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Abuse vs. Dependence


The Diagnostic and Statistical Manual of Mental Disorders (DSM)[i] produced by the American Psychiatric Association is often referred to as the “doctor’s bible,” because it provides an authoritative list of symptoms medical professionals can use in order to diagnose disease in their patients.

In the past, the DSM defined substance abuse and dependence (or addiction) as two separate disorders, with separate lists of symptoms for each. The DSM-5, however, suggests that substance abuse and addiction are best thought of as a continuum, with abuse on one end and dependence or addiction as a severe manifestation of the same disorder. It’s confusing, but a little explanation can help the terms come into sharp focus.

Substance Abuse

The term substance abuse has different meanings, depending on the substance that’s in play. For example, people who take in illicit substances like heroin or cocaine are committing substance abuse, as they’re using a substance for the sheer purpose of getting high as these substances have no legal usage. Even one little hit is a symptom of a substance abuse problem. Similarly, those who take prescription medications in order to get high are committing substance abuse as they’re not using the therapies to combat disease. Those who drink exclusively in order to get drunk are also dealing with a substance abuse issue.

As these examples make clear, someone can abuse substances without really feeling the need to use those substances again. The mere act of taking them just once, or taking them improperly, is part of an abusive profile.

Dependence or Addiction?

Those who continue to abuse substances can develop a dependence on those substances, which means they might be simply unable to curb their use. They may engage in the following behaviors:

The U.S. Centers for Disease Control and Prevention considers this dependence syndrome to be a chronic condition, meaning that people who develop this problem might learn to keep it under control, but they might not ever be free of all of the symptoms involved with the problem.[ii]

Treatment Is Vital

If abuse and dependence are on a continuum, it’s vital for people to get treatment early, so they can stop the progression of the disease before the symptoms become chronic. Therapy can help. People who are just beginning to move from social drinking to isolated binge drinking, for example, might need only a few sessions of therapy in order to change their ways for the better.

However,those who have made the complete switch from abuse to dependence often need intensive therapies in order to manage their condition. Talk therapy, medication management, alternative therapies and support group work might all play a role in helping people to understand the dangers of their habits so they can build a better future.