What Is the Difference Between Substance Abuse and Substance Dependence?

Substance abuse is the use of drugs or alcohol to the point where it causes problems in your life. Substance dependence (addiction) is when you are unable to quit using drugs or alcohol.

Chances are good that you have heard the terms substance abuse and substance dependence, but did you know that they aren’t the same thing? Both terms describe the use of alcohol or other drugs in an unhealthy way, but each term describes the degree of symptoms. Here’s what you need to know when it comes to substance abuse vs. substance dependence, how to recognize the differences, and how to get help.

Within the last year, 70% of Americans report having had at least one drink. 10% of people over the age of 12 also report using other drugs within the last month. Most people drink in moderation and know about the dangers of illicit drugs, but how do you know if you’re drinking or using too much? 

The answer is easy when it comes to teens and young adults. Since their brains are still developing, any alcohol or drug use can be damaging to their growth. When it comes to adults, it’s not so simple. There are several factors, including your health history, personal lifestyle choices, and if there is any history of addiction in your family.

Medical professionals have created guidelines for terms associated with using drugs and alcohol:

• Substance use: consuming any amount of alcohol or drugs. Some people can consume these substances and not form a dependency, while others cannot.
• Substance abuse: the use of drugs or alcohol to the point where it causes problems in your life. These could be problems related to your health, personal relationships, or your career.
• Substance dependence (addiction): you are unable to quit using drugs or alcohol. This can cause you to use them frequently and have withdrawal symptoms if you try to quit.

Substance abuse. Substance abuse is recognized by doctors and mental health professionals as a health disorder. Alcohol is the most commonly abused substance, but other common ones include:

• Tobacco
• Marijuana
• Prescription drugs
• Steroids
• Cocaine
• Methamphetamine 
• Hallucinogens

Substance dependence. This is a medical term used to describe using drugs and alcohol to the point of addiction. If you have a substance dependence, or chemical dependency, your tolerance usually goes up over time so that you need higher amounts of drugs or alcohol to get the same effect. You might be aware that your dependence is causing problems in different aspects of your life but you continue using these substances anyway.

There isn’t a single cause of substance abuse or dependence. While it is up to each person individually to choose whether or not to try drugs or alcohol for the first time, some factors can determine if this can lead to substance abuse:

• Genetics
• Environmental stressors
• Mental health problems
• Personality characteristics
• Social pressure

Your society and culture, as well as the laws where you live, also determine how much drug and alcohol use is okay. While the choice to initially try drugs or alcohol is voluntary, over time, it becomes harder to stop. Brain scans taken from people who have a chemical dependency show that the brain physically changes with the long-term use of drugs and alcohol. This includes brain areas that are important in decision-making, behavior, and judgment.

It can be hard for people to realize that they have a substance abuse disorder. Many turn to alcohol and drugs to deal with stress or difficult emotions, so they see it as only a temporary problem. Some common signs of substance abuse or dependence, though, include:

• Losing interest in things you enjoy because of substance abuse
• Avoiding family or friends and keeping secrets from them
• Using drugs or drinking alone
• Getting in trouble at work or school, or even with the law, because of your substance abuse
• Caring less about your physical appearance
• Changes in sleep patterns
• Arguing with your family and friends on being asked if you have a problem with drugs or alcohol
• Forgetting about appointments or commitments 
• Spending more and more time with people who use drugs or alcohol and enable your habits
• Lying about using drugs or alcohol

Substance abuse can take its toll on your mental health, as well as your physical health. Many people use drugs or alcohol to help them feel better or relieve symptoms of a mental health problem. On the flip side, using drugs or alcohol can actually trigger mental health problems. Studies show that those experiencing mental health issues have a much higher rate of drug abuse problems when compared to those that aren’t.

The people closest to you, like your friends and family, will likely be the first ones to recognize these symptoms and ask you if you have a substance addiction. They may notice that your behavior has changed or that you’re acting differently, especially if you’re becoming more anxious or hostile.

If you recognize that you may have a substance abuse disorder, a doctor or mental health professional can make an official diagnosis. Your doctor may ask you questions about what substances you use, how long you have been using them, and when the last time you used them was. Your doctor may take note of things like:

• Weight loss
• Constant fatigue or problems sleeping
• Lack of care for personal hygiene
• Depression, anxiety, or being irritable
• Symptoms of withdrawal, like seizures or hallucinations
• Red eyes

Your doctor will create a treatment plan for you based on several factors, including the severity of your substance abuse or substance dependence and what the substance is. Your doctor may also ask you what your goals are or if you have any opinions or preferences when it comes to creating a treatment plan.

Treating drug or alcohol addiction is quite serious, since most people can’t quit cold turkey. Your doctor may recommend either inpatient or outpatient treatment programs that can have several stages:

• Detoxification
• Behavioral therapy
• Counseling for you and for loved ones who are also affected by your substance abuse or dependency

Support systems are important during this time. As your treatment continues, your doctor may recommend group meetings and continued medical supervision to make sure that you have the support that you need to avoid relapsing.