Understanding Substance Misuse, Abuse, Dependence and Addiction

Understanding Substance Misuse, Abuse, Dependence and Addiction

Knowing the differences between the misuse and abuse of drugs or having a dependence on or an addiction to psychoactive substances like alcohol or pain relievers can help you communicate to others, particularly medical and mental health professionals, about your relationship with substances. These affiliated terms of substance use may seem to represent the same thing, and you'll find that some providers use a few of them interchangeably. But, if you want to understand the breadth of your relationship with psychotropic substances, the descriptions of these terms below may be informatively revealing.

Substance Misuse

The misuse of drugs or alcohol occurs when a person consumes a substance in an improper or unhealthy way that extends beyond the parameters of whatever is its intended use. Substance misuse is the opposite behavior of taking medication as prescribed or drinking in moderation, for example. Taking a drug repeatedly with the aim of inducing euphoria is an example of misuse. Consuming substances to alter your perception of reality or to evade it or using them to manage elevated stress are other examples of drug misuse.

In many scenarios, misuse is often unintentional or done with genuine innocence. An example would be to miss your regular dose of prescribed medication and then doubling the amount you take the next time. Substance misuse typically has nothing to do with addiction, but sometimes misuse can eventually devolve into addiction. 

Substance Abuse

Drug abuse has a recognizable distinction from misuse. A person is abusing a substance when they have a continued tendency to seek the drug and regularly use them despite any internal or external harm it's causing them. Drug abuse can often lead a person to inevitable distress and impairment.

Prolonged patterns of substance abuse can come with negative consequences, which could include financial or legal issues. A user may become a threat to themselves or others emotionally, psychologically and physically. Their typical behavior may change and as a result, start having painful and guilty feelings that their life is slipping away or crumbling into bits.

Other indicators of abuse are a negation of responsibilities and shunning significant obligations like work and school. No matter the recurring issues a person has when abusing substances, they cannot stop seeking and using more drugs or alcohol. 

Physical and Psychological Dependence

Even if a doctor prescribes a drug, physical dependency is possible after continued daily or nearly daily use of the drug. It's a natural response for the body to adapt to any substance, whether caffeine or cocaine when a person repeatedly exposes their body to it. A person may experience uncomfortable feelings of withdrawal when they stop consuming the drug. So, to avoid having to bear the withdrawal symptoms, a person may seek the substance to soothe and silence persistent cravings.

Psychological dependence comes from a person's substance use as a conditioned response to one or more triggers. These are cues that cause biochemical activation and changes in the brain. Triggers can be specific people, objects, sounds, places, or activities that directly or indirectly correlate to a person's automatic inclination to use drugs. Once a person gets triggered, addictive behavior usually ensues.

At one time, dependence and addiction were synonymous. However, although sharing similar symptoms, it's possible to depend on a substance without also being addicted to it.

Substance Use Disorder and Addiction

The National Institute on Drug Abuse (NIDA) defines “addiction” as a chronic disease and compulsive behavior involving drug-seeking and drug use with no regard to the ramifications of their actions and potential harm.

In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) had an update that replaced the previously listed terms "substance dependence" and "substance abuse" with one, known as "substance use disorder (SUD)." This update aimed to create inclusiveness, with subcategories of the condition ranging from mild to severe. Addiction is the most severe manifestation of a SUD. However, the DSM does not list addiction with any specific identification within the updated manual.

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