Addiction is a word that’s used to describe a variety of conditions which are all characterized by an abnormally strong need to act in predictable ways to try to satisfy the intense driving forces that are felt by anyone with an addiction.
Substance abuse, which can also be called drug abuse, is one form of addiction. It involves the intense craving and need to consume, inject, sniff or smoke, one or more of a wide variety of psycho-active drugs. A psycho-active drug is any chemical which has the property of changing how the brain functions.
The word Addiction is also used to describe some behavioral disorders such as pathological gambling or abnormal eating behavior, where no psycho-active substance use is involved, but the features of this sort of addiction, still closely resemble those of substance abuse addiction.
Those behavioral types of non-drug addictions such as gambling and eating disorders, are sometimes called Process Addictions because they involve an action, or ‘process’ – a behavior, not a drug. Consumable drugs that have neurological and chemical effects on the brain, are not directly involved at all in a Process Addiction.
Examples of psycho-active substances which affect the brain in some way are heroin, cocaine, smack, ice, amphetamines, so-called ‘bath salts’, cannabis, ecstasy, alcohol, nicotine, and many others.
Some of these substances are illegal and others are not, but they can still be the substance involved in an addiction. This is because, at the heart of all addictions, is the one feature that defines addiction from anything else:
the person loses control over their use of the substance or behavior, and importantly, they are aware of that loss of control.
This loss of control is the hallmark of all addictions.
The abnormal drives and cravings for the substance, or the behavior in the case of eating and gambling, sex addiction, porn addiction and computer game addiction, are so compelling, that even if they wish to stop consuming or doing them, people who have developed an addiction find that now, they cannot stop.
What’s the Difference between Substance Abuse and Addiction?
These different labels can sometimes be confusing. The problem is partly because of the way that mental disorders have been classified in the past. The classification and definition of Addiction has changed slightly over the years. There is a so-called mental health Bible, called the Diagnostic and Statistical Manual of Mental Disorders, or DSM.
This manual is where experts in the field put down in writing, the agreed criteria for diagnosing different types of mental disorders, and it’s used as the reference for describing and classifying all mental illnesses, including addiction.
The need to have a standardized reference for all mental disorders is extremely desirable. It means that everyone in the field of mental illness, knows they are talking about the same health condition when talking to each other about different patterns of illness. This reduces the risk of misunderstandings.
It also means that any specific group of symptoms can be given a label – a diagnosis – so the treatments that help to control that particular set of symptoms can be well targeted to those people that do, in fact, have that particular set of symptoms and problems.
It’s important to realise that these labels refer to the illness itself, and not the person who has the illness.
The DSM was updated to its fourth edition, DSM IV, in 1994. At that time it was decided to change the definition of Addiction. This resulted in the broad, general term of Addiction, being subdivided into two separate subtypes of Addiction: Substance Abuse and Process Addiction. This sub division allowed health professionals to distinguish between
- addiction that involved chemicals that acted directly on the brain – the psycho-active chemicals such as heroin, amphetamines and alcohol etc. which was now Substance Abuse,
- and behavioral addictions such as gambling and eating disorders which were now called Process Addictions.
That is why addiction and substance abuse are sometimes used to mean the same thing. In many people’s mind, they do mean the same thing, but this can also lead to confusion.
Substance Abuse is an Addiction, and Process Addiction is also an Addiction, but Addiction might not be Substance Abuse – it could be a behavioral Process Addiction.
But both subtypes are true addictions, with the same mental pathways being adversely affected in similar ways. Substance Abuse is also sometimes called Drug Abuse.
Also, to add to the confusion, the word ‘Abuse’ can sometimes be used to describe Physical Abuse, Mental Abuse and Child Abuse, but these are not classified as addictions. The difference in the meaning of the word is usually clear from the context where it’s used.
Is there a Difference Between Addiction and Dependency?
In ordinary conversation, probably not, but here again, these labeling words can be confusing. The word Dependency is commonly used to describe Substance Abuse, which is commonly used to describe Addiction. The defining criteria of all these terms, is that the drives to continue are internally generated – and the affected person is increasingly unable to stop using the drug, even though it is causing damage to their bodies and lives.
In that sense, they are totally dependent on the drug, physically, but also psychologically. They have lost control over their ‘need’ for the drug and will go to almost any lengths to obtain it, with little regard to the harmful effects the drug is causing to themselves and others.
However there is also a more specific use of the word ‘dependency’ to refer to ‘physical only dependency’ that can develop, but which is not an addiction. The body and brain adapt to the drug, and tolerance to the drug is built up over time.
This tolerance means that larger and larger doses of the drug are required to produce the same physical or mental effects. Once this has happened, any sudden loss of the drug causes your body to react to the ‘withdrawal’ of that drug.
However, this does not necessarily mean that you have developed an addiction.
Is it Possible to Become Physically Dependent on Prescription Medicines, and not have an Addiction
Yes it is – suppose you have been prescribed some sleeping tablets and you find that you have to take bigger and bigger doses to get a good night’s sleep. If you can still control your desire for the tablets, and choose to keep on the low dose prescribed, you do not have an addiction, yet.
If you are told by your doctor to reduce the amount of pills you are taking, your body will probably react by giving you very vivid dreams, or you may toss and turn and be unable to sleep for a few nights. This is because your body has already become ‘physically dependent’ to some degree on the sleeping pills, and is reacting to the loss of the medication.
But, as long as you can still control your choices, you are not addicted, but you are at risk.
Physical dependence can happen with the long-term use of many drugs that have an effect on the brain, even medications properly prescribed by your physician, described in the above example with sleeping tablets.
Other prescribed tablets that can cause problems include pain medications that contain opioids, such as the Codeine in Oxycodone, or anti-anxiety medications in the group of benzodiazepines, such as Diazepam, Temazepam, and the commonly used drug of addiction, Rohypnol, also known as ‘Roh-ies’.
Although addiction and physical dependency often occur together, it’s important to realise that addiction and dependency are not always the same.
Physical dependency is a temporary physical condition, not a mental illness. But addiction is altered brain function in someone who has a physical dependency as well.
It sounds complicated, and it can be confusing, but it’s useful to know what health professionals are really talking about when they use these words.
Is it Possible to Become Addicted to Medications Prescribed by Your Doctor?
Unfortunately, it is possible to become addicted to prescribed medications. It isn’t common, but recently there has been a rise in this form of addiction. To minimise the risk of addiction, physicians will usually assess their patients for possible risk factors, such as a previous personal or family history of addiction, before prescribing potentially addictive medications.
Any risk of addiction is minimized by either using alternative treatments, or by carefully monitoring their patient’s use of the drug. Therefore, it’s important that patients always follow their physician’s instructions about how much, and how often, they take the medication, and tell their doctor if you are starting to take more pills than were prescribed for you.
With careful monitoring, any sign that an addiction might be developing can be diagnosed early and treated before it becomes established.
What’s the Difference between Recreational Drug Use and Substance Abuse?
Recreational, or non-medical use of a drug does not necessarily mean you have an addiction or that you will develop one. Some people are able to use psycho-active drugs and still keep control over how much, and how often, they ‘use’ them.
The problem is that many people gradually lose control over how much they use, and are overcome by the increasingly strong desire to consume more and more of the drug. That is when so called ‘Recreational Use’ turns into an addiction – when control is lost and the cravings take over and dominate a person’s life.
For example, many people can regularly drink limited amounts of alcohol, and their drinking remains under their control. Unfortunately, there are quite a few people who lose that control over time, and they develop uncontrollable cravings for alcohol. In other words, they become addicted – they now ‘need’ regular alcohol, just to feel normal. They have now become what is commonly known as an Alcoholic.
Using psycho-active drugs for recreational use always carries some risk that you may develop an addiction. This risk is increased if you have also inherited a genetic predisposition for addiction from your parents. But addiction can still happen to anyone, whether you have increased risk or normal risk – we are all potentially at risk. The good news is that even if you have inherited an increased risk for addiction from your parents, risk awareness and sensible choices can prevent you falling into the trap of addiction.
See article: Causes and Risk Factors for Addiction.
• Oxford University Press – Oxford Specialist Handbook: Addiction, 2009.
• National Institute on Drug Abuse (NIDA) The Science of Addiction, 2010 http://www.nida.nih.gov/scienceofaddiction
• Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, 1994. http://en.wikipedia.org/wiki/Substance_abuse#DSM
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