Substance Abuse vs. Addiction: What’s the Difference?

In everyday conversation, the distinction between substance abuse and drug addiction can sometimes be ambiguous. However, while both substance abuse and addiction can have detrimental effects on your life, not everyone who abuses substances will go on to develop an addiction. Recognizing early warning signs of substance abuse can alert you to the need for treatment before a full-blown addiction occurs.

What is Substance Abuse?

Substance abuse is not the same thing as addiction, though it is still a cause for concern. Both overusing a substance and using a substance in a manner other than its intended use are signs of substance abuse. For example, if you are prescribed a painkiller but you take it more often, or in higher doses, than your prescription dictates, this is a sign of substance abuse.

Behavioral signs of substance abuse include:

  • Regularly missing work, school, or social events
  • Failing to fulfill obligations
  • Irritability and moodiness
  • Denying the severity of the drug use problem
  • Isolating oneself from family and friends

Once a person admits there is a problem and decides to seek treatment, new challenges often present themselves. While this commitment is difficult, making the choice to get addiction treatment is the best way to find hope, rebuild your life, and overcome the illness.

What Is The Difference Between Substance Use and Substance Abuse?

Some people view their drinking or drug use as a “phase.” Some see it as just something to do, maybe while out with friends at the club, while others can track their use back to a legitimate prescription.

All of these scenarios involve substance use that can lead to substance abuse, or what’s also known as a substance use disorder (SUD). For many drinkers and drug users, a chemical dependence is possible each time they use an addictive substance.

Whatever their reasons are for using, many substance users find they just can’t stay away from their drug of choice no matter how much they try. This inability to stop using often leads to abusive behaviors that put them on the thorny road of addiction.

But at what point does substance use become substance abuse? How can one know for sure, and where can one look for answers?

When Does Drug Use Become an Addiction?

Characteristics of Addiction

According to the National Institute on Drug Abuse (NIDA), addiction is a chronic, relapsing disorder characterized by:

  • Compulsive drug-seeking
  • Continued use despite harmful consequences
  • Long-lasting changes in the brain

NIDA also notes that addiction is both a mental illness and a complex brain disorder.

Diagnosing addiction requires an assessment by a trained and certified professional. Talk to a doctor or mental health professional if you feel that you may have an addiction or substance abuse problem.

Behavioral Manifestations of Addiction

When friends and family members are dealing with a loved one who is addicted, it is usually the outward behaviors of the person that are the obvious symptoms of addiction.

Those behaviors are primarily centered around the addict’s impaired control:

  • The excessive frequency of drug use in spite of attempts to control
  • Increased time using or recovering from drug effects
  • Continued use in spite of persistent problems
  • A narrowing of focus on rewards linked to addiction
  • An inability to take steps to address the problems

The Inability to Abstain

Research has shown that prolonged drug use causes a chemical change in the brain of the addict that alters the brain’s reward system that prompts compulsive drug seeking in the face of growing negative consequences.

This state of addiction, when the activity continues in spite of negative consequences and despite the fact it is no longer rewarding, is termed by addiction experts the “pathological pursuit of rewards.” It is the result of chemical changes in the reward circuitry of the brain.

How Addiction Gets Started

The reason that people engage in activity that can become addictive in the first place is to experiment, because of the social environment, or achieve a feeling of euphoria or to relieve an emotional state of dysphoria. When people drink, take drugs, or participate in other reward-seeking behavior (such as gambling, eating, or having sex) they experience a “high” that gives them the reward or relief they are seeking.

Genetic Factors

Addiction also has a genetic component that may make some people more susceptible to becoming addicted to drugs. Some people have described feeling addicted from the first time they use a substance. Researchers have found that the heritability of addictions is around 40—60% and that genetics “provide pre-existing vulnerabilities to addiction [and] increased susceptibility to environmental risk factors.”

Changes in the Brain

A high is the result of increased dopamine and opioid peptide activity in the brain’s reward circuits. But after the high they experience, there is a neurochemical rebound which causes the reward function of the brain to drop below the original normal level. When the activity is repeated, the same level of euphoria or relief is not achieved. Simply put, the person never really gets as high as they did that first time.

Lower Highs and Lower Lows

Added to the fact that the addicted person develops a tolerance to the high—requiring more to try to achieve the same level of euphoria—is the fact that the person does not develop a tolerance to the emotional low they feel afterward.

Rather than return to “normal,” the person reverts to a deeper state of dysphoria.

When becoming addicted, the person increases the amount of drugs, alcohol, or the frequency of the addictive behaviors in an effort to get back to that initial euphoric state. But the person ends up experiencing a deeper and deeper low as the brain’s reward circuitry reacts to the cycle of intoxication and withdrawal.

When Reward-Seeking Becomes Pathological

According to the American Society of Addiction Medicine (ASAM), this is the point at which the pursuit of rewards becomes pathological:

  • Reward-seeking becomes compulsive or impulsive
  • The behavior ceases to be pleasurable
  • The behavior no longer provides relief

NIDA also notes that addiction is both a mental illness and a complex brain disorder.

Diagnosing addiction requires an assessment by a trained and certified professional. Talk to a doctor or mental health professional if you feel that you may have an addiction or substance abuse problem.

No Longer a Function of Choice

To put it another way, the addicted person finds himself compelled—despite his own intentions to stop—to repeat behaviors that are no longer rewarding to try to escape an overwhelming feeling of being ill at ease but find no relief.

According to ASAM, at this point addiction is no longer solely a function of choice.8 Consequently, the state of addiction is a miserable place to be, for the addict and for those around him.

Chronic Disease and Relapses

For many addicts, addiction can become a chronic illness, meaning that they can have relapses similar to relapses that can happen with other chronic diseases—such as diabetes, asthma, and hypertension—when patients fail to comply with their treatment. These relapses can occur even after long periods of abstinence. The addict can take action to enter remission again. But he remains at risk of another relapse. The ASAM notes “Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”