Abuse Versus Dependence

With respect to addictions, is there a difference between abuse and dependence? This is a commonly asked question; the answer is yes. It is an important distinction to understand, as it may affect the type of treatment sought out and the level of difficulty encountered in recovery.

Although both abuse and dependence can cause significant problems in a person's life, dependence involves physiological changes that lead to an addictive process. Therefore, dependence on substances and/or behaviors can be more difficult and complicated to treat. Repeated abuse of substances and/or behaviors can develop into habits that are hard to break.

However, abuse doesn't necessarily lead into the physiological changes of addiction. Either abusing or being dependent upon a substance or a behavior can diminish one's ability to fully participate in and enjoy everyday life.

Substance Abuse

Substance abuse occurs when a person uses drugs or consumes alcohol excessively. This excessive use typically causes significant problems in a person's life. For example, if a person drinks excessively on a Sunday evening and is unable to go to work on Monday morning or is unable to perform job functions as well as usual, this is abuse.

It is abuse when a person uses alcohol or other substances excessively and then gets in his car to drive home, putting his own and others' lives in danger. There may be legal problems such as DUIs (driving under the influence) or arrests for disturbing the peace as a result of excessive use of alcohol or other substances.


How big of a concern is substance abuse and dependency? The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) reported in its 2006 National Survey on Drug Use and Health that 22.6 million individuals aged 12 and older experienced either substance abuse or dependency problems in the previous year. This is approximately 9.2 percent of the U.S. population.

A parent who uses alcohol or other substances excessively may not be able to take care of her children responsibly. Essential household functions such as taking out the trash, maintaining cleanliness, and so forth may be neglected when men and women use substances excessively. Persons who are abusing substances often repeatedly have problems getting along with others. These are only a few illustrations of the ways in which substance abuse can negatively affect a person's everyday life.

Historically, it has been more common for substance abuse to be associated with men, but times have changed. Both men and women are now seen engaging in substance abuse or addictive behaviors in movies, commercials, and advertisements.


It is now commonly accepted that all substance-related and behavioral addictions involve compulsive use, loss of control, and continued use despite adverse consequences. These are important characteristics for you to be aware of as you consider whether you or someone you care about may have a problem with addictions.

For some, substance abuse may be considered a rite of passage or an introduction into an adult social arena considered by a certain segment of the population as acceptable entertainment. One might think that with more openness related to substance abuse in our culture, it would be easier to acknowledge the problems and get treatment.

Sadly, however, shame is still a significant barrier to overcome in recognizing substance abuse and seeking treatment. This is especially true if the problems and negative consequences associated with substance abuse become public. Confusion and mixed messages abound.

Substance Dependence

Can alcoholism develop if someone only drinks wine or beer?

Yes. Since wine and beer have lower alcohol content than other alcoholic beverages, some mistakenly believe that they cannot develop an addiction. The fact is, if enough wine and beer are consumed, alcohol addiction can develop.

Dependence on a substance can include any or all of the problems of substance abuse. It is important to be aware, however, that with dependence, the problems become even more complicated because of the physiological changes that occur. A couple of key points that will be important to understand involve the two primary physiological issues associated with dependence: tolerance and withdrawal.

Tolerance means a person needs more and more of the substance over time to get the same effects he experienced when he first began using the substance. It can also mean that if a person's use of the substance stays the same, the initial effects experienced will decrease with use over time.

Say, for example, that a person had her first beer at 16 and got a real buzz from the experience. By the time she is 20, she might need six to 12 beers to get that same buzz. If she is a regular drinker and keeps her drinking level to one beer, she would likely feel no buzz at all by age 20. (Of course, this time frame would vary for the occasional drinker versus the regular drinker.)


Addictions were first identified as a disease process rather than a mental disorder or moral failure by Dr. Benjamin Rush in 1810. In 1945 the American Medical Association formally adopted this definition as well, and most other professional organizations have followed its lead.

After a person has used an addictive substance over a period of time, he may experience withdrawal symptoms if he chooses to stop using the substance. Withdrawal symptoms can be physical, behavioral, or psychological in nature. The symptoms that a person deals with are specific to the substance being used. For example, the withdrawal symptoms of alcohol are not completely the same as those of cocaine usage. More will be discussed later on the unique withdrawal symptoms of different substances.

No one would argue that withdrawal symptoms for any substance can be very uncomfortable, unpleasant, and even life-threatening. An addict in recovery goes through an ambivalent struggle knowing that taking more of the addictive substance would result in relief from the discomfort of withdrawal. This can lead to misunderstanding by those who might see the addict as insincere and untrustworthy, saying she wants to be rid of her addiction but not following through with the necessary treatment to achieve her goal.


The biological processes of tolerance and withdrawal have been found to occur in both substance addiction and addictions to compulsive behaviors such as gambling, pornography, sex addictions, food addiction, compulsive spending, and other excessive behaviors. The technical term for these biological processes is neuroadaptation.

In many cases, it's not that the addict doesn't want recovery, it's that she is avoiding the pain of withdrawal. This is the time when an addict needs to be patient with herself and most needs the understanding and support of her friends, family, and treatment providers.

It is not uncommon for an individual to take more of a substance than was originally intended. This may be due to peer pressure, not realizing the potency of the substance, or experimental use gone awry. He might find himself wanting to stop using the substance but repeatedly being unsuccessful. This is very discouraging, and people in this situation need a great deal of support to succeed.

In such circumstances, the addicted person may realize that more and more of his time and money are being spent on getting the substance. He may give up other activities, even activities he typically enjoys, in favor of using the substance. He may also find himself continuing to use the substance in spite of the knowledge that there will be serious consequences that can negatively affect him and people he loves.

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