The terms substance “abuse” “dependency” and “addiction” are often used interchangeably, yet when substance abuse and addiction professionals use these terms, they are often discussing different conditions, differing in behavior patterns and physiological characteristics.
The most confusion - and at times division among professionals - occurs over the terms "dependency" and "addiction." Individuals can become chemically "dependent" on a drug and not become addicted. Many life-saving medicines - such as those for high blood pressure and asthma - can cause physiological "dependency."
At issue among professionals are the stronger "pain" medications prescribed for chronic pain called opioids, medications that can be highly addictive with long-term use - and undeniably cause chemical dependency. At what point does a chronic pain patient cross from dependency to addiction?
Substance abuse and behavioral disorders are complex, and oftentimes those who develop these disorders have both physical and behavioral conditions that further complicate the disease. Understanding what separates and brings these disorders together is the first step in sorting through the maze of substance abuse and addiction.
What is Substance Abuse?
Someone routinely late for work because of late-night drinking, or suffering through work days with hangovers or who frequently calls in sick because of partying are all signals for potential substance abuse. Or a parent failing to care for his or her children, or attend to the needs of a spouse, constantly high or drunk, are also substance abuse warning signs.
What is the “Substance” in Substance Abuse?
Substance typically refers to the pathological use of a medication or non-medically indicated drug or toxin, which results in repeated adverse social consequences. The National Institute on Drug Abuse lists the following substances as possible agents for abuse:
Individuals who “get high, stoned or drunk” and then drive, swim or ski are potential substance abusers, as are college students repeatedly "binge drinking."
In other words, the use of a medication or non-medically indicated drug or toxin that results in repeated adverse social consequences, such as failure to meet work, family, or school obligations, interpersonal conflicts - or legal problems - typically defines "substance abuse."
How do professionals separate abuse from dependency or addiction? According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV-TR®), the criteria for substance abuse do not include tolerance, withdrawal, or a pattern of compulsive use, and instead include only the harmful consequences of repeated use.
“In order for an Abuse criterion to be met, the substance-related problem must have occurred repeatedly during the same 12-month period or been persistent,” the manual states.
Some individuals can abuse drugs or alcohol for years, never becoming physically tolerant, dependent or even “addicted” to the substances.
Yet, the substance abuse causes severe social consequences - job loss, legal problems, carelessness that can cause harm to oneself or others. Those who abuse substances need treatment as well as those with more serious addiction disorders.
What is Substance Dependency?
One of the most confusing and misused terms, substance dependency occurs with the use of many drugs used for legitimate, life-saving medical purposes. Long-term use of the medications causes the body to become dependent on them, a body that has adapted to the chemical changes caused by the drugs.
Dependence occurs when a lack of the drug causes the body to have harsh or severe reactions. It means that the body has physiologically adapted to its presence, so that the sudden removal of it leads to withdrawal symptoms.
Withdrawal Symptoms vary according to the drug and dosage, and they can include:
- weight loss
- diarrhea/stomach upset
- inability to focus/lack of concentration
- dry mouth
Individuals taking medications that cause dependency must taper off of them slowly. Withdrawal can be serious, and a patient must receive the appropriate medical guidance when tapering and stopping the medication.
Some drugs, such as benzodiazepines, the most commonly prescribed depressant medications in the U.S., when taken long term must be tapered, or doctors and pharmaceutical companies warn of such serious withdrawal symptoms as seizures and even suicide. Some of more commonly prescribed benzodiazepines include Xanax, Librium,Valium, and Ativan.
Because of their sedative properties, benzodiazepines have a high potential for abuse, especially when used with other depressants such as alcohol or pain medications such as opioids - another type of medication that has severe withdrawal symptoms if stopped abruptly. Examples of opioids are oxycodone (OxyContin), those containing hydrocodone (Vicodin), and heroin.
The increased use of drugs like OxyContin and Vicodin for chronic pain patients over the past decade has increased concerns among some healthcare and mental health providers for the potential of individuals to develop an addiction. Others believe that long-term use of these drugs for chronic pain does not automatically lead to addiction - however, there is no question that ongoing use of these powerful painkillers cause a chemical substance dependency.
Unfortunately, the presence of many of these pain medications, now in home medicine cabinets, has also led to the illegal use of these drugs by other family members, or even visitors to homes who search bathrooms for these drugs.
Those who take large doses of opioids and become chemically dependent, and/or addicted, often must take a medication called methadone during withdrawal to ease withdrawal symptoms.
What is Substance Addiction?
Addiction means a chemical and psychological dependency on a drug. It is a compulsion, causing individuals to satisfy a need for a particular stimulus, and to keep satisfying it regardless of the physical, mental, social and emotional costs. Substance addicts will put themselves, their families, and anyone else in harm's way to get drugs.
Substance addictions start with casual or social use of a drug, becoming more frequent and then requiring higher and higher doses of the drug to get high - called developing a drug tolerance. Soon it becomes almost impossible to go without the drug, and, since the body is now chemically dependent, abruptly stopping the drug can cause serious withdrawal symptoms.
Why some individuals are able to continually abuse substances while others only ingest a substance occasionally and become addicted continues to challenge scientists, yet research points to a number of factors that predispose some individuals to addiction. These factors include genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric or emotional disorders.
According to the Mayo Clinic, addiction symptoms or behaviors include:
- Feeling that you have to use the drug regularly — this can be daily or even several times a day (also called "craving" the drug)
- Failing in your attempts to stop using the drug
- Making certain that you maintain a supply of the drug
- Spending money on the drug even though you can't afford it
- Doing things to obtain the drug that you normally wouldn't do, such as stealing
- Feeling that you need the drug to deal with your problems
- Driving or doing other risky activities when you're under the influence of the drug
- Focusing more and more time and energy on getting and using the drug
Research has shown that those who become drug addicts often have underlying psychological issues that also need to be addressed before treatment for addiction will be successful.
If you are interested in working in the field of substance abuse and addiction, a psychology-based degree is the first step in achieving this goal. Most treatment facilities require a master's degree and certification to work as a substance abuse counselor. To get started, request information from psychology schools, and inquire about special concentrations and certificates in substance abuse and behavioral disorders.