At What Point Does Substance Use Become Substance Abuse?
By: Elysia L. Richardson
Some people view their drinking or drug use as a “phase.” Some see it as just something to do, maybe while out with friends at the club, while others can track their use back to a legitimate prescription.
All of these scenarios involve substance use that can lead to substance abuse, or what’s also known as a substance use disorder (SUD). For many drinkers and drug users, a chemical dependence is possible each time they use an addictive substance.
Whatever their reasons are for using, many substance users find they just can’t stay away from their drug of choice no matter how much they try. This inability to stop using often leads to abusive behaviors that put them on the thorny road of addiction.
But at what point does substance use become substance abuse? How can one know for sure, and where can one look for answers?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) offers some insight.
What Are Substance Use Disorders?
DSM-5, the manual published by the American Psychiatric Association, no longer uses the terms “substance abuse” or “substance dependence” to define problematic behaviors related to substance use. It defines those behaviors as “substance use disorders,” and categorizes them as either mild, moderate, or severe. Certain diagnostic criteria must be present before it can be determined which category best fits an individual’s condition or situation.
The DSM-5’s guidance on whether a pattern of behavior constitutes substance use or substance abuse can help determine when substance use has gone too far.
The Substance Abuse and Mental Health Services Administration (SAMHSA) highlights this DSM-5 guidance on its website.
It writes, “Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.
“According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.”
There Is a Difference
Various factors come into play when determining the differences between substance use and substance abuse. A person’s age, weight, family history, metabolism, and social environment can influence how much and how often someone chooses to use alcohol and drugs. These and other factors can affect how people are affected when they use substances.
“Substance use” is when a person uses drugs and/or alcohol. Use doesn’t necessarily mean one will come to abuse the substance they are taking or develop a chemical dependence, but the possibility is there as long as it’s in use.
Addictive substances change how the brain responds. They increase the natural neurotransmitter dopamine, which regulates the brain’s reward center, sometimes five or 10 times more than the normal level. This increase creates powerful cravings for substances that become harder to ignore.
So the more someone uses substances that flood the brain with dopamine, which triggers pleasurable feelings, chances are likely the person will seek those feelings out again and will do what is needed to ensure they experience them.
This seeking-out-and-rewarding cycle results in regularly using substances to experience the same feelings over and over again. And it is regular use that can be the slippery slope into “substance abuse.”
As a person engages in regular substance use, they may discover they have to use more of the same substance to attain the effects they experienced before. At that point, the body has built up a tolerance for the drug. The desire for pleasurable feelings is so powerful that a person can start to abuse substances. This is one of the earliest warning signs.
“Substance abuse” is when a person uses addictive substances regularly to the point of overindulgence. Such use can be characterized as excessive, and it often occurs even when it brings about problems and consequences that can jeopardize someone’s life. “Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control,” writes WebMD.
And there is a third category, known as “substance dependency,” which is when a person experiences changes in mind and body if they attempt to go without the substance of choice. Chemical dependence is considered an addiction to the substance. One sure sign that someone is chemically dependent is noticing what happens should they reduce their use or stop taking the drug altogether. If they experience withdrawal symptoms, then dependence or addiction has set in.
Recognize the Warning Signs of Substance Abuse
Not everyone who uses substances will develop a dependence on them. But despite the fact that this can be a tricky area to navigate, there are signs that there could be danger ahead.
Compulsive use of substances is indicative of a problem. Here are some questions to ask to help determine if substance use has turned into substance abuse. These are all red flags.
- Is use continued despite the negative effects on their daily routines, health, work, personal and professional relationships?
- Are there intense, frequent cravings for the drug?
- Are there changes in spending habits to support buying addictive substance, even to the point of not being able to afford it?
- Is the substance used longer or more often than intended?
- Is recovery from substance use extensive? Does the recovery period last days or weeks?
- Is there an inability to stop using the substance despite wanting to?
- Has a high tolerance to the substance developed with regular, prolonged use of the substance? Is more of the substance needed to achieve a high?
- Are more attempts being made to obtain the substance? Have these attempts become illegal or reckless?
- Do withdrawal symptoms emerge when substance use suddenly stops or is reduced?
Other signs that substance use is becoming substance abuse or substance dependency include:
Changes in appearance: Weight loss, weight gain, puncture marks, skin infections; red or bloodshot eyes; poor grooming
Changes in behavior: Mood swings, which are noticeable changes in a person’s emotional state, are common. A lack of energy that results in sleeping more than usual or a sudden burst of energy that seems to last longer than usual could be signs of substance abuse.
Changes in interpersonal relationships: Substance abusers and people with addiction may become more isolated and withdrawn. They may also start to hang out with people who are sketchy and spend less time with close family members and friends.
Is It Time to Get Help?
It is important to remember your personal limits when considering what’s all right and what’s too much. But, as the DSM-5 guidance advises, if failing health (including mental health) or a failure to meet responsibilities tied to school or work are noticed, substance use may have become a substance abuse disorder, which requires another level of care.
If you or someone you know is at the point of substance use becoming substance abuse, it’s good that you have been honest about coming to that conclusion and perhaps need to figure out what the next steps are. The important thing is to get professional help if drinking and drugging has gotten to the point of putting lives in jeopardy, whether it’s the substance abuser’s life or theirs and other people’s lives.
There are hundreds of treatment facilities and drug and alcohol rehabilitation centers with supportive staff members who are ready to help you or your loved one find the right detoxification and treatment programs. Call Delphi Behavioral Health Group at 844-899-5777 to start your search now and end substance addiction.