Abuse and Addiction: Understanding the Connection


Though the words abuse and addiction are often used interchangeably, they in fact refer to two different patterns of substance use. Not all substance abuse leads to addiction, but all addiction is a compulsive form of substance abuse. Let’s look more closely at these behaviours, and how we define them.

Defining Substance Abuse

Simply put, substance abuse is defined as nonmedical use of prescription medication, or any use of illegal substances, over a period of time. Taking extra sleeping pills as a one-off event, for example, counts as substance misuse, and not abuse. The concept of abuse also includes continued use of substances in spite of social problems and any psychological and physical health issues that may arise.

With prescription medication, abuse is characterised by taking it more frequently, in higher doses, or for a longer period than was prescribed. Taking any illegal substances counts as abuse. These are not considered safe to use or consume, either by legal authorities or by medical professionals. Also, their purpose is recreational use – experiencing their pleasurable effects. Legitimate substances are used to treat certain conditions – their aim is not to make people ‘high’.

Alcohol is slightly different in that it is both legal and freely available. Alcohol abuse is defined largely as consuming more than the recommended amount, per day, per week, or in one sitting. However, some individuals may drink marginally more than the amounts considered safe by health authorities, while still drinking responsibly. Alcohol abuse is characterised by drinking with the aim of becoming intoxicated, a strong urge to drink, and limited control over how much and how often alcohol is consumed.

Connection Between Substance Abuse and Addiction

As mentioned above, not all substance abuse habits inevitably lead to addiction. But when they do, there is a well-documented progression.

Legitimate Drug Use and Substance Abuse

We should start by pointing out that simply taking a medication that has a potential for misuse, does not mean a person will begin to abuse it. Powerful, potentially addictive medications exist for common conditions such as general anxiety disorder, panic disorder, ADHD, depression, insomnia, and so on. And medications that improve these conditions – benzodiazepines such as Valium or Xanax, stimulants like Adderall or Ritalin – are in fact widely abused. When taken in accordance with a doctor’s instructions, they can be of great benefit to patients. Their use need not become problematic.

How Abuse Leads to Addiction

Substance abuse leads to addiction because of the physiological and psychological changes that take place in a person when they abuse a substance over a period of time. Many drugs affect what are known as the ‘reward pathways’ in the brain. Neurotransmitters like dopamine flood these neural circuits, inducing a feeling of euphoria. Other substances cause great relaxation, or on the contrary, heightened alertness and increased energy. All of the above can be experienced naturally – but when they are substance-induced, the feelings are much more intense.

In a nutshell, escalation of a person’s drug abuse is what leads to addiction. A number of things happen:

  • Tolerance: When a person is regularly taking a substance, their mind and body develop a tolerance to it. This means that it has less of an effect on them, so they have to take more of it, and perhaps more often, to achieve the same feeling and sensations.
  • Physical dependence: With increased tolerance, a person begins using more of their substance of choice. There can come a point where the body is so used to a substance that it can no longer function without it. The person is physically dependent on it.
  • Withdrawal symptoms: Once a person has a physical need for their substance, they experience adverse effects if they go without it for too long or try to quit. These effects are the body reacting to being deprived of its drug, and are called withdrawal symptoms. Withdrawal can lead to or reinforce addiction, because the easiest way to alleviate these symptoms is to take the substance that caused them again.
  • Psychological dependence: This is due largely to the changes in brain chemistry mentioned above. A person can feel their state of mind is just not right without their drug. They can also develop an obsession with using their substance and having more of it close at hand. They become convinced that their drug is essential to their mental balance. Just the thought of not having it can cause them emotional distress.

Major Differences Between Substance Abuse and Addiction

From the above, abuse and addiction may still appear to overlap – and to some extent, they do. But, a few key elements differentiate the two.

  • Abuse: A person is in a sense self-medicating. They use their substance to produce the effects and degree of intensity they desire. This may include keeping unpleasant thoughts or emotions at bay. However, the person retains the ability to stop or interrupt their substance use, of their own volition. In short, it is the way a person uses a substance that defines abuse. They seek effects more powerful than the medications were intended for, or use illegal substances to achieve them.
  • Addiction: Addiction is characterised by the compulsive use of a substance, and, in contrast with abuse, the inability to stop. Another hallmark of addiction is continued use in spite of frequent, and often serious, negative consequences. With addiction, mental and physical changes in a person reach the point where they interfere with their willpower, discernment, and judgement. In short, the substance has a grip on the individual, and holds them in its grasp. They become subservient to it.

While both substance abuse and addiction are similar, addiction is a stage of substance misuse which is more difficult to overcome. If a person has enough self-awareness to realise they are abusing a substance. And to realise the slippery slope they are on, they can reach out for timely help. In this way, developing an addiction can often be prevented.


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