Many terms are commonly thrown around when talking about substance use disorders—addiction, dependence, abuse, tolerance, withdrawal, etc. Many of these terms are used either incorrectly, or with limited understanding, and can be troublesome when trying to overcome and understand substance use related problems. As medical knowledge changes, so does the terminology, and in 2013, the American Psychological Association updated the clinician’s diagnosis manual, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to more accurately reflect substance use disorders and what these types of disorders typically mean.
Abuse and Dependence
Perhaps most often in the media, and in our everyday lives, we hear the terms substance abuse and drug dependence (outside of only the callous, addict and alcoholic). Prior to 2013, both of these phrases were considered clinical in nature and were often used to provide a diagnosis for someone who was utilizing substances despite knowing the negative consequences, and were physically and mentally dependent on using the substances—often in higher and higher amounts. After 2013, however, both terms were dropped from the medical terminology as they did not accurately reflect the disease of substance use disorders and dependence on drugs did not always mean that a substance use disorder had developed.
Today, the only remaining correct use of either term is, “physical dependence,” or what the National Institutes of Health define as the body’s physical response to a substance being taken away once it has come to rely on it or regularly have access to. These responses to physical dependence can be potentially harmful, and sometimes even deadly. They are commonly referred to as withdrawal symptoms—and side effects can include delirium tremens, severe dehydration, strokes, or others.
Addiction is no longer a term utilized in the DSM-V by medical professionals. However, it is still commonly used within the medical profession and by government agencies that focus solely on the field of severe substance use disorders. When used correctly, addiction is most closely related to a severe substance use disorder. Addiction is often preceded by increased tolerance of substances (needing more and more of a substance to feel the same effect) and an inability to stop using substances once negative consequences begin to occur. While it is common to see the term addiction applied to many situations—you have probably had that friend who has said: “I am so addicted to that new show!”—but remember, severe substance use disorders are extremely dangerous and should be taken seriously, with the appropriate medical care.
Substance Use Disorders
Substance use disorders is a broad term that encompasses a spectrum of substance use related issues and problems. After 2013, substance use disorders are used by medical professionals to diagnosis individuals with a mild, moderate, or severe substance use problem. Following a diagnosis, professionals can then recommend an appropriate plan of treatment to overcome the disorder. Often times the severity, types of substances used, and the presence of any physical dependence will inform the type of treatment recommended. Regardless of whether a substance use disorder is mild, moderate, or severe, all forms of the disease should be taken seriously. Mild and moderate forms of the disorder can often progress to severe stages, where intervention and successful treatment can become harder for families, loved ones, and the individual who needs help.
How Substance Use Disorders Happen
Similar to the phrases thrown around to describe problems with substance use, there is also a common misunderstanding of how the disorders develop and progress over time. Many think that simply using a substance, over and over again, is the sole cause of a problem. While this may increase your tolerance, simply using a substance, again and again, is only one piece of the puzzle. Increasing tolerance with prolonged substance use can lead to a higher chance of physical dependence (more common in opioids, benzodiazepines, and alcohol), though with newer synthetic substances such as fentanyl, physical dependence can happen long before tolerance is dramatically increased. With increasing tolerance, potential physical dependence, and the desire to use more and more, more severe substance use disorders begin to develop as someone begins to ignore negative consequences to continue to use. The release of “feel-good” brain chemicals (serotonin, dopamine, etc.) is enticing, and wanting to experience those can often overcome the inhibitions to stay away from negative consequences. Over time, as substance use continues, the amount it takes to feel the effects of the “feel-goods” (increased tolerance) becomes so high, that finding the require amounts of the substance becomes the only focus —leading to using despite anything. At this point, a substance use disorder has gone from mild to severe, with the brain seeking only to feel good, ignoring everything else.
Everyone is susceptible to substance use disorders—no matter their age, race, gender, tolerance, or physical dependence. Understanding and being able to talk about substance use issues is the first step to either getting the help you need, or the help a loved one needs.