Is it Substance Use, Abuse or Addiction? Know the Difference
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By Payton Hogan
PAYTON HOGAN, M.S., IS A LICENSED MENTAL HEALTH THERAPIST AND CONSULTANT RAISED IN NORTH OMAHA.
I recently created a post on my Facebook page asking the question, “Can you be addicted to weed?” Not surprisingly, a lot of people chimed in on this topic. Answers covered a range of opinions.:
“Weed is the Earth’s medicine. You can’t be addicted to it.”
“You can have a dependence, but not really be addicted.”
“I use it every now and then, but I can start and stop whenever.”
All of the answers given gave insight into the different types of substance users. To make things more clear, not every substance user or person who consumes/smokes weed is clinically addicted/dependent to it. In fact there are four categories that substance users can fall into:
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Experimental user or someone who just “tries things” once or twice but never really gets any further than that.
Recreational or social user who uses only when in social settings with others.
Medicinal user or someone who uses only when medically related ailments or disturbances are present.
Addict or chemically dependent user who uses compulsively, despite adverse consequences, and over extended periods of time. (Click here for the 11 criteria listed in the DSM-5 that indicate a substance use disorder is present.)
Often, I see how individuals can confuse recreational and medicinal use with potential substance use dependence. Many times this comes into play when other mental health disorders are present such as depression and anxiety. Some people, including myself at one point in time, utilized substances to mask symptoms of depression, anxiety, lack of self-esteem and self worth, despair, hopelessness, emotional and mental distress, and so many other unpleasant experiences and emotions in life.
Substance use can impact our mental health, especially when we are not in optimal health. The way substances interact with our body and mind is actually quite simple. According to the Industrial Psychiatry Journal, many times the active compound mimics one or more hormones from our body creating experiences ranging from:
Euphoria (dopamine)
Intense spikes in energy (cortisol and adrenaline)
Pain cessation (endorphins)
Audio and visual hallucinations (serotonin)
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Emotional experiences we have are directly tied to the body's production or lack of production and release of hormones. When an individual is experiencing feelings of depression, this is an indicator that our body is not currently producing or releasing dopamine. Use of a substance that mimics dopamine causes the body to stop producing the hormone. It then begins to rely solely on the substance to create the “euphoric” experience. This is dangerous and is a pathway to addiction.
When we utilize substances to improve our moods, the line between recreation and dependence becomes severely blurred. The substance use allows for instant gratification and quick relief from the negative and unpleasant mental and emotional experience. But it also initiates a pattern of use that requires increased frequency to regulate the user's mental and emotional states.
DSM-5 Criteria for Substance use disorder:
Taking the substance in larger amounts or for longer than you're meant to.
Wanting to cut down or stop using the substance but not managing to.
Spending a lot of time getting, using, or recovering from use of the substance.
Cravings and urges to use the substance.
Not managing to do what you should at work, home, or school because of substance use.
Continuing to use, even when it causes problems in relationships.
Giving up important social, occupational, or recreational activities because of substance use.
Using substances again and again, even when it puts you in danger.
Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
Needing more of the substance to get the effect you want (tolerance).
Development of withdrawal symptoms, which can be relieved by taking more of the substance.
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With any substance, there are always side effects to the use. These become more prevalent and apparent due to the nature of use. What once started as something that was potentially enjoyable quickly becomes something that must be done.
According to the National Institute on Drug Abuse, over 60% of adolescents in community-based substance use disorder treatment programs meet diagnostic criteria for a mental illness. This is what is known as comorbidity or meeting criteria for both substance use disorders and mental illness diagnosis. In many cases, individuals look to treat their mental illness with substance use, further exacerbating the illness and leading them in a cycle of use and abuse.
The impact of using substances when struggling with a mental illness can truly be detrimental.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), over 60% of deaths by suicide involve some form of substance use and abuse. Utilizing substances as coping mechanisms does not help.
If you or someone you know are struggling with mental illness, and are unsure of how to deal with it outside of using substances, reach out to a therapist online. Psychology Today has a wide range of therapists you can work with to develop healthy coping skills to avoid substance dependence.
Substance use is a norm in our culture today, but it comes with risks. Understanding the different types of use and indicators for chemical dependency is essential. Be smart, be safe, know the signs.
