- Statistical Overview of Substance Use Disorder
- Historical Definitions
- Abuse, Dependence, or Addiction?
- Seeking Help
- Key Sources
- Medical Disclaimer
If you find yourself struggling to control your alcohol or drug use, you’re not alone. Whether it’s prescription medications, smoking, or illicit street drugs, it can be difficult to manage your substance use and to know whether you’re heading towards addiction.
The differences between substance abuse, dependence, and addiction can be difficult to define. If you’re concerned about your drug use and whether it’s crossing the line towards addiction, an understanding of these terms can help.
Statistical Overview of Substance Use Disorder
Drug abuse and addiction (now more commonly known as “substance use disorder” or “problematic substance use”) have led to a major health crisis in the U.S. Not only are millions of Americans struggling with substance use disorder, but in 2014 alone, there were more than 45,000 overdose deaths, over half of which involved prescription opioids and heroin. Alcohol abuse is also a continuing problem in the country, with over 65 million people binge drinking in the past month.
Other statistics related to substance use disorder in the U.S. include:
- According to the National Survey on Drug Use and Health (NSDUH), 19.7 million American adults (aged 12 and above) had a substance use disorder in 2017.
- In 2017, 8.5 million adults in the U.S. suffered from co-occurring mental health and substance use disorders.
- Roughly 74% of adults who have struggled with a substance use disorder also struggled with an alcohol use disorder in 2017.
- In 2017, roughly 38% of adults struggled with an illicit drug use disorder.
- In that same year, 1 out of 8 adults had simultaneous alcohol and drug use disorders.
- When it comes to cost, drug abuse and addiction can add up to over $700 billion annually in terms of a loss in workplace productivity, healthcare expenses, and costs associated with crime.
The term “addiction” has been somewhat controversial history over the years. In the 1980s, the American Psychological Association sought to change this definition in the DSM (the Diagnostic and Statistical Manual of Mental Disorders). After a careful vote, “addiction” was changed to “substance dependence” and it remained that way until the DSM entered its 5th edition in 2013.
To confuse matters further, “substance dependence” was then changed to “substance use disorder” in the new DSM-5. The intention was to simplify the phrasing by grouping substance abuse and substance dependence into one category. This change also provided clarity, since previously, the definition of dependence was narrower and only referred to physiological dependence.
However, these recent changes mean that “dependence” now includes both physical and physiological dependence (in terms of tolerance and withdrawal symptoms). Substance use disorder, on the other hand, is used in clinical and diagnostic settings to refer to “addiction.” The condition also has varying levels of severity and is categorized as mild, moderate, or severe.
Abuse, Dependence, or Addiction?
If you are struggling with your alcohol or drug use, it can be helpful to explore these three definitions to determine whether there might be a problem.
According to the National Center on Substance Abuse and Child Welfare, substance abuse includes one of the following behaviors in the last 12 months:
- Chronic substance use that results in a failure to meet obligations at work, home, or school.
- Recurrent substance use in physically hazardous situations.
- Chronic substance-related legal problems.
- Continued substance use despite any persistent social or interpersonal issues that are caused by or exacerbated by the substance.
For example, substance abuse could involve a college student who uses drugs or alcohol regularly and takes these in excess — often mixed with other substances. Abuse, in this case, is excessive use of drugs in a way that is hazardous and can interfere with school or home life.
Dependence, on the other hand, is characterized by a physical and psychological loss of control due to substance abuse. For example, physical dependence occurs when the body is reliant on the chemical interactions caused by a drug or substance. In this case, medical support may be required to help wean the individual off the drug. However, in this state, a person can be physically dependent on the medication, but not addicted.
For example, a person may become dependent on a pain medication prescribed by their doctor. While the person has difficulties physically withdrawing from the drug, they don’t have an intense or compulsive psychological or physiological need for it.
Addiction or substance use disorder occurs when individuals are largely unable to function without the drug. People who are addicted develop a physical and psychological reliance on a substance that leads them to go to extreme lengths to continue taking it.
For example, individuals who are addicted to prescription drugs will take more than the prescribed amount and for longer than its intended use. They will tend to be secretive about their use and will need the drug to function normally.
If you experience three or more of the following signs or symptoms over a 12-month period, then you meet the criteria for substance use disorder or addiction:
- Withdrawal symptoms (physical and psychological) such as nausea, depression, anxiety, cravings, and insomnia after drug use is stopped.
- A tolerance to the substance where the body is used to the drug and requires larger amounts to achieve the desired effects.
- Intense and ongoing cravings for the drug or substance.
- Taking increasingly larger amounts of the drug to achieve the feeling of the “first high.”
- Loss of interest in hobbies, interests, career, or social activities.
- Withdrawal or retreat from friends and family.
- Engaging in behavior that revolves solely around drug use or getting high.
- Relapses or unsuccessful attempts to stop drug use or cut down.
- Continued use of drugs and alcohol despite ongoing physical or psychological problems related to their use.
Questions to Ask Yourself
Definitions aside, what also matters is how you feel and whether you suspect that drug use is taking over key areas of your life. For example, ask yourself the following questions:
- Do you find yourself hiding your drug use?
- Do you find it hard to stop thinking about taking your next dose?
- Have you started to take more than you are prescribed (or than you intended to take)?
- Do you lie about your drug use?
- Have you withdrawn from family or friends over your drug use?
- If you are using prescriptions, have you run out of your medication before your next prescription is due?
- Do you feel remorseful, guilty, or sad about your drug use, even though you are taking substances to feel better?
If you think your substance use is causing problems in your life, help is available. Alcohol and drug treatment centers are well-equipped to assess your substance use and provide tailored, individualized recovery plans. Below is a list of the most common forms of substance abuse treatment programs and what they entail.
Detox programs are available at certain clinics and medical facilities, where they supervise a person’s drug withdrawal and provide supportive medications, where necessary. These clinics are usually staffed with a team of doctors and nurses who have experience with addiction and drug withdrawal. The advantage of going to a detox center is that medical assistance is readily available. A detox center will place you in comfortable surroundings where you can be assured of help in case of emergencies. These clinics also provide medications to ease some of the symptoms.
Short-Term Inpatient (Residential)
Short-term inpatient centers typically start with medical detox and are followed by a program of addiction treatment, such as therapy or counseling for 30 to 90 days. These programs range from basic inpatient to luxury options, all varying in terms of their amenities and types of therapy. These facilities usually provide 24-hour medical support and are often led by a team of counselors, clinicians, and doctors. Short-term inpatient rehab is ideal for individuals who need detoxing and therapy, but who don’t require long-term treatment.
Long-term inpatient treatment programs vary in length, but typically last between 3 to 18 months. This type of rehab is best suited to individuals with long-term chronic addictions, especially those who have co-occurring mental health issues. Depending on the severity of the addiction, long-term treatment may be a good option, especially as many programs address the underlying emotional causes of one’s drug abuse. Long-term treatment also provides an opportunity for the individual to physically withdraw from whatever drug they were abusing while they focus on their mental and emotional rehabilitation. These centers also vary in terms of their provision of amenities, which range from basic to luxury options.
Partial Hospitalization Programs (PHP)
For individuals who are seeking intensive treatment but still prefer to live at home, partial hospitalization (PHP) or day treatment programs are also available. PHP typically consists of hospital treatment 5 to 7 days a week, for 4 to 8 hours per day. Like inpatient treatment, clinical staff are on hand to assist with detox, medication management, and withdrawal symptoms. PHP also involves counseling and group therapy, as well as specialized services that focus on skill-building, relapse prevention, and employment assistance.
Intensive Outpatient Programs (IOP)
These are less involved than partial hospitalization programs and typically take place at a treatment center or outpatient clinic. Clients receiving intensive outpatient treatment will usually visit the center 2 to 5 days per week for 2 to 4 hours per day. IOP programs vary, but they often involve a mixture of individual and group therapy, case management, 12-Step programs, experiential therapies, cognitive-behavioral therapies (CBT), and services that cover topics like skill-building, goal setting, and relapse prevention.
Standard Outpatient Programs
These programs are suited to individuals who have just completed an inpatient program and want to continue some form of therapy. Standard outpatient is also ideal for people who may be juggling other responsibilities, such as work or school. Individuals typically report to a treatment center or clinic 1 or 2 days per week.
If you or a loved one are struggling with substance abuse, dependency, or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Dual Diagnosis.org. (2021). Difference Between Abuse and Addiction. https://dualdiagnosis.org/drug-addiction/abuse-and-addiction.
National Institute on Drug Abuse. (2017). Trends & Statistics. https://www.drugabuse.gov/drug-topics/trends-statistics.
Stea, J. (2020). Drug Addiction vs. Drug Dependence. Psychology Today. https://www.psychologytoday.com/gb/blog/writing-integrity/202003/drug-addiction-vs-drug-dependence.
Substance Abuse and Mental Health Services Administration. (2006). Appendix E: Substance Use, Abuse, Dependence Continuum, and Principles of Effective Treatment. https://ncsacw.samhsa.gov/files/SAFERR_AppendixE.pdf.
Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report.
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
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