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Substance Use vs. Substance Abuse: What Are the Differences?

If you've heard the terms "substance use" and "substance abuse," you may wonder whether they mean the same thing or whether there's any difference between them.


Both terms refer to the act of utilizing substances, such as alcohol, drugs, nicotine, cannabis, or prescription medications. 


However, one refers specifically to problematic use, whereas the other is a broader term that refers to all substance use, difficult or otherwise:

  • Substance Use: "Substance use" is the act of using any legal or illegal substances, says Maeve O'Neill, MEd, LPC-S, CHC, CDTLF, the Executive Vice President of Addiction and Recovery at All Sober. "Substance use" is a broad term that encompasses all forms and frequencies of using harmful substances.

  • Substance Abuse: The term "substance abuse" was previously used to describe addiction or risky/dangerous use of one or more substances, says O'Neill. However, the professional diagnostic manual, known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), no longer uses the term "substance abuse" as it can be stigmatizing—the preferred term is "substance use disorder," O'Neill explains.


Why the Term "Substance Abuse" Is No Longer Used

According to the National Institute on Drug Abuse, the term "substance abuse" has been discontinued because the word "abuse" has negative connotations and is associated with judgment or punishment.


"Substance use disorder" is now the medical term used to describe the uncontrolled use of a substance despite harmful consequences to one's health, work, studies, family, and day-to-day functioning.


Substance use disorder is considered to be both a complex brain disorder and a mental illness that is classified as mild, moderate, or severe based on criteria met by each individual, says O'Neill.

Previously, the term 'substance use' was meant to describe mild use of a substance, and the term 'substance abuse' was used to describe moderate or more severe use. We no longer use the term 'abuse,' as language is essential.

- MAEVE O'NEILL, MED, LPC-S, CHC, CDTLF 


Symptoms

When does having a drink with friends or taking a painkiller for a headache (occasional substance use) turn into alcoholism or a painkiller addiction (substance use disorder)?


When the person starts to experience these symptoms, they may be diagnosed with a substance use disorder:

  • Experiencing intense cravings for the substance

  • Using more of the substance than intended

  • Not being able to cut down on one's use of the substance despite wanting to or continually trying to

  • Spending a lot of time procuring, using, or recovering from the aftereffects of the substance

  • Facing problems at home, work, or school due to one's substance use

  • Continuing to use the substance despite relationship problems caused by substance use

  • Reducing or discontinuing other hobbies and activities as a result of substance use

  • Engaging in risky or unsafe behavior under the influence of substances

  • Using the substance even though it is causing or exacerbating physical or psychological health conditions

  • Developing a tolerance to the substance and requiring more and more of it each time to achieve the same effect

  • Experiencing withdrawal symptoms while not using the substance and feeling the need to take the substance to prevent withdrawal


Diagnostic Criteria

Based on the number and severity of symptoms the person has, their healthcare provider will determine whether their substance use is a cause for concern and whether they have mild, moderate, or severe substance use disorder.


The diagnostic criteria are as follows:

  • Mild substance use disorder: Having two or more of these symptoms in the last 12 months (this is the threshold that separates occasional substance use from substance use disorder)

  • Moderate substance use disorder: Having four to five of these symptoms in the last 12 months

  • Severe substance use disorder: Having six or more of these symptoms in the previous 12 months


Causes of Substance Use

Substance use often starts in the following ways:

  • Trying the substance: People often use substances out of curiosity, as an experiment, or due to peer pressure.

  • Taking the substance to feel good: People use substances to experience feelings of intoxication and pleasure, commonly known as "a high."

  • Taking the substance to do better: Some people use substances to improve their performance, alertness, energy levels, and cognition.

  • Using the substance to feel better: People sometimes turn to substances to forget their problems, relieve stress, reduce pain, and feel numb.


Causes of Substance Use Disorder

After a person has started using substances, they may be at risk of developing substance use disorder. These are some factors that can contribute to the risk of developing substance use disorder:

  • Genetic vulnerability

  • Social pressures

  • Environmental stressors

  • Mental health conditions

  • Individual personality characteristics 

  • The effects of the substance


Cultural, social, religious, historical, and legal factors can also play a role in determining what forms of substance use are acceptable. For example, public laws decide which substances are legal or illegal and how much of a substance can be legally consumed. Additionally, some cultures discourage the use of certain substances and permit others.


Diagnosis

Professionals who are certified or licensed in addiction medicine can determine whether a person's substance use is a cause for concern and diagnose and treat substance use disorder, says O'Neill. Your primary doctor can provide a reference to a specialist if needed.


According to O'Neill, the diagnostic process involves a complete assessment, which often includes:

  • An interview with the person who is using a substance

  • Discussions with others who may be in the person's life

  • The use of diagnostic tools to determine whether the person's symptoms meet the diagnostic criteria for substance use disorder listed in the DSM-5-TR

  • A physical examination or other tests to determine the extent of the person's use, assess their health status, and check for other physical or mental health conditions


It's essential to be open and honest about your symptoms and substance use with your healthcare provider so they can accurately determine whether or not your substance use is a cause for concern and if you have or are at risk of developing a substance use disorder.


"Proper diagnosis is critical to ensure you receive the most helpful level of care," says O'Neill.


Treatment

If the person's healthcare provider determines that their substance use is problematic and they have substance use disorder, they may require treatment.


Treatment involves a professional assessment and treatment plan to meet the person's needs for sustained recovery, says O'Neill. "The treatment plan can vary depending on several factors, such as severity of use and the person's resources and sources of support."


According to O'Neill, treatment for substance use disorder can involve:

  • Detoxification

  • Medication

  • Therapy

  • Support group meetings

  • Treatment in an outpatient, inpatient, or residential setting

  • Aftercare, such as sober living

  • Other forms of education, awareness, or support


Preventing Substance Use Disorder

Substance use disorder is preventable if we build systems of care that help us intervene at earlier stages of use. Schools and communities need to work collaboratively together to actively find and correct the conditions that lead to substance use disorder to prevent it or mitigate its effects.


Summary

Substance use is a broad term that encompasses every instance of using harmful substances such as alcohol, drugs, nicotine, cannabis, or prescription medications. Substance use disorder, however, is a medical condition that refers specifically to the problematic use of these substances to the extent that the person experiences negative consequences in several areas of their life.


Trying a substance or using it occasionally is often the precursor to substance use disorder, particularly if someone is predisposed to it due to genetic, social, environmental, or individual factors. Therefore, it's important to take steps to prevent substance use, particularly among young people, to help prevent substance use disorder.


A qualified healthcare professional can diagnose whether a person's substance use is problematic and meets the diagnostic criteria for mild, moderate, or severe substance use disorder listed in the DSM-5. Based on their assessment, they will devise a treatment plan for the person.


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Source:

Sanjana Gupta - Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Published on September 30, 2022

Medically reviewed by John C. Umhau, MD, MPH, CPE

 


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