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How Substance Abuse, Substance Dependence, and Addiction are Different


Addiction. Substance Abuse. Substance Dependency. While these terms are similar and related in certain situations, they are not the same. Defining the terms can help us better understand the differences and emphasizes the gravity of the disease of addiction.

What is Substance Abuse?

According to Dr. Mike Wilkerson, Corporate Medical Director for Bradford Health Services, substance abuse is “The intentional overuse of a substance in cases of celebration, anxiety reduction, despair, or ignorance.” While this may sound the same as addiction, the difference is that people who abuse substances are not necessarily reliant on the substance. Dr. Wilkerson explains that a substance abuser does not need their drug of choice to function in everyday life. Their brain does not crave the drug in the same way that it craves essentials like food and water.

While it is true that addicts may overuse drugs in these types of situations, they will also overuse them in their regular daily lives. Where a substance abuser can stop whenever they want to, an addict cannot. In short, all people who are addicted are substance abusers, but not all people who abuse substances are addicted.

Think of a partying college student. Many teenagers who gain freedom from their parents begin to experiment with drugs and alcohol in the form of college. They may consume drugs and alcohol at high rates alongside their peers. This experimentation is often met with negative consequences, from the simple, a hangover, to the more serious: an arrest for underage drinking. A substance abuser’s usage rate will decrease when met with these consequences or when they move to a different environment upon graduation.

What is Substance Dependence?

Another term often confused with addiction, substance dependence, is a little trickier to define.  

“Dependence is a state in which an organism functions normally, only in the presence of the drug,” says Dr. Wilkerson. “It can also be a solely physical reliance on the substance. Physical withdrawal symptoms will manifest when the use of this substance ends.”

This response should not be confused with people who are addicted to a substance. Addiction “rewires” a person’s brain to believe that they physically require for survival. Someone who is only dependent can stop using when needed.

For example, let’s say that someone is taking a benzodiazepine, such as Xanax. They follow the instructions of their doctor and take their medication as prescribed. Their body will adapt to the drug and become reliant on it to maintain a homeostatic balance. When this person stops taking this drug, upsetting the balance, and they will experience withdrawal symptoms. While they were indeed dependent, this is not the same as an addict who cannot control their usage.

What is Addiction?

Dr. Wilkerson shares that the way addiction differs from substance abuse and substance dependence is in how it affects the addicted person’s brain and its ability to interpret signals. While all three do cause impairment, a person suffering from addiction experiences a complete loss of control over their drug use. The disease changes how the brain is wired, creating dysfunction in the brain’s pleasure pathway.

As mentioned before, a person with substance addiction or Polysubstance dependence can’t just make themselves stop using. Overcoming addiction requires formal treatment and clinical interventions, such as therapy and counseling. In some instances, it can require medical detox and drug therapy. Like any serious disease, addiction should be treated by specialized healthcare professionals. Depending on the person’s needs, a clinical professional may recommend they receive care at an inpatient or residential rehab facility or treatment at an outpatient rehab clinic. 

Understanding the disease of addiction and how it is different than substance abuse and substance dependency is essential in breaking the stigma and can encourage those affected to seek treatment. Bradford is here to help if you or a loved one are struggling with drug or alcohol addiction. Call 888-577-0012 to speak with a Recovery Advisor today.