Substance Misuse, Abuse, Addiction, and Dependence...

Did you know there is a difference between substance misuse, abuse, addiction, and dependence? I actually didn't either, but there is! In working at a residential treatment center that treats addictions, the line between use, misuse, abuse, addiction, and dependence often gets blurred. However, the difference between them is very real and very relevant.

Substance misuse refers to "the use of prescribed drugs in greater amounts than, or for purposes other than, those prescribed by a physician or dentist. For non prescription drugs or chemicals such as paints, glues, or solvents, misuse might mean any use other than the use intended by the manufacturer." (Hart, Ksir 2013.)

In working in "the field", we treated many clients who misused chemicals.  This was mostly those who were scared to get addicted, scared they were going down the 'wrong road', or parents and family who were scared for their loved ones. I found that those who 'misused' chemicals were a challenge to treat, a challenge to reach, to help...

Substance abuse is basically substance misuse that 'causes problems or greatly increases the chances of problems occurring." (Hart, Ksir 2013.) These problems can range from psychological, legal, occupational, relational and social. 

It has been my experience in working with substance troubles, that those seeking treatment at the "substance abuse" stage seem to be the most likely to participate in their own 'recovery.' This stage is early enough that chances are serious damage has not yet been done, yet serious enough that the potential of serious damage is staring the client in the face. That is, fear.  Fear often triggers change.

Addiction is not a black and white term. Addiction has different meanings for different people. According to the book Drugs, Society, and Human Behavior (2013), "because the term is so widely used in everyday conversation, it is risky for use to try to give it a precise scientific definition, and then have our readers use their own long-held perspectives whenever we use the term. Therefore, we have avoided using this term, instead relying on more precisely defined terms such as dependence."

So what is dependence???

The term dependence is usually what people think of addiction.  The substance use is so consistent that one can hardly function without using the drug (be it physical withdrawal or physiological withdrawal.) The dependence has all but taken over.

This, in my own personal opinion, is the most challenging to treat in the 'recovery' world. To be dependent on a substance is, in my experience, a delicate process of not only getting the person to release the hold the substance has over them, but getting them through detox, replacing that 'hold' with something else more constructive and 'fulfilling', and teaching that person how to live. There is a saying that a person stops emotionally aging at the time their dependence takes over.  Now, that's food for thought.

So what do we do with all of this information?

Is recovery possible?

I'll address that and more in my next blog post...