Substance Use vs. Abuse

By Priscilla de Llovio, LCPC, CADC

Often if we are concerned about a loved ones’ use of drugs and alcohol (or our own usage), it is difficult to tell when the use becomes a “problem”.  To help define use of substances, we refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which defines substance use disorders as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria the individual meets. The three types of disorders are as follows:

Substance Use: When someone consumes alcohol or drug in a moderate and responsible manner.

Substance Abuse: When someone continues to use a substance, even though there are consequences such as: problems at work caused by the use, relationship problems (family, partner, employment, friends), legal problems such as DUI’s/arrests, putting self in danger, poor performance at school or work, engaging in risky behaviors, complications with mood such as increase of sad mood that can lead to depression, mood changes (anger tantrums/drastic highs and lows in mood), anxiety.

Substance Dependence: Developing a chemical tolerance for the drug/alcohol. If the individual stops on their own, he/she may experience withdrawal symptoms such as: headaches, sweats, shaking, anxiety/hear rising and difficulty breathing, insomnia, vomiting/nausea, among others.

There are many factors that can influence whether someone is abusing or addicted to drugs/alcohol, such as socio-cultural (peer pressure, to fit in the crowd), psychodynamic (emotional issues, past history, and psychological disorders which sometimes are unconscious), and biological factors (genetics). In addition, mental illness can play a strong role in addiction. Many people who suffer from psychological disorder(s) can turn to drugs and/or alcohol as a way to "self-medicate"/"cope" with emotional and psychological distress. Other lifestyle stressors that could also be impacting day-to-day functioning are: financial, relationship, employment, family, and medical problems.

One can abuse alcohol without necessary being addicted to alcohol. It is important to understand that people with addictions have a chemical dependency (chemicals in the brain) that prevents them from changing on their own. Will power alone is most of the time not enough for change of behavior, especially if the body is chemically addicted to it.

If you are worried by the idea of stopping or cutting down your drinking, or if you just can't cut down, it might help to talk to a substance use counselor to evaluate your severity, triggers, and treatment options. Changing your habits and style of life is a challenge and can take some time, but it is never too late to live a healthy happy lifestyle.  

If you are interested in learning if you could be abusing alcohol and could help you in making a decision to whether or not you would like to search for help, here are two questioners that you can complete and score on your spare time: