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This article delves into the distinction between substance abuse and dependence. It dives into the varied criteria for each, emphasizing their differences. Additionally, it helps readers understand prevention strategies and treatment avenues for teens grappling with drug use. Learning more about these differences is crucial in addressing drug problems effectively.

There is a clear distinction between drug use and drug addiction. But the difference between addiction and dependence is often more muddied, and in some cases, these terms are used interchangeably. But what is substance abuse? What is substance dependence? What constitutes addiction? When do doctors pathologize drug use, and at what point is it considered a medical non-issue? 

Understanding the differences between drug use, drug dependence, and drug addiction can help teens and parents alike better understand the dangers and misconceptions around addictive substances, help destigmatize and better treat addiction, and highlight the importance of taking early action when dealing with teen drug use, in particular. 

Exploring Substance Abuse

Most of the time, when someone is talking about substance abuse, they’re talking about the continued and long-term use of drugs in a way that insinuates an addiction. 

Medically, substance abuse is not a used term. Instead, doctors talk about substance use disorders. A substance use disorder is defined as a neurological condition as well as a psychological one. The impact of long-term drug use can be observed in the brain, changing neural pathways and making it more difficult to stay away from a drug over time. There are physical and psychological factors that increase or decrease the risk of a substance use disorder. There are also physical and psychological consequences to substance use. 

In addition to physical and psychological factors, substance abuse is also characterized by its complicated social factors. 

For example, parental drug use and peer pressure help enable substance abuse. Furthermore, substance abuse is highly stigmatized and socially isolating. It is a criminal activity with hefty legal consequences, and a history of extreme persecution through law enforcement. It forces people to the fringes of society, and often goes hand-in-hand with victimization and exploitation. Substance abuse eliminates employment opportunities while gobbling up finances to pay for itself, making treatment difficult. 

Sometimes, substance abuse is used as a term to refer to any improper use of an addictive substance – for example, teenage drinking, as well as the use of someone else’s prescription medication, or the use of an illicit drug. 

However, it’s important to differentiate substance use (even illegal substance use) from substance abuse. 

Yes, any drug use represents a slippery slope. But drug use does not always lead to addiction. While about half of all teens have experienced drug use at some point in their early life, only 16.5 percent of all people aged 12 or older met the criteria for a substance use disorder, for example. Even with a significant margin of error, there is a large difference between trying a drug and being addicted to it. 

The difficulty lies in knowing where the line is drawn. At some point, drug use becomes drug addiction, defined by certain characteristic behavior such as an inability to stop using, multiple failed attempts at quitting, and serious behavioral changes that result in damaged relationships, lost opportunities, or even legal consequences. Only the diagnosis of a medical professional can identify a substance use disorder, such as alcoholism or cocaine addiction.

Understanding Substance Dependence

Substance dependence is a potential component of a drug addiction, but the two are not mutually inclusive. In other words, a person can experience a substance dependence without being addicted, and they can experience addiction before experiencing signs of physical dependence. 

Drug dependence occurs naturally through long-term use of any drug, including many medications. This is a neurological and biological phenomenon that, in the case of a potentially addictive substance, occurs when the brain and body work together to metabolize the drug more efficiently, diminishing its effects, and causing a side-effect wherein the body “requires” continued regular intake of the drug to stay “regular”. 

Outside of addictive substances like alcohol or pain medication, a good example for an innocuous substance dependence is caffeine. Caffeine is a psychoactive drug that acts as a mild stimulant. While caffeine addiction has been explored in scientific literature, there is no evidence of a caffeine use disorder existing. However, caffeine withdrawal is a very real thing. 

Some people become dependent on caffeine. Without caffeine, they experience headaches and a significant drop in cognitive performance. Once they start drinking their daily coffee or energy drink, however, the symptoms go away. This is an example of substance dependence, and substance withdrawal. 

Addictive drugs can result in a more extreme version of this same mechanism. Some substances can even cause fatal withdrawal symptoms – particularly alcohol and anti-anxiety medication, like Xanax. 

However, just like caffeine, individual sensibilities play a big role here. There are people who can’t stomach a cup of coffee without experiencing jitters for the rest of the day. There are others who can drink three to four cups a day without any adverse health effects. There are some people who experience extreme coffee withdrawal symptoms, and others who have been drinking coffee for years, but don’t experience any withdrawal if they stop. 

Key Differences Between Substance Abuse and Dependence

Substance abuse or addiction refers to a diagnosed health issue characterized by an inability to quit using an addictive drug. This inability to quit is caused by neurological, physical, mental, and social factors, which may include a substance dependence. 

Substance dependence, on the other hand, refers to the physiological effect of becoming dependent on a drug to function, usually in combination with substance withdrawal, which occurs when a person stops taking that drug. 

People can experience substance dependence and substance withdrawal without experiencing addiction. A good example of this is the smoker who is successful in quitting smoking on their first try. It might feel terrible, and they might experience cravings, irritability, and weight gain because of their nicotine withdrawal, but after a few months, they no longer want to smoke. Because they managed to stop smoking when they wanted to, they do not qualify for a nicotine addiction – one of the behavioral hallmarks of a substance use disorder is the inability to stop on your own. For context, the average smoker relapses 8 to 30 times before they stop smoking for good. 

Drug dependence and drug withdrawal also occur with entirely non-addictive drugs, such as certain medications. It’s critically important to taper off of anti-depressants before switching to another kind, for example, due to the negative effects of going cold turkey. 

Prevention and Treatment Options

Prevention for drug use depends largely on a person’s home environment and community or neighborhood. For teens, especially, parental influence and family history remain the most powerful indicators for drug use and drug addiction. 

Strict guidelines against drug use, consequences for drug use, a lack of drug use at home, and a positive parent-child relationship can serve as protective factors against teen drug use. Conversely, drug use at home and a family history of addiction are often predictors for drug use later in life. 

Neighborhood risk factors include drug availability, and access to mental health resources. Teens with a history of mental health issues, and/or victimization, are more likely to struggle with an addiction if they try drugs. Access to treatment resources and counseling can be a strong preventative measure for teen addiction. 

Treatment for a substance dependence, if needed, would be to taper from the substance instead of going cold turkey. By reducing intake day by day, or week by week, the effects of a potential withdrawal are eliminated. In people who experience drug dependence in addition to drug addiction, a taper is a crucial part of the detoxification process, often medially supervised. 

Treatment for a substance use addiction is largely psychotherapeutic. While there are novel medications that can help reduce cravings or even make certain drugs ineffective, meaning you can no longer get high while on your medication, the caveat of a condition with biopsychosocial factors is that it requires a holistic, multimodal approach that considers the physical effects of addiction, the mental effects of addiction, and the social effects of addiction.

Residential treatment programs, such as those offered by Visions, can help teens achieve long-term sobriety and learn to manage their addiction as they grow into adulthood. 

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