Substance Use, Abuse and Addiction are topics about which everybody seems to have an opinion. It can be hard to find straight talk on these subjects.

Different words may be used to refer to the same problems of drug use. Different people or professions may use these terms with different meanings. Medical, religious and lay groups may have very different opinions on the cause and treatment of substance abuse problems. It can all be quite confusing.

SupportNet uses plain language to answer your questions about Substance Use, Abuse and Addiction. The Primer on Addiction explains some of the words that are commonly used to discuss these problems.

What is Substance Use?
Young people may first experiment with alcohol or drugs for reasons of curiosity or social influence. Some drugs such as alcohol or cannabis may be used in moderation and on occasion with no serious consequence.

Experimentation and/or casual use of these drugs is never without risk. One in ten people are likely born and/or bred with a tendency to Substance Abuse or Addiction. A young person who begins to experiment with alcohol or drugs will not be alert to this risk.

Regardless of how or why one begins to use alcohol or drugs, some will progress to a more serious problem of substance abuse or addiction.

What is Substance Abuse?
Substance Abuse is apparent when use is excessive, dangerous, continues despite problematic consequences or when loss of control over use arises.

Drinking alcohol to the point of blackout is an indication of Alcohol Abuse. Continuing to use cannabis despite falling grades in school is evidence of a Substance Abuse problem. Using drugs when alone or in secret is an indication of a serious problem of abuse.

Certain drugs are so dangerous that first or any other use is clearly Substance Abuse. This is  true for any use of crack cocaine, methamphetamine, glue sniffing or heroin.

Any use of any drug by injection is dangerous and by definition, Substance Abuse. Any person who is drawn to these drugs or means of use has a serious problem from the outset.

Unfortunately, a Substance Abuse problem may not be apparent to the person who is using. The symptoms of Substance Abuse and Addiction include denial, rationalization and justification of use.

A person with a substance problem will also tend to associate with others who use alcohol or drugs heavily. As a result,  their use is not seen or challenged as the problem that it is.

What is Denial?
You may see someone using drugs or alcohol to excess, creating problems in their life due to use or losing control. They may not see these same problems as you or others do. This is called Denial.

Bottom line is that nobody will feel good about themselves if they believe they are losing control or doing something harmful to themselves. Those with a substance abuse problem will try to hide the problem from others, may lie about the extent of their use or try to rationalize why they continue to use.

Denial is about fooling yourself into believing that everything is okay. It is like a blind-spot for the consequences of Substance Abuse and Addiction. Denial is not something that anyone sets out to do. It just happens.

Because Denial blinds people from the problems that arise from their use, they do not seek help. If you don’t see a problem, there is no reason to get help for it.

The extent of denial is a measure of how sick a person is with substance abuse or addiction. How bad does it have to get?

Some will realize a problem and accept help after a first charge for impaired driving. Some will spend time in jail or hospital, but still not see that they have a problem. Others will die in denial.

What is Substance Addiction?
Substance Addiction is a neurobiological sickness that has two types of symptoms. It is firstly a compulsive drive to obtain and to use alcohol and/or other intoxicating drugs.

While many people may use this or that drug of their free choice and/or for casual reasons, this is not Substance Addiction. Most who suffer with true Substance Addiction will say that they do not really want to continue using, but that they feel drawn and/or compelled to use for reasons that they don’t understand.

Continuing to use when you do not really wish to do so - or relapsing to use alcohol or some other intoxicating substance - is the hallmark of Substance Addiction. And it is this unexplainable compulsion to use that is so difficult for others to understand - or to appreciate its devastating power over the addicted person.

The second part of Substance Addiction refers to all of the distorted thoughts, the emotional upheaval and disordered behaviors that result from the compulsive drive to obtain and to use drugs.

The thoughts and beliefs in our mind will shift according to how we behave. If I use a drug every day for several years, I will come to believe that I need to use this drug every day. I will think of reasons why I must continue to use and explain these to myself and others.

Perceptions also change. If I use drugs every day whether I want to or not, I will eventually come to see myself as a drug addict. If I try to stop and find that I either cannot stop - or that I just start using again later - I may eventually find some acceptance of my life as a drug addict. With this change in perspective, I may stop trying to recover. I stop believing it to be possible.

There are many reasons why taking a drug or different drugs on a regular basis will cause changes in mood, feelings of anxiety and/or fear and other emotional turmoil.

Searching for drugs, lying and keeping secrets about drug use, stealing to support a habit, neglecting responsibilities to use and using in preference to all other activities are indications of Substance Addiction. These are sometimes referred to as Addictive Behaviors.

All of these changes in thinking, feeling and behavior are symptoms of Substance Addiction. The best way to think about Substance Addiction is as an unexplainable, driving need - or compulsion - to use. The other features of Addiction - the changes in thinking, feeling and behavior - all arise from this compulsion and from the consequences of use over time.

What is Substance Dependence?
This is a phrase that is used to mean different things by different people. Generally, it refers to a person whose well-being has become dependent on the use of a drug for physical reasons, emotional reasons or both.

What is Physical Dependence?
When taken on a regular basis for a period of time, some drugs will cause changes in your brain’s chemistry. Physical Dependence may result from these changes.

There are two signs that Physical Dependence has developed. The first sign is that you need to take more of a drug to achieve the same effect that you previously found from taking a smaller amount. This is Tolerance.

The second indication of Physical Dependence occurs when you try to stop taking the drug and Withdrawal Symptoms arise.

Tolerance and Withdrawal Symptoms indicate that your brain chemistry has adjusted to the regular presence of a drug in your body. Your brain now expects the substance to be present.

Certain drugs are more likely to cause a physical dependence than others. For example, regular use of an opiate drug may result in changes in brain chemistry, tolerance and withdrawal. SupportNet provides information about Opiate Dependence in the section on Methadone Maintenance Treatment.

It is possible to develop a Physical Dependence on a drug without being aware that this is occurring. For example, anyone who takes a benzodiazepine drug (i.e. diazepam, lorazepam, clonazepam) for sleep on a regular basis for several months is likely to develop a Physical Dependence. There will eventually be a need to increase the dose of the drug. And when you try to stop, rebound insomnia and anxiety may occur.

Physical Dependence may or may not be associated with Addiction. Physical Dependence is largely a result of taking a certain drug on a regular basis for a long time. Addiction tends to result when one is using a drug for intoxicating purposes or to chase a ‘high.’

When Physical Dependence and Addiction do occur together, the consequences may be severe and particularly tragic.

Opiate Dependence is a good example of this horrible condition. An opiate drug may first be enjoyed for the ‘high’ feeling that these drugs induce. But once used on a regular basis, changes in brain chemistry and tolerance occur. When you try to stop, terrible withdrawal symptoms occur. Fear of withdrawal feeds a deepening cycle of Addiction and further Physical Dependence.

Methadone is an example of a drug that results in a physical dependence when taken regularly. But methadone does not produce any intoxication or ‘high’ and as a result, does not fuel addiction. This unique property of methadone allows for its use to treat and alleviate severe Addiction to opiate drugs.

What is Psychological Dependence?
The use of alcohol or a drug may become a habit for reasons other than physical need. For example, one may drink alcohol before a party to ‘loosen up’ or to ‘get in the mood’ for a social event.

Once this becomes a habit, the tables may turn - you may come to believe that you ‘need’ a drink or two before attending a social function. If you then try to attend without a drink, you may feel awkward - anxiety may arise and you do not have much fun. This provides further ‘evidence’ that you ‘need’ to drink before or at a social function. This is Psychological Dependence.

The social use of alcohol or cannabis may be used to hide social anxiety. Self treatment of anxiety or other distressing emotional symptoms creates a fast path to Psychological Dependence.

Psychological Dependence is really a form of self treatment that may certainly lead to a worsening cycle of Addiction. Psychological Dependence is just a term that is sometimes used to refer to a cause of Substance Abuse. Most people who Abuse substances have some degree of Psychological Dependence.

Can Physical and Psychological Dependence both occur?
The answer to this question is yes - sometimes but not always.

As one example, you may start to use alcohol on occasion for fun. Once you realize that it helps you to feel more at ease with people, you may drink more regularly and with increasing amounts. This habit sets the stage for Psychological Dependence and Abuse.

After a longer period of regularly using alcohol in this way, a compulsive need to drink, Addiction and Physical Dependence may all occur.

Some drugs do not change brain chemistry in a way to produce Physical Dependency. Cannabis is one example. But it is still possible - and not uncommon - for cannabis use to become habitual for psychological and/or emotional reasons. It can seem an easy treatment for many of life’s ailments.

Are some people more likely to become addicted than others?
Yes. Many young people will experiment with cannabis or alcohol when young. Not all will end up addicted to drugs, attending a recovery or methadone program years later.

Family or genetic history makes some more prone to alcohol or drug addiction than others. An inherited risk may cause your brain or body to respond to alcohol or drugs differently than may be the case for others.

Some people have a tendency to grow taller than others. A family may have several members who have diabetes or heart disease. People are born and/or bred with a higher or lower risk to Substance Abuse, Addiction and Dependency. Then many other factors come in to play.

When young, most of us do not imagine that we could ever get addicted to alcohol or a drug. We all tend to believe that our determination and ability for self control will win out.

But the big book of Alcoholics Anonymous refers to alcohol as “cunning, baffling and powerful.” The same can be said of any drug used for intoxication. Substance Addiction is a great reminder that there is more to life’s path than self will.

Are some drugs more addictive than others?
Yes. Amphetamines, cocaine and opiate drugs create an intense ‘high’ and are highly addictive drugs to use. The compulsion to abuse these drugs may escalate very rapidly.

But isn’t alcohol and drug using just a choice that people make?
The best answer to this question is yes, no and maybe.

Starting to use alcohol or another drug is certainly a choice. Young people face this choice every day at school, at parties or just walking down their street. The safest option is always abstinence.

As the driving compulsion of Substance Addiction or Physical Dependence sets in, choice tends to mix with need. Drug use becomes - or seems to become - less of a choice and more of a necessity.

Many people are far down the course of deep drug addiction before they realize that they are no longer in control - it is the alcohol or drug which is controlling them. Denial runs deep - and the Compulsion to use is far more persistent, powerful and unexplainable than most appreciate.

But at some point along their path, most people who suffer with Substance Abuse and/or Addiction will hear that recovery is possible. They may attend - or be forced to attend - a recovery program or learning seminar about the options for treatment.

Denial, false beliefs, compulsion and physical dependency remain powerful motivators to use. But once an addicted person has been introduced to the possibility of recovery, choice is once again an option.

Do I really want to stop using? Am I prepared to do what I need to do to recover? Can I trust what these people are saying to me? Do I believe it possible for me to recover? Am I a lost cause? Am I prepared to die in addiction?

These and other questions are the choices that the addicted person will make each day of their lives after learning about the options for recovery.

Can Addiction be cured?
No. Addiction cannot be cured. Once addicted, the risk of relapsed use or cross addiction never returns to zero. Any risk of relapse to use or addiction may be minimized with recovery and treatment. But risk does not disappear and relapsed use may rapidly become worse than any previous.

The causes of Addiction - genetic, biological variation and family learning - run far deeper than most people appreciate. The neurobiological changes that may occur during and as a result of addiction can also have lifelong impact.

People are likely born with a greater or lessor tendency, or risk towards Addiction. Family learning and other life experiences interact with this inborn risk - Addiction may or may not result.

But one’s risk - or tendency - towards addiction will persist throughout a lifetime, expressed during active Addiction, hidden during periods of abstinence, but never ceasing to exist.

Changes in lifestyle, medical treatment and daily participation in recovery may all be necessary to protect yourself from a return of the compulsion to use and/or relapse.

Recovery from Addiction allows for remarkable healing and personal growth. But far too often abstinence is equated with recovery and the underlying risk of relapse is minimized.

Isn’t it pessimistic to believe that Addiction cannot be cured?
No - it is foolish to ignore the realities of deep Addiction. A person with diabetes is always at risk of recurrent illness - if they do not look after their health on a daily basis. But if they do what they need to do, a healthy and rewarding life usually results. The same is true for alcohol or drug dependence.

There are many false and fanciful beliefs about Addiction. While some prefer to believe that Addiction is just a choice - that it can be cured by counseling or resolved by ‘understanding the root conflict’ - these beliefs do not usually result in lasting relief.

Recovery from Addiction requires a true understanding of the disease. Those who understand and do what they need to do for their recovery lead lives of satisfaction and health.

Another helpful way to think about alcoholism or addiction is to consider whether the person is in Active Addiction, is Abstinent or in Recovery.

What is Active Addiction?
This refers to a person who is addicted to alcohol or another substance, is actively using the substance or who is behaving in a manner that will shortly lead to use.

What is Abstinence?
Abstinence refers to a period of time when an addicted person is not using any substances of intoxication. There are all sorts of reasons why one with alcohol or drug addiction may stop using for some time. Jail, probation, threat of job loss and family separation are all common reasons for periods of abstinence.

Abstinence may be a state of stability and comfort, or may be a time of just hanging on.

What is Recovery from Addiction?
Recovery refers to an active process of learning to enjoy life without the use of alcohol or drugs of intoxication. Recovery is not just about not using - it is about healing, growth and sobriety - learning to enjoy life on its own terms and at its own pace.

Twelve Step Recovery first began with the program of Alcoholics Anonymous. These twelve steps are now applied to recovery from narcotics and many other compulsive conditions. The basic principles of recovery are now widely applied in other treatment and recovery programs.

What is Cross Addiction?
This refers to the tendency of Addiction and compulsion to express itself in multiple ways or differently at different times in a person’s life. A person with alcohol and gambling addiction is said to be Cross Addicted.

Similarly, an opiate addicted person who is abstinent from opiates may develop a dependency on sleeping pills or alcohol. This is another example of how a tendency towards Addiction may persist over time and does not disappear with abstinence from one drug.

Others in recovery from alcoholism or drug addiction may engage in compulsive behaviors that are not as commonly thought of as addiction. Examples include ‘workaholism,’ sexual compulsion or compulsive care-taking of others. These may also be examples of Cross Addiction.

This is a lot of new words. Can you summarize these for me?
Yes, these terms can be confusing and are often used in misleading ways in the popular press.

People may start to Use alcohol or another substance for all sorts of reasons - or for no very good or specific reason at all.

The social Use of some drugs such as alcohol or cannabis may not result in negative consequences and may not progress to a problem of Substance Abuse.

Substance Abuse refers to excessive use, persistence of use despite negative consequences or evidence of loss of control over use of alcohol or another substance.

Some drugs are so dangerous that first use or any other use is clearly Substance Abuse. This is true for any use of crack cocaine, methamphetamine, glue sniffing or heroin. Any use of any drug by injection is dangerous and by definition, Substance Abuse.

A seemingly unexplainable but driving compulsion to use drugs is referred to as Addiction. The emotional turmoil, denial, disordered thoughts and addictive behaviors are all symptoms of the sickness of Addiction.

Inherited vulnerability, family learning and the regular use of a substance to get ‘high’ are the most important reasons why some persons will develop an Addiction while others may not. 

An addicted person may or may not have a Physical Dependence on their drug or choice. Some drugs are more likely than others to cause Physical Dependence. Some drugs rapidly cause Physical Dependence while others do not do so at all.

Physical Dependence is largely a result of taking a certain type of drug regularly for a long time. The reason why you are taking the drug does not so much matter.

Sleeping pills of the benzodiazepine family or opiate drugs such as oxycodone, morphine or heroin are notorious examples of drugs that may cause Physical Dependence.

Taking a sleeping pill every night may result in a Physical Dependence, but not necessarily an Addiction. Regular use of an opiate drug to get ‘high’ will result in a devastating condition of both Physical Dependence and Addiction.

Drinking or using a drug regularly to change how you feel, to treat symptoms of social anxiety, relieve stress or to boost confidence may all indicate a problem of Psychological Dependence.

Self treatment of emotional symptoms with alcohol or drugs, habitual use and Psychological Dependence are all indications of Substance Abuse and may eventually result in Substance Addiction, Physical Dependence or both.

The tendency towards Addiction and risk of relapsed use may be life long. Active Addiction refers to a person with Addiction and who is actively using alcohol, drugs or is behaving in a way that will lead to use. Abstinence refers to a person with Addiction but who is not using at present. Recovery refers to an active process of learning to enjoy life without the use of alcohol or drugs.

Cross Addiction refers to the expression of addiction in different ways and/or at different times in life. The Cross Addicted person may be addicted to both alcohol and gambling or may be addicted to crack cocaine when young and an opiate drug when older.