Understanding Substance Abuse vs Addiction

Understanding Substance Abuse vs Addiction

Every year, drug overdoses kill 44,000 people. This shocking statistic includes those who are addicted to drugs and those who are abusing and using drugs. The number does not include alcohol-related deaths.

Drug use, abuse, dependency, and addiction are serious problems in today's world, but in order to help those affected, understanding abuse vs addiction is key.

Whether you're suffering from drug or alcohol abuse or addiction, or your loved one is, this guide will provide the information you need in order to start seeking or offering help.

Keep reading to find out the definitions of both abuse and addiction, including how they affect the physical and less tangible elements of the lives of addicts and their loved ones.

Abuse Vs Addiction: A Sliding Scale

There are actually more ways to categorize how someone is using drugs beyond the two "a" words. On a scale of increasing severity, those categories include:

  • Substance use
  • Substance abuse
  • Substance dependency
  • Substance addiction

All four of those categories can be cause for concern but as they influence the user and those around the user differently, and require different types of treatment, they should be understood as separate terms.

We're going to skip substance use for the purposes of this guide, however, since it could refer to someone who had one beer and nothing more. As you continue to read, keep in mind that substance abuse, dependency, and addiction are medical illnesses. They're not moral or ethical deficiencies.

Substance Abuse

Substance abuse is defined as using drugs despite the fact that the use has become a problem in one's life. This is where abuse differentiates from use--the key is the substance must cause a problem. The other key is the user must continue to use despite that.

Abuse can begin without the user or anyone else noticing any negative consequences or results. For example, Sue might notice her friend and coworker Joanna drinks a lot socially. Joanna might be able to function at work, so Sue thinks nothing of Joanna's drinking.

Over time, the user continues to use the substance, so negative consequences might start to become apparent. Maybe Joanna starts coming in late to work and misses important meetings.

Why People Abuse Substances

There could be many reasons someone abuses a drug or alcohol. Some of the most common reasons include:

  • The user is under undue stress.
  • The user desires to feel the pleasure the substance provides.
  • The user wants to either avoid or change their reality.

No matter the reason, continued substance abuse can transform into substance dependency, which can then transition into an addiction. If you believe a loved one us abusing substances, or if you're abusing them yourself, now is a good time to seek help.

It can be difficult to tell if someone is abusing a substance. In 2013, 9.4% of people reported using an illicit drug within the 30 days prior to a survey conducted by the National Institute on Drug Abuse.

The 9.4% is just use of an illicit drug (so it excludes alcohol and tobacco). Of those people, any of them could become drug abusers.

When Substance Abuse Is A Problem

How do you determine if someone's--or your own--substance use has become substance abuse? You look for negative consequences, to start. Let's look at the example of Joanna and Sue more closely.

Joanna breaks off a long-term romantic relationship and stops going out with Sue and their other friends from work for Wednesday happy hour. Joanna talks less with her friends and when Sue does see her, she's standoffish.

Joanna's work performance continues to slip. Not only is she frequently late, but she's often unprepared for meetings. One day, she and Sue are supposed to make a presentation, but Joanna leaves all the work to Sue.

Joanna often talks about her favorite cocktails, and when she meets Sue for yoga class on Saturday mornings, Sue can smell alcohol on Joanna's breath. At work, Joanna starts taking extended bathroom breaks, and when she returns to her desk, Sue notices Joanna is sometimes inebriated.

One night, Joanna is pulled over while driving under the influence. She's arrested and calls Sue from the police station. Joanna's alcohol use has become a problem in her life, and over the course of several months, Sue has noticed it more and more.

Joanna might be on her way to dependency and addiction. In 2014, more than 16 million American adults suffered from alcoholism.

Sometimes, a substance abuser will discount the severity of their abuse because they don't experience withdrawal symptoms. But as you'll see in the next sections of our guide, withdrawal symptoms are a sign that abuse has become more serious.

Substance Dependency

Dependency occurs when a user's brain starts to change in response to a substance like drugs or alcohol. Specifically, dependency impacts the brain stem and/or the thalamus.

The brain stem controls many of the essential functions of the body, such as the cardiovascular and pulmonary systems. The thalamus is responsible for sending signals relating to alertness and motor movements.

Both substance abusers and substance addicts can suffer from dependency. This is important to remember as you attempt to seek treatment for yourself or a loved one. The difference between abuse and addiction is that the latter doesn't affect everyone, but dependency can affect anyone.

Biologically speaking, dependency is the brain's physical adaptation to a particular substance. This relates to tolerance, which is one of the possible symptoms of an addiction as you'll see below.

Substance Addiction

Now that you understand substance abuse and dependency, we want to take the opportunity, before diving into substance addiction, to remind you that none of these conditions represent any failing on the part of the addict. Addiction is recognized by the medical community and now appears in the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

Because of the way drugs and alcohol alter the operation of a person's brain, addiction is considered a brain disease. Addiction is a chronic and relapsing condition, so loved ones and addicts must exercise continued vigilance, even after treatment.

The changes the brain undergoes can lead to consequences that are lifelong. Those changes can spur former addicts to act differently, even engaging in self-destructive or harmful actions.

For addicts who inject or snort a drug, the path to addiction is often shorter than for those who take a substance orally. This is because the drug passes the blood-brain barrier more easily when injected or snorted.

According to the DSM, not everyone is equally susceptible to addiction. While drug exposure and other environmental risk factors play a part, genetics also can affect how likely one is to become addicted.

The reason use, abuse, dependency, and addiction take such a strong hold over the brain is that drugs and alcohol affect the brain's pleasure and reward centers. This rewiring of the brain is why addicts go to such length to fulfill cravings and avoid withdrawal symptoms.

When Is Someone Addicted?

In 2014, 1 in 12 people suffered from drug addictions. This number excludes alcohol addiction. Substance addiction is a serious epidemic, typically diagnosed when a person meets at least three of the following criteria over the course of 12 months.

  • Tolerance
  • Withdrawal
  • Overuse
  • User tries--and fails--to quit
  • The substance takes up large swaths of time
  • The user gives up social, work, or recreational activities
  • The user continues to use despite consequences

We'll examine each of these in more detail to below.


Earlier, when we discussed substance dependency, we mentioned adaptation. With each repeated use, the brain adapts more to the substance, increasing its tolerance for the drug or alcohol. The result is that more of the substance is required to produce the same pleasure or reward.

If Joanna of our earlier example used to experience the reward response after three drinks, it might start to take four, five, or even more drinks to offer the same reward. This is known as tolerance.


Withdrawal symptoms are often considered an important part of the difference between habit and addiction. People who experience withdrawal symptoms when they're not using a substance would have this symptom. So too would those who use drugs in order to avoid withdrawal.

Different drugs cause different withdrawal effects. For example, Joanna, who in our example has become an alcoholic, will experience a slow withdrawal. Immediate symptoms might take days or even weeks to overcome.

However, it may take months or longer to overcome the late withdrawal symptoms associated with alcohol and benzodiazepine use, such as fatigue.

Stimulants, like cocaine or crystal meth, have a shorter withdrawal period. Symptoms of withdrawals from a stimulant might include:

  • Fatigue
  • Irritability
  • Paranoia
  • Anxiety
  • Trouble focusing
  • Depression

Withdrawal symptoms on their own are not enough to signal an addiction, so keep reading to learn more about the symptoms of addiction.


This is different from tolerance because it involves a person using more of a substance than they intended. It can also include using the substance for a longer period of time than they initially meant to. Overdoses fall into this category, but not all overuse is an overdose.

Failed Attempts To Quit Or Cut Back

Sometimes, a person knows they're using a substance more than they should, but they don't always realize they're addicted. For addicts, quitting or cutting back isn't simple or easy. This is because of the adaptations in the brain.

If you know someone--or if you are someone--who has tried and failed to quit using a substance, it doesn't necessarily mean that you're addicted. However, if you fall into this category and have at least two of the other symptoms listed here under substance addiction, it might be time to get treatment.

The Substance Sucks Up Time

Someone who is an addict may spend a lot of time each day trying to obtain their drug of choice or alcohol. They may spend a lot of time using the substance. Additionally, they may spend a large chunk of their day or night recovering from the effects of a substance.

Social, Professional, Recreational Isolation

One sign that someone is starting to suffer negative consequences of drug or alcohol addiction is if they start to become more isolated. They may avoid social and recreational situations. They may even avoid going to work, or they might participate less in group tasks.

Keep in mind that, like the other symptoms on this list, no one symptom is a sign that someone is definitely addicted to a substance. However, if you notice someone pulling back from social interactions like this, it may be a hint that substance addiction is playing a part. Such behavior may also point to other behavioral or medical problems.

Continued Use

In our example of Joanna, she continued to use alcohol despite the fact that bit by bit, it was taking away the positives in her life and replacing it with negatives. Someone suffering addiction will continue to use and abuse a substance despite negative consequences.

Those consequences could be physical, psychological, or both. They might be severe. An addict cannot help but continue to use anyway.

Conclusion: Seeking Help

Whether you've identified that someone you care about--or yourself--exhibits the behaviors of abuse, dependency, or addiction, many people don't know what to do next. How does one go about getting treatment?

Regardless of whether you're dealing with substance abuse vs addiction, an intervention may be a good starting point. You've probably seen an intervention performed on television or in a movie, but one thing you may want to consider is hiring a professional facilitator for an intervention if you plan to have one.

Other treatments might include therapy for the individual. In some cases, group therapy may be most helpful. You've probably heard of the 12-step program as well; this is another treatment plan for those suffering addiction.

When it comes to abuse vs addiction, there is one treatment distinction we will make. For addiction, rehab may be the best path--though it can often be used along with interventions, the 12-step program, and group or individual therapy.

If you or a loved one is suffering from addiction, find a rehab center to get the help you need.