Substance Use, Abuse and Addiction are topics about which
everybody seems to have an opinion. It can be hard to find straight talk on
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
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
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
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
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
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
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
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
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
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
Abstinence may be a state of stability and comfort, or may be a time of just
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,
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
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
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.