What Is the Difference Between Addiction and Substance Abuse Disorder?

Symptoms of substance abuse disorder and addiction involve distorted thinking and behaviors that generally fall into four categories: 

• Impaired control
  • Intense craving or strong urge to use the substance
  • Desire or failed attempts to cut down or control substance use
• Social problems
  • Interpersonal problems, with family members, friends, classmates, or co-workers
  • Failure to complete major tasks at work, school, or home
  • Changes in personality
  • Social, work, or leisure activities are given up or cut back because of substance use
• Risky use
  • Substance is used in risky settings
  • Continued use despite known problems
• Drug effects
  • Intoxication 
    • The intense pleasure, euphoria, calm, increased perception, enhanced senses, and other feelings caused by the substance
  • Abnormal movements 
  • Tolerance (needing larger amounts to get the same effect)
  • Withdrawal symptoms (different for each substance)

Continual substance use can cause changes in brain function that can last long after the immediate effects of the substance wears off. 

Other psychiatric disorders often accompany substance abuse disorder and addiction. 

The National Institute on Drug Abuse notes a variety of reasons people abuse substances, such as:

• To feel good: getting high or intoxicated
• To feel better: for stress relief, to forget problems, or to feel numb
• To do better: for improved performance or thinking
• Curiosity, peer pressure, or experimentation

Most of the time, people start using alcohol or drugs voluntarily, but after repeated use, brain changes interfere with a person’s self-control and ability to stop taking the substance. Drugs usually affect the brain's “reward circuit,” causing euphoria as well as flooding the brain with the neurotransmitter dopamine. Surges of dopamine reinforce pleasurable but unhealthy behaviors such as drinking alcohol or taking drugs, which cause people to repeat the behaviors.

Continued use of drugs or alcohol causes the brain to adapt by reducing the ability of cells in the reward circuit to respond to it, which results in a person needing larger amounts to get the same effect (called tolerance). 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines substance use disorders as mild, moderate, or severe based on the number of diagnostic criteria met by an individual. 

Diagnostic criteria for substance use disorders and addiction includes evidence of: 

• Impaired control 
• Social impairment
• Risky use
• Pharmacological criteria

Treatments for addiction and substance use disorders first involve recognizing there is a problem. If a person does not perceive a problem with substance abuse, it may be difficult for them to recover. 

Substance use disorders and addiction often require multiple types of treatment, and a combination of medication and individual or group therapy tends to be most effective. 

Recovery plans are tailored to a person’s specific needs and may include:

• Hospitalization for medical withdrawal management (detoxification)
• Therapeutic communities (highly controlled, drug-free environments) or sober houses
• Outpatient medication management and psychotherapy
• Intensive outpatient programs
• Residential treatment (“rehab”)
• Support groups helpful (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery)
• Self-help groups for family members (Al-Anon or Nar-Anon Family Groups)