What do you think are the differences between substance use, substance abuse, chemical dependency, and addiction? Are there differences? What’s your opinion? My take is this: there are significant differences between them and, when viewed as a whole, they make up the spectrum of drug use.
For a long time I viewed chemical dependency and addiction as interchangeable, they aren’t. I cannot stress this enough, the thresholds for each stage of the spectrum differ from person to person. This is the roadmap to what people have commonly referred to as the rabbit hole of drugs. I know because it’s a road I’ve traveled. The problems that arise at each stage of the spectrum become progressively more detrimental the farther down the rabbit hole you go.
Allow me to provide a definition for each level. The first one isn’t earth shattering, substance use is the act of ingesting a substance to alter one’s mental state. For most people infrequent drug use won’t be all that detrimental so long as it doesn’t progress down the spectrum. Millions of Americans drink socially among friends with little adverse effects. Everyday people are given diamorphine in hospitals to treat acute pain and most of them don’t become heroin addicts even though diamorphine is literally heroin.
Usually the problems start when use becomes substance abuse. Use turns into abuse when a persons consumption begins to exceed the “recommended dose,” when you begin drinking with such frequency that you develop a tolerance or when you start doubling up on the Vicodin pills. SummitBHS.com describes it as, “a pattern that begins to cause problems and distress in one’s life. Substance abuse precedes chemical dependency, but is directly related.” They go on to describe the difference between abuse and chemical dependency/addiction:
If a substance user can quit, and once the substance has left their system, they no longer crave or obsess about the substance. This person is not suffering from addiction. If the same substance user is noticing that their using is out of control and are still unable to stop, they are now abusing the substance, they may in fact suffer from addiction.
Chemical dependency is a normal bodily response to an addictive chemical. Folks far smarter than myself at Johns Hopkins University described substance, or chemical, dependency as, “the medical term used to describe abuse of drugs or alcohol that continues, even when significant problems related to their use have developed.” Based on their definition I would speculate “significant problems” to be physical addiction ie the depression that comes along with prolonged drug use, physical withdrawals, basically all the negative shit that comes along after the first week or two of ending drug use. As I described in a previous post chemical dependency is responsible for the first tier of cravings (physical cravings).
Now addiction, according to The American Society of Addiction Medicine (ASAM) it’s a “primary, chronic disease of brain reward, motivation, memory and related circuitry dysfunction leading to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.” Or as I put it, addiction is a fundamental confusion, or misunderstanding, between pleasure and happiness.
This isn’t entirely a mainstream approach to the topics discussed. What is widely accepted is that addiction is a mental illness, often times it can be the symptom of another underlying mental illness. What this means, in my opinion, is that anyone can become chemically dependent on drugs or other substances but not everybody is going to become an addict.
In some instances it can be like the question, what came first the chicken or the egg? I believe that addicts can be born addicts, at least that was the case for me, my “addiction” manifested in a number of ways before drugs were ever a part of the equation. Some of the other areas in my younger years included: habitual overeating as a child (I was the fat kid), video games (I would play for five, six, or seven hours at a time), porn and hyper-sexuality (you can use your imagination for that one), and later on in life it would manifest at work.
I think it’s important to differentiate between the two because addiction is something that has always been present for me in my life. It’s surprisingly common, maybe you’ve heard this in the past, for someone to say that from the first time they took a drink/drug they were hooked. This was me, as I genuinely believe there was no progression from use/abuse to dependency to addiction. What contributed to my addictive tendencies was a refusal to recognize the aspects of my that were chaotic as being sources of turmoil. Acceptance was the problem, and I couldn’t accept my life being anything less than ideal. As kids we want to believe so bad that we’re not broken, that our lives epitomize normalcy, and while that just wasn’t the case for me, it was a false belief I held onto for far too long. I certainly didn’t do myself any favors starting drug use so early. In any event most people aren’t born addicts. I encourage you to keep your vices in check before they develop control.