Are Addiction and Substance Abuse Disorder the Same?

Substance use disorder — and therefore addiction — is a mental illness. It’s defined as different degrees of problematic use of substances like drugs and alcohol.

NIDA finds it helpful to frame their discussions of addiction around the idea of drug use versus misuse. Drug use is any instance where you consume a drug — including anything from caffeine to a prescribed medication — in a healthy or prescribed way. 

Drug misuse is when your consumption becomes unhealthy, or you aren’t using a drug as directed. NIDA prefers the use of the term “misuse” over “abuse” because it detracts from some of the stigma and self-condemnation the word “abuse” can trigger.  

Addiction is, in all cases, the most severe end of the spectrum — where you lose your ability to control your drug use. Most drug use causes your brain to release a large burst of chemicals that make you happy. The more you use drugs, the less of these chemicals your body naturally makes. Eventually, you need more and more of the drug to feel normal.    

Substance use disorder and addiction can be very disruptive and dangerous conditions that can interfere with every aspect of your day-to-day life. In fact, the misuse of different substances is linked to hundreds of thousands of deaths a year.  

Although there’s no cure for substance use disorder, it’s important to know that all degrees of substance use disorder are treatable. With enough determination, you can manage your condition and regain control of your life. 

The DSM5 categorizes substance use disorder into three main categories — mild, moderate, and severe — depending on how many diagnostic criteria you meet. 

You should consult the DSM-5 for a thorough description of each, but they include: 

• Taking more of the substance than you wanted to or taking it for a longer period
•  You have a continued desire — or have previously failed — to cut down on or stop your substance use
• You put in a lot of time, energy, money, and other resources to acquire, use, or recover from this substance 
• You frequently feel cravings for this substance
• You can’t accomplish everything you need to because of your substance use
• Your substance use has repeatedly created problems in your home and social life
• You have sacrificed other important activities to prioritize your substance use
• You continue to use the substance even when it’s physically dangerous for you
• You continue to use the substance even when it makes any underlying physical or psychological condition worse
• You have an increased tolerance — where you need more of the substance to produce the desired effect 
• You experience withdrawal symptoms — unique to each substance — when you can’t use the substance 

People with mild substance use disorder meet only two or three of the above criteria. If you meet four to five, you have moderate substance use disorder. Six or more means you have severe substance use disorder, or what NIDA would call an addiction. 

The symptoms of substance use disorder fall into four main categories: 

• Impaired control
• Social impairment
• Using the substance despite the risks
• Pharmacological criteria — including signs of tolerance and withdrawal

The symptoms of addiction are at the more extreme and problematic end of these categories. 

The symptoms can appear in your day-to-day life. Many of the behaviors listed above are used to diagnose substance abuse severity. 

Each substance can have different symptoms even when you aren’t actively using it, and they also have unique treatments. It’s important to understand your substance use disorder or addiction within the context of your particular substance. 

Commonly misused substances include: 

• Alcohol
• Cocaine
• Fentanyl
• Heroin
• Inhalants
• Marijuana
• Synthetic cannabinoids
• Prescription medications — both your own and someone else’s
• Steroids
• Bath salts — also known as synthetic cathinones
• Tobacco and nicotine — cigarettes and vapes 

The first step to treating your substance use disorder, or addiction, is deciding you need to make a change. The way your treatment proceeds will depend on the severity of your disorder and the substance you’re misusing. 

Medications are available for some substances — like nicotine — that can help you quit. But you’ll need to overcome the misuse of many other substances without the help of medications.  

A variety of behavioral therapies will often be the most effective treatment regardless of what substance you’re misusing. You can work closely with your behavioral therapist to figure out a treatment strategy that is best for you. In general, people with the most severe substance use disorders and addictions will need the most intensive and time-consuming treatment plans. 

Half of all people with substance use disorder also have a different mental disorder at the same time, including:

• Anxiety
• Depression
• Bipolar disorder
• Personality disorders 

You need to remember that this isn’t a fast process, and relapse is likely with many substances. It’s important you know that relapsing doesn’t mean failure and isn’t a reason to give up on your treatment plan. 

You and your loved ones know best whether drug use interferes with your daily life. You should find help as soon as you realize you need it. 

You need to seek professional advice for yourself or a loved one as soon as possible in the case of severe substance misuse and addiction — especially when the situation is dangerous. Doctors, community medical facilities, and emergency medical services are all available to you. Use these services for advice, a treatment plan, or immediate assistance — whatever your situation requires.