Substance Abuse or Addiction

Both terms are used, substance abuse or addiction treatment, interchangeably, although a distinction is made if we’re talking about diagnoses. When I first started in the addiction treatment field, the term substance abuse treatment was often used in lieu of addiction treatment. I don’t know if substance abuse had a less harsh sound to it, or if professionals at the time thought of addiction as abuse. I guess semantics can be tedious, but sometimes language should be as exact as possible — when dealing with addiction there should be no room for misunderstanding.

It’s true that many people who drink or use drugs will abuse alcohol or other drugs at times. A person might be going through a divorce, and he or she starts drinking more than usual to deal with the emotional pain. These types of alcohol and drug users don’t typically show up in treatment, and, when they do, they normally receive short-term counseling to deal with the situation and behavior that’s causing temporary problems. To be clear, substance abuse is different from addiction. Not all people who abuse alcohol or other drugs have an addiction problem, but all people who are addicted abuse alcohol or other drugs. This is how the NIH describes addiction:

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs.

It helps to distinguish between a chronic brain disease and the behavior of someone situationally abusing mood altering substances. This doesn’t mean that someone in the early stages of addiction is merely abusing alcohol or other drugs due to external stressors. In treatment we must try to distinguish between early stages of addiction and situational substance abuse. Substance abuse and early addiction can look the same — what makes the difference is a collection of signs and symptoms a counselor can gather through an in-depth assessment. Addiction goes through stages — early, middle and late. Sadly, most people don’t make it when they reach the late stages of addiction. Too many alcoholics and drug addicts are misdiagnosed in the early stages, yet this is the prime time for intervention, education and treatment.

The substance abuser needs to learn better ways to deal with stress, and this can be accomplished with short-term counseling, but addiction usually requires more than a few counseling sessions. This is not to diminish the damage caused by substance abuse — any time someone is drinking or using drugs which can be described as abusive, much damage can be done. This is also from NIH:

Drug abuse and addiction have negative consequences for individuals and for society. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs, exceed $600 billion annually. This includes approximately $193 billion for illicit drugs,¹ $193 billion for tobacco,² and $235 billion for alcohol.³ As staggering as these numbers are, they do not fully describe the breadth of destructive public health and safety implications of drug abuse and addiction, such as family disintegration, loss of employment, failure in school, domestic violence, and child abuse.

It’s mind boggling to consider how society is so negatively affected by addiction and substance abuse, yet only 10 % of those with a problem seek treatment.