The Important DIFference Between Substance Abuse and Substance Dependence

New Jersey Therapy and Life Coaching, Voorhees NJ, Marlton NJ, and Cherry Hill NJ

If you drink or use drugs, you may hear your therapist say that you have a "substance abuse" problem or a "substance dependence” problem. But just because you drink or use drugs does not mean you have one of these problems. Many of us are what is called social drinkers or occasional users.

If you do have a substance use problem, it may be characterized as “substance abuse” or “substance dependence”. What’s the difference between the two? It is essential for you (and your therapist) to identify the specific problem you are experiencing, as each is treated differently. They are related when diagnosing addiction problems, but one is more intense than the other. They are ultimately different stages in the progression of substance use problems.

Abuse

Substance abuse is a pattern of harmful or even dangerous use of substances. It is recurrent use that can lead to negative consequences, such as legal or relationship problems, or even risky behaviors. However, substance abuse doesn’t mean you are physically dependent on drugs or alcohol. If you are characterized as a substance abuser, you might continue using or drinking despite negative consequences. A substance abuser doesn’t experience physical withdrawal symptoms when they stop using or drinking.

Dependence (Addiction and Alcoholism)

Substance dependence is more severe. When you are dependent, you are physically and psychologically addicted. You can’t live without drinking or using. Dependence has many symptoms, including tolerance (requiring increased amounts of drugs or alcohol to achieve the same effect), withdrawal symptoms when you stop, and compulsive use of the substance despite harmful consequences. Often, dependence is a chronic condition. When you are dependent, your brain must have the substance for you to feel normal. When you are dependent, stopping substance use is extremely difficult without help.

The Difference between Them

The main difference between abuse and dependence is that when you are dependent and try to stop, you go into withdrawal. Symptoms such as sweating, having tremors, high anxiety, or nausea reinforce continued substance use. Substance abusers, on the other hand, may not have any physical withdrawal symptoms. But, they can have psychological cravings or other substance use-related problems. These problems are treated differently, so being able to recognize where you land is essential.

Substance abuse is sometimes episodic. It can involve occasional use, but users or drinkers consume more than a social user or drinker would. Dependence dominates a person's life and creates unmanageability, while abuse does not dominate one's daily life. Dependence is a daily struggle to obtain the substance and use it. The path from abuse to dependence can occur gradually and is influenced by psychological vulnerabilities, a genetic predisposition, and even environmental stressors.

Understanding and identifying this progression is essential. It makes sense to address your problematic substance use while in the abuse stage, before it progresses to addiction.

Recognize the Problem

Those with substance abuse issues may recognize their problematic behavior and seek help voluntarily, especially when there are negative life consequences. If you are dependent, you may be ambivalent due to the physiological dependence and intense cravings, making the motivation to change more difficult.

The terms "abuse" and "dependence" have changed over time in the diagnostic manuals like the DSM (Diagnostic and Statistical Manual of Mental Disorders). Older editions clearly distinguish between the two. Recent editions combine abuse and dependence under the umbrella of "Substance Use Disorder," which emphasizes levels of severity rather than separate diagnoses.

If you are struggling with substance abuse or substance dependence, and your life is being negatively impacted as a result, you must seek help, and you must be open and honest with your therapist about what you use, how much you use, and how often you use. Don’t minimize and ignore the negative consequences substance use brings to your life. Find a professional who can assist you, and take the necessary steps to recover.