Words and terms like “addiction,” “substance abuse,” “substance dependence,” and “disorder” get thrown around a lot, but it is not often that we take time to understand what is meant by these different terms fully. At first glance, it seems that these terms above referring to addiction and substance use should all mean the same thing; that is, at least, how we use them in many cases. However, there may be something different within these different terms, and it is useful to get a better understanding of what is meant by each one. Here in this article, I’d like to unpack these terms a little bit to get a clearer understanding of these terms and how they are used. First, we will turn our attention to “addiction,” next to “substance abuse and substance dependence,” and finally to “substance use disorder.”
At this point, addiction is a common term. Sometimes it is used in a way that serves to intensify something, like how someone might describe another as being “addicted to video games,” but only means that the individual is severe and invested in their video games. Even when the term “addiction” is applied to alcohol and drugs, it is not often used clinically. That is to say; the speaker is not usually unpacking a list of criteria for addiction and comparing how the “addict” measures up to the signs of addiction. More often than not, the word “addiction” is simply a label for someone who seems to have a consistent problem with a substance.
The National Institute on Drug Abuse describes addiction somewhat more specifically as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.”[i] Obviously, this provides something more specific with which to work. Another way of visualizing this is to see that addiction consists of the following:
- Continuing patterns of seeking out drugs
- Continuing use despite the negative consequences
- Long-lasting effects on the brain
One thing this should remind us of is to take care of when throwing terms around. It is easy to toss out labels and apply them to others, but our words are important. Addiction is a serious issue, and we should be careful that the label is applied only where appropriate. By understanding the meaning more precisely, we are more equipped to understand addiction signs, seek help appropriately, and avoid others’ inappropriate labeling.
Substance Abuse and Substance Dependence
At one point, the clinical terms for addiction being used were “substance abuse” and “substance dependence.”[ii] These terms were used by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders. Such a text aims to have a way to analyze and diagnose different mental disorders to be effectively treated. The terms “substance abuse” and “substance dependence” were meant to indicate something of the changes in the severity of the addiction, where “abuse” was the misuse or excessive use of drugs but not yet in such a way that the individual was fully dependent on the drugs mentally and physiologically.
With the release of the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (also referred to as the DSM-5), the terms “substance abuse” and “substance dependence” were removed and replaced with “substance use disorder.”[iii]
Substance Use Disorder
Even though we have provided a clearer explanation of addiction above, there is an even more precise and specific way of determining the problem’s nature. The DSM, using the term “substance use disorder,” lists eleven separate criteria, which are indicators of this disorder, as well as a scale. Individuals are considered to have a “mild substance abuse disorder” if they meet two or three of the criteria; a “moderate substance abuse disorder” if they meet four or five criteria; and a “severe substance abuse disorder” if they have six or more of the symptoms.
Some of the diagnostic criteria in the DSM-5 include the following:
- Increases in the amounts or lengths of time a substance is used beyond what was prescribed
- Repeated failures to reduce the usage of a substance
- Large amounts of time are put toward obtaining, using, or recovering from a substance.
- Significant cravings urge or desire to use a substance
- Negative impacts on fulfilling responsibilities at work, school, or home caused by the use of a substance
- Continued use of a substance even after it causes or increases problems in social or interpersonal situations
- Reduction or cessation of important social, occupational, or recreational activities because of the usage of a substance
- Continued usage of a substance in physically hazardous situations
- Continued usage of a substance despite known physical or psychological issues that are caused or increased by a substance
- Increased tolerance of a drug as evidenced by either a need for significantly increased amounts of a substance to become intoxicated or decreased effects from a substance with the same amount
- Withdrawal from a drug as evidenced by either the characteristic withdrawal syndrome for a particular substance or usage of a substance (or similar substance) to decrease or remove withdrawal symptoms[iv]
Unfortunately, issues like substance use and abuse do not admit easy analyses sometimes. It can be difficult to determine the line between appropriate use or something shifting into a substance use disorder. While these criteria are subjective to some extent (someone has to use judgment to determine if the individual is suffering from the symptoms), they provide a helpful framework for understanding and analyzing addiction and substance use issues.
We find on closer analysis that “addiction” is a more general term for chronic substance abuse. “Substance abuse” and “substance dependence” are potentially useful terms generally, but outdated clinical terms for substance use disorders or addiction. Finally, “substance use disorder” is the current clinical term for addiction and substance abuse issues and includes within its criteria for determining the nature and extent of the issue.
[i] NIDA. “The Science of Drug Use and Addiction: The Basics.” National Institute on Drug Abuse, 25 Jun. 2020, https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics Accessed 31 Mar. 2021.