Abuse vs. Dependence

Summary

Medical professionals follow certain criteria to determine if a person abuses alcohol or drugs.
These established criteria also can mark whether the substance abuse has progressed to dependence.
Alcohol and drug dependence cause people to suffer from withdrawal symptoms when they stop using the substance. Dependence also causes major behavioral changes, such as overwhelming preoccupation with drug or alcohol use.

Some people who start as casual drinkers or drug users will stay that way. But others will become substance abusers or dependent, feeling that they need a drug to feel alive. The difference between abuse and dependence is not always clear to the general public, but medical professionals use a set of criteria to distinguish between these two categories of problem use.

The essential feature of abuse is a pattern of substance use that causes someone to experience harmful consequences. Clinicians diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use:

Failure to meet obligations, such as missing work or school
Engaging in reckless activities, such as driving while intoxicated
Encountering legal troubles, such as getting arrested
Continuing to use despite personal problems, such as a fight with a partner

Dependence is more severe. Medical professionals will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a twelve-month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral signs occur with every substance.

The physiological factors are:

Tolerance, in which a person needs more of a drug to achieve intoxication
Withdrawal, in which they experience mental or physical symptoms after stopping drug use

The behavioral patterns are:

Being unable to stop once using starts
Exceeding self-imposed limits
Curtailing time spent on other activities
Spending excessive time using or getting drugs
Taking a drug despite deteriorating health