The difference between them may seem intuitive enough, but there's some history behind the terms "substance use" and "substance abuse." Today, we prefer "substance use disorder" (SUD) when referring to a diagnosable condition encompassing the myriad and complicated harms that drugs and alcohol can cause.
All Sober EVP of Addiction and Recovery Maeve O'Neill spoke with Verywell Mind to clarify the terms, explain what happens when "use" crosses into "substance use disorder," and share guidance for SUD treatment and prevention:
Both terms refer to the act of utilizing substances, such as alcohol, drugs, nicotine, cannabis or prescription medications. However, one refers specifically to problematic use, whereas the other is a broader term that refers to all substance use, problematic or otherwise:
- Substance Use: "Substance use" is the act of using any legal or illegal substances, says Maeve O'Neill, MEd, LPC-S, CHC, CDTLF, the executive vice president of addiction and recovery at All Sober. "Substance use" is a broad term that encompasses all forms and frequencies of using harmful substances.
- Substance Abuse: The term "substance abuse" was previously used to describe addiction or risky/dangerous use of one or more substances, says O'Neill. However, the professional diagnostic manual known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) no longer uses the term "substance abuse," as it can be stigmatizing—the preferred term is "substance use disorder," O'Neill explains.
Why the Term 'Substance Abuse' Is No Longer Used
According to the National Institute on Drug Abuse, the term "substance abuse" has been discontinued because the word "abuse" has negative connotations and is associated with judgment or punishment.
"Substance use disorder" is now the medical term used to describe uncontrolled use of a substance despite negative consequences to one's health, work, studies, family and day-to-day functioning.
Substance use disorder is considered to be both a complex brain disorder and a mental illness that is classified as mild, moderate or severe based on criteria met by each individual, says O'Neill.
"Previously, the term 'substance use' was meant to describe mild use of a substance, and the term 'substance abuse' was used to describe moderate or more severe use. We don't use the term 'abuse' anymore, as language is important," says O'Neill.
When does having a drink with friends or taking a painkiller for a headache (occasional substance use) turn into alcoholism or a painkiller addiction (substance use disorder)?
When the person starts to experience these symptoms, they may be diagnosed with a substance use disorder:
- Experiencing strong cravings for the substance
- Using more of the substance than intended
- Not being able to cut down on one's use of the substance despite wanting to or continually trying to
- Spending a lot of time procuring, using, or recovering from the after-effects of the substance
- Facing problems at home, work or school due to one's substance use
- Continuing to use the substance despite relationship problems caused by substance use
- Reducing or discontinuing other hobbies and activities as a result of substance use
- Engaging in risky or unsafe behavior under the influence of substances
- Using the substance even though it is causing or exacerbating physical or psychological health conditions
- Developing a tolerance to the substance and requiring more and more of it each time in order to achieve the same effect
- Experiencing withdrawal symptoms while not using the substance and feeling the need to take the substance in order to prevent withdrawal
Based on the number and severity of symptoms the person has, their health care provider will determine whether their substance use is a cause for concern and whether they have mild, moderate or severe substance use disorder. …
Professionals who are certified or licensed in addiction medicine can determine whether a person's substance use is a cause for concern, and diagnose and treat substance use disorder, says O'Neill. Your primary doctor can provide a reference to a specialist, if needed.
According to O'Neill, the diagnostic process involves a complete assessment, which often includes:
- An interview with the person who is using a substance
- Discussions with others who may be in the person's life
- The use of diagnostic tools to determine whether the person's symptoms meet the diagnostic criteria for substance use disorder listed in the DSM-5-TR
- A physical examination or other tests to determine the extent of the person's use, assess their health status and check for other physical or mental health conditions
It's important to be open and honest about your symptoms and substance use with your health care provider, so they can accurately determine whether or not your substance use is a cause for concern and if you have or are at risk of developing substance use disorder.
"Proper diagnosis is critical to ensure you receive the most helpful level of care," says O'Neill.
If the person's health care provider determines that their substance use is problematic and they have substance use disorder, they may require treatment.
Treatment involves a professional assessment and treatment plan to meet the person's individual needs for sustained recovery, says O'Neill. "The treatment plan can vary depending on several factors, such as severity of use and the person's resources and sources of support."
According to O'Neill, treatment for substance use disorder can involve:
- Support group meetings
- Treatment in an outpatient, inpatient or residential setting
- Aftercare, such as sober living
- Other forms of education, awareness or support
Below, O'Neill outlines some steps that can help prevent substance use and substance use disorder.
Preventing Substance Use
The best approach to prevent substance use is to provide comprehensive education and support at all opportunities.
"It's important to teach children, adolescents and adults about the prevalence and dangers of substance use, and help them develop resilience skills to avoid using substances," says O'Neill.
Preventing Substance Use Disorder
Substance use disorder is preventable if we build systems of care that help us intervene at earlier stages of use. Schools and communities need to work collaboratively together to actively find and correct the conditions that lead to substance use disorder, in order to prevent it or mitigate its effects. …
If you're worried about your substance use and think you might be at risk for a substance use disorder, the best thing to do is to seek help and information, says O'Neill. "There are many counselors, coaches and support group meetings that can help you understand and learn more about it. You are not alone and recovery is possible."
To learn more about substance use disorder, read the full article at Verywell Mind.