Substance Use, Abuse, and Addiction

Understanding the Differences

What is the difference between substance use, abuse, and addiction, and is there a connection between them? At La Jolla Healing Center, we get that question quite often. And we do make sure to differentiate between the three. It’s not always easy to tell the difference for yourself or for a loved one. While some people completely abstain from alcohol and substance use, and some are able to use in moderation, others struggle with abuse or even addiction.

How Much is Too Much?

For children and adolescents any substance use is too much, as their brains are still developing. For adults, the answer becomes more personal. It involves your choices, history of earlier addiction (both personal and in your family), and how well you manage your life in general. There are clearly defined guidelines of what constitutes abuse and addiction, also known as dependence. Setting these definitions help psychologists and medical staff assess a person's situation based on objective guidelines.

Signs of Use, Abuse, and Addiction

Understanding these definitions could help you or a loved make an informed decision about your relationship with a substance, and may encourage you to seek help. Becoming familiar with the differences between the terms use, abuse, and addiction (or dependence) will also provide clarity when talking about alcohol and substances.

Use

Substance use is any consumption of a mood-altering substance, including alcohol. Even common things such as having a glass of wine for dinner or a beer at a game would be considered “substance use”. Substance use may not be a problem at all, and many people regularly use substances without developing an abuse or dependence. Examples of Use include:

  • Using in moderation and/or on occasion

  • Being able to stop using after starting

  • Not having any legal or social problems due to intoxication

  • No craving, desire, or compulsive behavior to get the substance

Abuse

Substance abuse is when someone continues to use alcohol or substances even when it causes them problems. This could affect their family, friends, work or school, or even their own health. Some people also abuse substances for short amounts of time, for example to relieve stress or during periods of grief. Examples of Abuse include:

  • Legal problems caused by alcohol or substance use

  • Harm caused to others, for example family or friends, while under the influence

  • Problems or inability to perform tasks and assume responsibility at home, work, or school

  • Ongoing use of the substance despite continued problems

Addiction

Substance addiction, or dependence, is when a person is unable to stop drinking or using drugs. If they do not use the substance for some time, they will experience physical withdrawal symptoms. Examples of Addiction include:

  • Experiencing withdrawal when not taking the substance

  • Needing to use more and more each time in order to feel the same effect

  • Showing less interest in family, friends, work, and school

  • Patterns of trying to stop but being unable to do so

  • Wanting or trying to stay high/intoxicated at all times

  • Continued use even after multiple problems related to the substance

 

Substance Use Disorder

Even with the above differentiation, it could still be difficult to distinguish between Use, Abuse, and Addiction. The American Psychiatric Association has developed specific criteria for addiction, or “Substance Use Disorder,” which can be found in the DSM-5. The criteria are based on decades of clinical research and knowledge.

The Criteria

  • Taking the substance in larger amounts or for longer than you've meant to

  • Wanting to cut down or stop using the substance but being unable to do so

  • Spending a lot of time getting, using, or recovering from use of the substance

  • Cravings and urges to use the substance

  • Not managing to do what you should at work, home, or school because of substance use

  • Continuing to use, even when it causes problems in relationships

  • Giving up important social, occupational, or recreational activities because of substance use

  • Using substances again and again, even when it puts you in danger

  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance

  • Needing more of the substance to get the effect you want (tolerance).

  • Development of withdrawal symptoms, which can be relieved by taking more of the substance.