What’s the difference between a substance abuse disorder, addiction, and disease? That’s a good question, and one we set out to determine. Although there are some different aspects of each, the results of our findings might enlighten you. Read on for more information.

Substance abuse can lead to addiction, a disease that can affect anyone no matter their age, lifestyle, ethnic background, profession, or gender. People with substance abuse disorder cannot be categorized in any specific way. They can be rich or poor, educated or not. They can be white-collar professionals, blue-collar workers, or those who do not fit into those groups. They can have long or short hair or no hair at all.

People with substance abuse disorder can be short or tall or of average height.

They can be slim or heavy or of average weight. They don’t lack character or morals. All of these people have something in common, though.

The disease of addiction. Addiction is also called severe substance use disorder.

Substance Abuse Terminology

Here are some common terms used when discussing or reading about substance abuse:

Substance use: A less serious drug or alcohol use disorder in which substance use causes distress and problems. Addiction is a severe form of this. (Center on Addiction)

Addiction: A primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. (American Society of Addiction Medicine (ASAM))

Disease: A definite pathological process having a characteristic set of signs and symptoms. The disease is caused by extrinsic influences (e.g., virus, bacteria)

Is It Substance Abuse Disorder (SUD) Or Addiction?

You can have a substance use disorder (SUD) to drugs or alcohol that leads to addiction (severe SUD). Addiction is a chronic brain disease in which continued use of the substance changes the reward system in the brain. It is a disease due to the characteristic signs and symptoms it presents.

  • Two or three of the criteria met within a year indicates a mild substance abuse disorder
  • Four to five of the criteria met within the year indicates moderate substance abuse disorder
  • Six or more of the criteria met in this same amount of time indicates a severe substance abuse disorder, which also indicates addiction.

Types Of Addiction

Addiction affects a person’s brain and behavior when using drugs or alcohol that can lead to the inability to control drug or alcohol use to the detriment of the person and his or her life.

  •  Alcohol use disorder
  •  Tobacco use disorder
  •  Cannabis use disorder
  •  Stimulant use disorder
  •  Hallucinogen use disorder
  •  Opioid use disorder

Symptoms Of Addiction

Symptoms can only be experienced by the addicted person. Signs are what other people observe of the addicted person. These are usually the same in both instances. Not all of the below have to be felt or seen to notate addiction. Some can be indicative of other life situations and not necessarily substance abuse addiction.

The Most Common Signs And Symptoms Are:

  • Secretiveness
  • Lying
  • Stealing
  • Financially unpredictable, perhaps having large amounts of cash at times but no money at all at other times
  • Changes in social groups, new and unusual friends, odd phone conversations
  • Repeated unexplained outings, often with a sense of urgency
  • Drug paraphernalia such as unusual pipes, cigarette papers, small weighing scales, etc.
  • “Stashes” of drugs, usually in small plastic, paper, or foil packages
  • Tolerance, which is the need to engage in the addictive behavior more and more to get the desired effect
  • Withdrawal happens when the person does not take the substance or engage in the activity, and they experience unpleasant symptoms, which are often the opposite of the effects of the addictive behavior
  • Difficulty cutting down or controlling the addictive behavior
  • Social, occupational, or recreational activities becoming more focused on the addiction, and important social and occupational roles being jeopardized
  • The person becoming preoccupied with the addiction, spending a lot of time on planning, engaging in, and recovering from the addictive behavior
  • Extreme mood changes – happy, sad, excited, anxious, etc.
  • Sleeping a lot more or less than usual, or at different times of the day or night
  • Changes in energy – unexpectedly and extremely tired or energetic
  • Weight loss or weight gain
  • Unexpected and persistent coughs or sniffles
  • Seeming unwell at certain times and better at other times
  • Pupils of the eyes seeming smaller or larger than usual

Is Addiction a Disease or a Choice?

This is a question that many people have. It is often thought that addiction is a choice people make and make again and again. Yet, there are not many people struggling with addiction who would say they made a conscious choice to become addicted to drugs or alcohol. However, those who believe in the “choice model” of addiction believe addiction stems from thought processes, learned behavior, or environmental factors.

Our thoughts affect our actions; therefore, we think we need a drink when we’re stressed or anxious, so we drink. If that drink doesn’t relax and calm us, we think we need another drink, and so we have one.

On the other hand, if, as a child, you saw your parents taking a pill to relax, to sleep, or to become more awake, we think that it’s OK to do the same because they did.

Or perhaps you live in an environment that is conducive to drug or alcohol abuse. Poverty is one example. An abusive household is another. These environmental factors greatly raise the possibility of substance abuse and addiction.

A guest blog written by Tom Hill on Mental Health First Aid says,  “It is easy to blame the individual for bad behavior – lying, cheating and stealing, as well as angry outbursts – rather than putting the focus on the disease that creates those behaviors.” The common thought is that an addicted person is a weak person lacking any morals, and it’s easy to just think or say that rather than dig deeper into why the individual can’t stop abusing substances.

It has long been proven that addiction is a chronic disease affecting the brain and brain function. The Partnership to End Addiction writes that “Addiction disrupts regions of the brain that are responsible for reward, motivation, learning, judgment and memory.” 

So, is addiction a disease or a choice? 

Why Is Addiction a Disease?

Medical research has identified areas of the brain that are key in the development and continuation of substance use and addiction. The brain pathways that contain dopamine, the brain’s natural “feel-good” chemical, are where drugs and alcohol exert their effects. Healthy brains release dopamine as a response to natural rewards, like eating ice cream or exercise. Drugs and alcohol take over the dopamine pathways and tell the brain these things are good, too.

If substance use continues, the brain produces less dopamine and can reduce the number of structures in it that receive dopamine. This means if you are continually abusing substances, you are not likely to feel the effects. Therefore, you will need more of the substance to regain its effects. Changes in the brain from chronic alcohol or drug use can last for years after you stop abusing substances. This is why you might relapse even if you have not abused substances for a long time.

Disease Model of Addiction

Addiction is defined as a disease by the American Psychiatric Association (APA) and other medical organizations. The APA states that a “substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequence.” It goes on to state that the brain’s structure and function change with repeated substance use, and this is what causes strong cravings, personality changes, and abnormal behavior. In addition, the APA states that studies of brain images “show changes of the brain that relate to judgment, decision-making, learning, memory, and behavior control.”

As a disease, addiction can completely take over an individual’s life in every aspect to where the only thing that matters is having more of the substance or engaging in more of the behavior that is resulting in negative consequences. 

Addiction Is a Family Disease

Addiction can be genetic, meaning that it can be passed down from one generation to another. It is also called a family disease because when one family member is addicted to alcohol or drugs, it affects the entire family. Drug and alcohol abuse ruins relationships, finances, and health.  When one person in the family has an addiction, every individual in their life will experience effects from it, and most are negative. 

Addiction vs. disease:  Both create physical, psychological, and social problems for you because addiction is a chronic disease that needs individualized treatment to overcome and manage in your lifetime. 

Factors In Chronic Disease

Many different aspects of a person’s life factor in when engaging in the discussion if someone is addicted to substances. The most crucial thing to remember is that addiction is a chronic disease. It is chronic in the same way that diabetes and heart disease are – they are manageable, treatable, and need lifelong treatment that is adaptable.

The National Institute On Drug Abuse (NIDA) States:

  • Drug addiction is a chronic disease characterized by drug-seeking and uses that are compulsive, or difficult to control, despite harmful consequences.
  • Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
  • Relapse is the return to drug use after an attempt to stop and indicates the need for more or different treatment.
  • Most drugs affect the brain’s reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.
  • Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.
  • No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences the risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.
  • Drug addiction is treatable and can be successfully managed.

Signs Of Addiction

The American Society for Addiction Medicine (ASAM) relays the “ABCDEs” of addiction:

  • Inability to consistently Abstain;
  • Impairment in Behavioral control;
  • Craving; or increased “hunger” for drugs or rewarding experiences;
  • Diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and
  • A dysfunctional Emotional response


Is substance abuse a disease?

The answer is that it can be if someone shows signs of and experiences the symptoms of addiction. Addiction is a severe form of substance abuse disorder, and it is a chronic disease of the brain.

The good news is that substance abuse disorder and addiction can be treated and managed.

If you or a loved one is struggling with addiction, Delphi Behavioral Health Group can provide the necessary treatment and support that you or a loved one needs to get sober.

Tap to GET HELP NOW: (844) 899-5777