If you see a character on TV who takes drugs or abuses substances, you may see them as an addict. But is everyone who abuses drugs or alcohol an addict? Where do we draw the line between the two? Although the two terms are often used interchangeably in everyday language, psychiatric diagnostic manuals like ICD-11 distinguish between Addiction and substance abuse. In this article, we'll explore this distinction.
To better understand the difference between drug abuse and Addiction, we will start by looking at the drug Abuse vs Addiction definition.
Next, we will consider the differences in drug abuse vs Addiction symptoms.
Moving on, we will discuss the psychological factors of drug abuse.
Finally, we will look at the treatments for drug addiction and substance abuse.
Drug abuse is associated with psychological difficulties, freepik.com
Difference between drug abuse and addiction
Let's first take a look at how we define drug abuse and addiction in psychology.
Drug Abuse vs Addiction definition
Addiction refers to a pattern of compulsive engagement in rewarding behaviours, often it's compulsive substance use, but gaming and gambling can also become an addiction. Loss of control over engagement in rewarding behaviours apart from substance use is referred to as a behavioural addiction.
Both behavioural addictions and addictions to psychoactive substances are considered psychological disorders that can be diagnosed and treated.
Addiction is a pattern of compulsive engagement in rewarding activities (like substance use) despite the harm they cause to one's life. People struggling with addiction can feel as though they have lost control over their behaviour and cannot break the pattern.
Addiction is characterised by a need to use more to achieve the same effect.
In the ICD-11, substance use disorders are conceptualised as a spectrum of drug abuse, with Hazardous Substance use diagnosis on one end and substance dependence on the other.
Substance use, substance misuse and substance abuse don't necessarily indicate addiction. Substance use is very common. Most of us use psychoactive substances, substances that alter our mental state, in everyday life:
- We drink coffee or tea, which often contain caffeine, and we take medicine when we are sick or experience pain.
- It is also common in most societies to take substances recreationally, for example, drinking alcohol or smoking tobacco products.
Substance misuse occurs when a psychoactive substance is used not as it was intended to be used. It includes taking higher doses of substances than one is supposed to, taking it for longer than necessary or with other substances.
Benzodiazepines are frequently prescribed for anxiety. However, the guidelines highlight that they shouldn't be taken for more than 2 to 4 weeks because they can lead to dependence and addiction.
If a person takes benzodiazepines against those guidelines, they engage in substance misuse, even if they don't become addicted or suffer any consequences.
Olivia abuses alcohol during parties. She tends to consume large amounts of alcohol, even though she often feels sick and anxious the next day after drinking. Olivia isn't likely to engage in very risky behaviours when she drinks. She only drinks alcohol every few weeks and doesn't experience compulsions to use it between those parties, she isn't necessarily addicted to or dependent on alcohol. Her use can be classified as low-risk use.
On the other hand, her friend Ella tends to engage in risky behaviours when she drinks. This can involve starting fights and driving under the influence. Her pattern of substance use can be classified as hazardous substance use, even if she is not addicted to alcohol because she puts herself and others at risk.
Drug abuse vs Addiction symptoms
While the clinical symptoms of drug abuse Stress the harm caused by drug use, symptoms of addiction and dependence highlight the loss of control over one's use.
Addiction and dependence symptoms
The main symptom of addiction is an inability to control the compulsion to engage in rewarding activities.
Addiction often co-occurs with dependence. When a substance is taken on a regular basis, our body and brain get used to it and start to become dependent on it to function. At that point, a person doesn't feel the reward of taking the substance anymore and has to increase their dose to experience the same pleasurable effects. This is because the body has built tolerance.
Moreover, if the person wanted to discontinue their use, they might experience withdrawal symptoms. When the body has become dependent on a substance, discontinuing its use will temporarily dysregulate the body.
For example, withdrawal from alcohol includes symptoms like nausea, hand tremors, anxiety, sweating, and insomnia.
The diagnosis of dependence requires at least two of the following features:
The dependent person experiences impaired control over their use, and the substance use can become compulsive.
Substance use becomes prioritised over other activities and responsibilities
Symptoms of physiological dependence e.g., tolerance or withdrawal symptoms if the use is discontinued
Noah's repeated cigarette use led him to develop symptoms of dependence. He noticed that he finds it hard to quit. Whenever he decides to limit the frequency of smoking or the number of cigarettes he smokes in a day, he fails.
His smoking started to have an impact on his family and work life. He isolates himself from his family members, so he can smoke more and takes frequent breaks at work despite the warnings from his boss. When Noah attempts to cut down on his use, he becomes irritable, he feels sick, his mood drops, and he finds it hard to focus.
Drug abuse symptoms
Depending on its severity, drug abuse can be diagnosed as low-risk substance abuse, hazardous substance abuse, harmful substance abuse or dependence. While drug abuse often co-occurs with addiction, not all substance abuse is compulsive, and therefore can't be considered an addiction.
Harmful substance use occurs when the user has already caused significant harm to the user or others. This pattern has to be continuous for at least 3 months or be evident for over a year for the diagnosis to be made.
Hazardous substance use involves putting oneself or others at risk of harm.
Drug abuse can be diagnosed on a scale, freepik.com/pch.vector
Drug abuse vs Addiction: Key features
Consider the following table which describes the key features of drug abuse vs addiction.
| Definition | Key features |
| Addiction | Compulsive engagement in rewarding activities, despite the harm they cause to one's life. | - Compulsive behaviour
- ICD-11 distinguishes both behavioural and substance addictions.
|
| Dependence | Dependence occurs when the body becomes so used to the substance that it cannot function well without it, perpetuating the use. | - Impaired control over substance use.
- Prioritisation of substance use.
- Physiological dependence.
|
| Substance misuse | Substance misuse occurs when a psychoactive substance is used against the guidelines. | This can lead to substance abuse. |
| Substance abuse | Using substances in a way that is harmful to users or other people. | Puts the substance user or other people at risk of harm or has already resulted in harm to oneself or others. |
Psychological factors of drug abuse
Alongside a genetic predisposition or environmental factors, an underlying psychological condition can be a major risk factor for drug abuse. People experiencing various psychological difficulties are vulnerable to drug abuse because they might be inclined to reach for drugs repeatedly to self-medicate. This is why we see a higher occurrence of drug abuse in people with mental health difficulties.
Self-medication involves taking substances to cope with distress, symptoms of mental illness or past traumas.
- A person with Depression may start taking substances to increase their mood or cope with fatigue.
- People with Schizophrenia typically take substances to cope with positive symptoms like hearing voices or negative symptoms, like an inability to experience pleasure.
- Similarly, people with social anxiety can take benzodiazepines or drink alcohol to cope with the Stress of socialising with others or public speaking.
While these examples don't necessarily indicate substance abuse, reliance on substances to cope with the difficulties of daily life can with time lead people to become dependent on them to function or abuse them.
Treatments for drug addiction
Some of the treatments for drug addiction include Aversion Therapy, self-management programmes and psychological interventions like Cognitive Behavioural Therapy.
Aversion therapy
Aversion Therapy is one of the oldest Behavioural Interventions for addiction, which uses the principles of Classical Conditioning. During this intervention, the substance one is addicted to is paired with negative stimuli like vomiting or electric shocks. This therapy aims to change the association between the substance and its rewarding effects to unpleasant effects.
Nowadays, instead of relying on real unpleasant stimuli to create a negative association, like the administration of electric shocks or drugs that induced vomiting, aversion therapy for drug addiction relies on imagined unpleasant stimuli.
Self-management programmes
Self-management programmes include 12-step programmes like Alcoholics Anonymous. They are characterised by a strong peer-support component, they view participants as active agents responsible for their recovery and capable of making a change in their life. They also offer a safe, non-judgemental space for people to share and reflect on their experiences with addiction.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy for addiction focuses on challenging one's maladaptive thoughts and beliefs that perpetuate the addiction. During CBT, the therapist also helps the client identify stressful situations that can lead the client to use substances, and can encourage them to try out different coping mechanisms to prevent relapse.
For example, if a client has a strong belief that they cannot cope with hearing voices sober, the therapist may encourage the client to experiment with different coping mechanisms that can help reduce their distress when experiencing psychotic symptoms. As the client's repertoire of coping strategies increases, the need for substance use may become replaced.
Drug Abuse vs Addiction - Key takeaways
- Addiction is a pattern of compulsive engagement in rewarding activities (like substance use) despite the harm they cause to one's life.
- Dependence occurs when the body becomes so used to the substance that it cannot function well without it, perpetuating the use. Addiction is characterised by tolerance and withdrawal symptoms.
- While the clinical symptoms of drug abuse stress the harm caused by drug use, symptoms of addiction highlight the loss of control over one's use.
- Substance abuse is characterised by using substances in a way that is harmful to users or other people. Substance misuse occurs when a psychoactive substance is used against the guidelines.
- Substance abuse can be motivated by a desire to self-medicate or cope with symptoms of mental illness.
- Some of the treatments for drug addiction include aversion therapy, self-management programmes and Cognitive Behavioural Therapy.
Explanations 
Textbooks 
Exams 
Magazine 
