction? If you’re concerned about a loved one’s drinking or drug use, it can be challenging to understand the distinction. Substance use disorder is a psychiatric diagnosis defined as use that causes serious impairment or distress. While this does not necessarily constitute addiction, addiction is considered the most severe form of substance use disorder (https://www.psychiatry.org/patients-families/addiction).

Characteristics of Substance Misuse

According to the National Alliance on Mental Illness, substance use disorder is ongoing nonmedical use of drugs or alcohol that causes difficulties with work, school, and/or family, including adverse consequences that affect others and damage to the individual’s physical or mental health (https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Taking-Care-of-Your-Body/Drugs,-Alcohol-Smoking). Substance misuse may lead to addiction and/or physical dependence. The National Institute on Drug Abuse (NIDA) notes that all illegal drug use is considered substance misuse, in addition to the overuse of legal substances such as alcohol (https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction).

Definition of Addiction

According to the Diagnostic and Statistical Manual of Mental Disorders, addiction is the continued compulsive use of a substance despite the negative consequences described above (https://www.samhsa.gov/disorders/substance-use). Addiction is typically driven by physical and/or psychological dependence on the substance. With physical dependence, uncomfortable withdrawal symptoms occur when substance use is discontinued, such as sweating, nausea, and tremors. Substances that can cause physical dependence include alcohol, opiates, and nicotine as well as some prescription drugs. Psychological dependence causes emotional or cognitive withdrawal symptoms, including depression, anxiety, irritability, and restlessness. Any substance can induce psychological dependence and can be a contributor of other types of addictions, such as gambling.

Other characteristics of substance addiction include the need to use more of the substance to create the same effect; loss of interest in hobbies or career; withdrawal from friends and family; behavior patterns that support substance use; and attempts to stop using the substance without success.

How Abuse Leads to Addiction

Drug abuse may result in addiction over time. This can be especially true when the drug is used for a specific purpose, such as the need to relax. The dependence on a substance for a specific purpose can lead an individual to believe that they can’t function without the substance (i.e. psychological addiction). The time that it takes for symptoms to develop varies among substances that cause physical addiction.

Assessment and Treatment

Many medical systems rely on an addiction severity index to determine the extent of the problems related to substance use. It assesses impacts on the individual’s health, job, legal status, family, and social connections.

When a substance use disorder is present without the diagnosis of addiction, medical treatment is usually not required. Intensive behavioral therapy and treatment for underlying mental health issues, either in an inpatient or outpatient setting, can be effective.

When addiction is present, the individual can receive medical treatment known as detoxification to ease the uncomfortable physical and mental health symptoms they may experience during the withdrawal period.

If you’re concerned that your family member’s substance use is becoming a problem, consider having an honest conversation about the effect the use is having on their life. This should not be an accusatory conversation; rather, you should make it clear that you love and support them and will help them seek assessment and treatment when they are ready.