Substance Abuse and Addiction – aren’t they one in the same? If not, then what’s the difference?
If substance abuse is not addiction, then what is it?
I was recently interviewed by AllTreatment.com and wanted to share with readers a few of the questions and answers about the misconceptions about substance abuse and addiction. Often it’s the misconceptions that get in the way of a substance abuser, drug addict, alcoholic and/or their family members and friends seeking or being open to change, treatment and recovery.
Your website states that its goal is to “change the conversations” about substance abuse and addiction. What do you see as some current misconceptions about these things?
- That addiction is not a disease, that it’s simply a lack of willpower.
- That underage drinking or drug use is “no big deal” something “all kids go through.”
- That an alcoholic/drug addict has to “hit bottom.”
- That there is nothing a family member or close friend can do.
- That a loved one’s drinking does not impact the family member or close friend — that once the drinking or drug use is stopped, they’ll be fine, too.
- That you must stop the drinking or drug use and then treat the mental illness (in the case of a dual diagnosis).
- That people are born alcoholics; it’s “in their blood.”
- That a 28-day rehab program should do it and that a relapse is because the person just didn’t want it badly enough.
How is an addiction a disease?
By its simplest definition, a disease is something that changes cells in a negative way. All diseases – cancer, diabetes, heart disease, HIV-Aids, to name a few – affect some type of cell in our bodies. This is because every organ inside our bodies (heart, brain, liver, eye, kidney, lung, stomach) is made up of cells. Some diseases affect many organs. Some affect one or two. Alcoholism/drug addiction affects cells in many organs, but of particular concern is its effect on cells in the brain. This is because the brain controls everything we think, feel, say and do, and its drugs/alcohol’s affect on the brain that changes the way a person thinks, feels and behaves. According to NIDA, NIAAA and many other prominent agencies and organizations, alcoholism/drug addiction is a chronic, often relapsing brain disease.
How is alcoholism (drug addiction) a brain disease? The chemical and structural changes in brain cells and neural networks brought about by substance abuse, coupled with the brain cell and neural network changes brought about by the five key risk factors for developing the disease (genetics, social environment, childhood trauma, mental illness and early use), cause the disease of alcoholism/drug addiction to actually change brain functioning.
With alcoholism/drug addiction (vs. alcohol or drug abuse), the brain embeds addiction-related neural networks around the characteristics of the disease, which include: cravings, loss of control, physical dependence and tolerance. A re-wiring the brain – by returning the brain to health – for which the first step is to stop all alcohol (or drugs, if that’s the substance of choice) use entirely – is the only “thing” that can alter the “power” of these embedded brain maps. This is because the alcohol or drug – even after months or years of not drinking or using – kick-starts the addiction-related embedded brain maps causing the alcoholic/drug addict to relapse into their disease. An alcoholic / drug addict cannot drink /use any amount, not ever, if they want to successfully treat their disease. For more information about the disease of addiction, check out The Addiction Project produced by HBO in partnership with the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), and the Robert Wood Johnson Foundation.
What distinctions do you make between abuse or misuse of drugs and alcohol versus being addicted to them?
Both abuse and addiction cause chemical and structural changes in the brain — these are what cause people to behave the way the do when they under the influence of drug or alcohol abuse. Again, that’s because the brain controls everything we think, feel, say and do. As for addiction, it is different because the brain no longer can function “normally,” due to the hijacked, embedded neural networks around the four key characteristics of the disease, which include: cravings, loss of control, physical dependence and tolerance.
For additional information, consider this more recent blog post, Is It Alcoholism? – How Can You Tell?
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Hi Lisa,
I appreciated reading your misconceptions about drug misuse and addiction. There is unfortunately some skewed opinions still out there on what causes addiction as well as how to best treat it.
Time to me can make all the difference on the long term recovery outcomes. When people have been spending years abusing their bodies, it seems unimaginable to me that they could completely recovery in 30 days. It takes much longer to internalize new life habits.
So true. When I work with individuals and families, I ask them to think of what all it would take to switch the hand they use to brush their teeth — perhaps a sticky note on the mirror, moving the toothpaste to their bedroom to jar their thinking when they reach for it… then I ask them to imagine what it would be like to change all reactions to cues to drink or use their drug of choice… it helps all concerned better appreciate what recovery is all about and why it can take a while. Thanks so much for your comment!