Substance Use Disorder Vs. Addiction

What is substance use disorder?

Substance use disorder, which has also been referred to as abuse, dependence and addiction, is diagnosed if certain criteria occur within a 12-month period as defined by the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association). The criteria include:

1. The substance is often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.

3. A great deal of time is spent to obtain, consume and recover from a substance.

4. Craving, or a strong desire or urge to use the substance, occurs.

5. Continued use of the substance results in a failure to fulfill major role responsibilities at work, school or home.

6. Use of the substance is contributing to relationship problems.

7. Important social, occupational or recreational activities are given up or reduced because of use of the substance.

8. Use of the substance is recurrent in situations in which it is physically hazardous (e.g., driving while intoxicated).

9. Continuing to use the substance despite knowing that it has an impact on physical or psychological problems likely caused by the substance (e.g., drinking with a liver condition or using opioids when depressed or anxious).

10. Tolerance, which means that the person needs more of a substance to get a desired effect or the same amount of a substance doesn’t produce the desired effect any longer.

11. Withdrawal, such that when the substance is not taken, a person experiences substance-specific withdrawal symptoms.

You’ll note that the DSM does not specify a certain amount like a six-pack of beer or two joints a day, but rather focuses on the lack of control, significant relationship and social problems, risky use, tolerance and withdrawal symptoms.

People who meet two or three criteria are considered to have a “mild” disorder, four or five is considered “moderate” and six or more symptoms is “severe.”

Many people experience substance use problems but are able to stop using or change their pattern of use without progressing to addiction.

What is addiction?

While the term “addiction” does not appear in the DSM, it is generally regarded as a severe substance use disorder. Addiction is the most severe form of a full spectrum of substance use disorders. It is a medical illness caused by repeated misuse of a substance or substances.

Addiction is defined by the National Institute of Drug Abuse (NIDA) as a chronic disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and can result in long-lasting changes in the brain. It’s more complicated than other diseases, as it’s considered both a complex brain disorder and a mental illness.

The important point to remember is that all substance use disorders are treatable regardless of whether they are mild, moderate or severe. The earlier families intervene and take steps to help a child or other loved one, the better.