Abuse Vs. Addiction: What’s the Difference?

A look at the clinical definitions of “substance abuse” and “addiction” with signs of each. Plus, a section on the myths and truths related to using drugs. A basic primer for curious readers here.

minute read
By Dr. Joshua Masino, PsyD
Executive Director and Neuropsychologist at Enterhealth

It can be difficult to tell drug abuse from addiction.

Here, we’ll take a look at the clinical definitions of each. We list the main signs and symptoms that you can look for in a loved one (or yourself). Finally, we take a look at some of the myths that surround the treatment of addiction. As always, your personal questions are welcomed at the end. In fact, we try to respond to all real-life questions personally and promptly.

So, what’s the difference?

Substance Abuse, simply put, is the use of any substance in a manner for which it is not intended and/or amounts which are excessive and chronic. Examples include using pain medication to feel pleasure or euphoria, as well as binge drinking alcohol. However, in the abuse phase a person can understand that there is a problem and can stop using.

The term addiction implies a more severe form of substance abuse. Addiction typically manifests with accompanying brain injury, or damage, called “dependence”. The symptoms of addiction can be either physical or mental and are usually a combination of both.

Most people experience a progression which starts with abuse, then edges into addiction with a mental dependence – that is, the person thinks he or she needs the substance – then finally progresses to the stage in which the person becomes physically dependent.

Common signs and symptoms of drug/alcohol abuse include:

  • Neglecting responsibilities at school, work or home (e.g., failing classes, skipping work, neglecting your children) because of drug/alcohol use.
  • Intermittent and erratic mood swings.
  • Incidents of putting yourself in dangerous situations or engaging in risky behaviors such as driving while on drugs or alcohol, using dirty needles or having unprotected sex.
  • Legal troubles such as arrests for possession, disorderly conduct, driving under the influence or stealing to support a drug habit.
  • Problems with interpersonal relationships, such as fights with your partner or family members, an unhappy boss or the loss of friends.

Common signs and symptoms of drug/alcohol addiction include:

  • Completely neglecting or abandoning activities such as hobbies, sports and socializing because of drug/alcohol use.
  • Tolerance to the abused substance. Addicts must use more of the drug to experience the same effects they used to attain with smaller amounts.
  • Taking drugs/alcohol to avoid or relieve withdrawal symptoms. Depending on the substance, if an addict goes too long without using the substance they may experience symptoms such as nausea, restlessness, insomnia, severe aches and pains, lethargy, depression, sweating, tremors, anxiety and seizures.
  • Loss of control over drug use. Addicts may want to stop, but feel a powerful compulsion to continue using.
  • Continuing to use the substance despite knowing it is causing harm, including blackouts, mood swings, depression, paranoia, etc.

In the vast majority of cases, the first and most obvious sign of addiction is the inability to stop using. Unfortunately, a person who is abusing drugs or alcohol almost never realizes when their recreational habit becomes an addiction. Further complicating things, due to the nature of the compulsion to use and the physical need for the drug, many addicts cannot stop using even if they desperately want to.

This is because repeated abuse of drugs or alcohol causes injury to the brain, and over time alters the person’s brain chemistry, leading to physiological changes in the brain. These changes are what lead to physical dependence and the inability to control drug/alcohol use, as the frontal lobes of the brain – which are responsible for functions such as inhibition control and rational thought – are essentially asleep at the wheel.

Is any amount of drug or alcohol use safe?

It depends.

The answer all comes down to how and why someone is using the substance.

Some substances are not harmful when taken in an appropriate manner and amount, but are frequently abused via excessive or improper use. These include substances such as prescription medications (e.g., Xanax, oxycodone, Adderall, etc.), over-the-counter medications (primarily cold and cough medicines) and, of course, alcohol.

There are some substances which are patently unsafe (in addition to being illegal), and the use of these drugs in any amount is automatically considered abuse or addiction. These include drugs such as heroin, cocaine and methamphetamine – commonly referred to as “street drugs.” Additional drugs that fit into this category include substances such as MDMA (ecstasy), GHB and “bath salts” (unregulated synthetic stimulants) which are usually referred to as “designer drugs” or “club drugs.”

Both of these categories of substances serve no legitimate purpose of any kind and pose serious dangers to personal health and safety with even a single use.

Common myths about addiction

As you evaluate your own relationship with drugs or alcohol or that of a loved one, it is important to understand addiction as a whole. There are a lot of myths you may have encountered, and the addiction experts at Enterhealth have debunked them below:

Myth 1 – Overcoming addiction is simply a matter of willpower. You can stop using drugs if you really want to.
Fact: Prolonged exposure to drugs alters the brain in ways which result in powerful cravings and a compulsion to use. These brain changes, along with the physical symptoms of withdrawal, make it extremely difficult to quit by sheer force of will.

Myth 2 – Addiction is a disease and there’s nothing that can be done about it.
Fact: Most experts agree that addiction is a disease that affects the brain, but that doesn’t mean anyone is a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise and other treatments.

Myth 3 – Addicts have to hit rock bottom before they can get better.
Fact: Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost everything.

Myth 4 – You can’t force someone into treatment, they have to want help.
Fact: Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.

Myth 5 – Treatment didn’t work before, so there’s no point trying again.
Fact: Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that sobriety is a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

How Enterhealth can help

If you think you or a loved one could be at risk as a result of substance use, don’t hesitate to get help as soon as possible. At Enterhealth, we have extensive experience treating all levels of addiction, and we offer several levels of care, from our inpatient facility, Enterhealth Ranch, to our Outpatient Center of Excellence.

Our highly trained addiction psychiatrists and therapists incorporate medically validated treatments and techniques that simply cannot be obtained at a lower level of care or in a 12-step treatment program. These include intensive one-on-one patient therapy, in-depth family and/or couples therapy, trauma resolution, pain/anxiety management, neurological testing and treatment, cognitive behavior therapy and spiritual/faith-based classes.

To learn more about Enterhealth’s personalized treatment plans, as well as the latest in science-based addiction treatment, you can visit our website at www.enterhealth.com, or call (855) 393-8656.

About the Author: Dr. Joshua Masino, PsyD is a neuropsychologist specializing in injury and rehabilitation to the central nervous system and brain. He is Director of Neurological Services at Enterhealth. Masino has more than 15 years of experience in clinical neuropsychology and rehabilitation research and psychology. Prior to joining Enterhealth, he was a neuropsychologist at Pate Rehabilitation in Anna, Texas and held director roles at the Florida Neurorehabilitation Center in Pensacola, Florida, and at the Georgia Neurorehabilitation Center in Alpharetta, Georgia. He also served as an adjunct professor in the Department of Psychology at Argosy University in Atlanta.
Masino has presented on topics pertaining to cognitive impairments and neuropsychology in both multiple sclerosis and traumatic brain injury. He is a member of the American Psychological Association, Division 40 and the National Academy of Neuropsychology. He earned a bachelor’s in psychology from the University of South Alabama and his master’s and doctorate in clinical psychology, with a neuropsychology focus, from the Georgia School of Professional Psychology. He completed his internship and fellowship at Mount Sinai Medical Center in New York. He is a licensed as psychologist in Texas and New York.
About the author
Headquartered in Dallas, Texas, Enterhealth offers a science-based alcohol and drug addiction treatment program created by a dedicated team of addiction experts determined to dramatically improve treatment outcomes. Based on the latest National Institutes of Health research identifying addiction as a chronic brain disease, this program is implemented by a full-time staff of addiction-trained physicians, psychiatrists, nurses and therapists, beginning with a thorough medical and psychological assessment designed to create a personalized treatment plan for each patient. Enterhealth Ranch is nestled on 43 scenic acres just 30 minutes north of Dallas/Fort Worth and features 40 beds, private rooms and bathrooms, chef-prepared meals, housekeeping service, a luxurious pool, a gym and more. Enterhealth Outpatient Center of Excellence, an outpatient treatment facility, is located in the Park Cities, just north of downtown Dallas, and provides ongoing addiction management care and support. For more information, visit http://www.enterhealth.com/.
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