Addiction Addictive Behaviors Substance Use vs. Substance Abuse: What Are the Differences? By Sanjana Gupta Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness. Learn about our editorial process Published on September 30, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print FatCamera / Getty Images Table of Contents View All Table of Contents Why the Term "Substance Abuse" Is No Longer Used Symptoms Causes Diagnosis Treatment Prevention Summary If you’ve heard the terms “substance use” and “substance abuse,” you may wonder whether they mean the same thing or whether there’s any difference between them. Both terms refer to the act of utilizing substances, such as alcohol, drugs, nicotine, cannabis, or prescription medications. However, one refers specifically to problematic use, whereas the other is a broader term that refers to all substance use, problematic or otherwise: Substance Use: “Substance use” is the act of using any legal or illegal substances, says Maeve O’Neill, MEd, LPC-S, CHC, CDTLF, the Executive Vice President of Addiction and Recovery at All Sober. "Substance use" is a broad term that encompasses all forms and frequencies of using harmful substances. Substance Abuse: The term “substance abuse” was previously used to describe addiction or risky/dangerous use of one or more substances, says O’Neill. However, the professional diagnostic manual, known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) no longer uses the term “substance abuse” as it can be stigmatizing—the preferred term is "substance use disorder," O’Neill explains. Read ahead to learn more about the differences between substance use and substance abuse (the remainder of the article will use the term "substance use disorder" rather than "substance abuse"). If you or a loved one are struggling with substance use disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Why the Term "Substance Abuse" Is No Longer Used According to the National Institute on Drug Abuse, the term "substance abuse" has been discontinued because the word "abuse" has negative connotations and is associated with judgment or punishment. “Substance use disorder” is now the medical term used to describe uncontrolled use of a substance despite negative consequences to one’s health, work, studies, family, and day-to-day functioning. Substance use disorder is considered to be both a complex brain disorder and a mental illness that is classified as mild, moderate, or severe based on criteria met by each individual, says O’Neill. Maeve O’Neill, MEd, LPC-S, CHC, CDTLF Previously, the term ‘substance use’ was meant to describe mild use of a substance, and the term ‘substance abuse' was used to describe moderate or more severe use. We don’t use the term ‘abuse’ anymore, as language is important. — Maeve O’Neill, MEd, LPC-S, CHC, CDTLF How Using the Right Language Can Destigmatize Mental Illness Symptoms When does having a drink with friends or taking a painkiller for a headache (occasional substance use) turn into alcoholism or a painkiller addiction (substance use disorder)? When the person starts to experience these symptoms, they may be diagnosed with a substance use disorder: Experiencing strong cravings for the substance Using more of the substance than intended Not being able to cut down on one’s use of the substance despite wanting to or continually trying to Spending a lot of time procuring, using, or recovering from the aftereffects of the substance Facing problems at home, work, or school due to one’s substance use Continuing to use the substance despite relationship problems caused by substance use Reducing or discontinuing other hobbies and activities as a result of substance use Engaging in risky or unsafe behavior under the influence of substances Using the substance even though it is causing or exacerbating physical or psychological health conditions Developing a tolerance to the substance and requiring more and more of it each time in order to achieve the same effect Experiencing withdrawal symptoms while not using the substance and feeling the need to take the substance in order to prevent withdrawal Diagnostic Criteria Based on the number and severity of symptoms the person has, their healthcare provider will determine whether their substance use is a cause for concern and whether they have mild, moderate, or severe substance use disorder. The diagnostic criteria are as follows: Mild substance use disorder: Having two or more of these symptoms in the last 12 months (this is the threshold that separates occasional substance use from substance use disorder) Moderate substance use disorder: Having four to five of these symptoms in the last 12 months Severe substance use disorder: Having six or more of these symptoms in the last 12 months Causes Substance use is often a precursor to developing substance use disorder. In fact, for some people, trying a substance or using it occasionally can be the first step of developing substance use disorder. Causes of Substance Use Substance use often starts out in the following ways: Trying the substance: People often start using substances out of curiosity, as an experiment, or due to peer pressure. Taking the substance to feel good: People use substances to experience feelings of intoxication and pleasure, commonly known as “a high.” Taking the substance to do better: Some people use substances to improve their performance, alertness, energy levels, and cognition. Using the substance to feel better: People sometimes turn to substances to forget their problems, relieve stress, reduce pain, and feel numb. Causes of Substance Use Disorder After a person has started using substances, they may be at risk of developing substance use disorder. These are some factors that can contribute to the risk of developing substance use disorder: Genetic vulnerability Social pressures Environmental stressors Mental health conditions Individual personality characteristics The effects of the substance Cultural, social, religious, historical, and legal factors can also play a role in determining what forms of substance use are acceptable. For example, public laws determine which substances are legal or illegal, and how much of a substance can be legally consumed. Additionally, some cultures discourage the use of certain substances and permit others. Why Mental Health Disorders Co-Exist With Substance Use Diagnosis Professionals who are certified or licensed in addiction medicine can determine whether a person's substance use is a cause for concern, and diagnose and treat substance use disorder, says O’Neill. Your primary doctor can provide a reference to a specialist, if needed. According to O’Neill, the diagnostic process involves a complete assessment, which often includes: An interview with the person who is using a substance Discussions with others who may be in the person’s life The use of diagnostic tools to determine whether the person’s symptoms meet the diagnostic criteria for substance use disorder listed in the DSM-5-TR A physical examination or other tests to determine the extent of the person’s use, assess their health status and check for other physical or mental health conditions It’s important to be open and honest about your symptoms and substance use with your healthcare provider, so they can accurately determine whether or not your substance use is a cause for concern and if you have or are at risk of developing substance use disorder."Proper diagnosis is critical to ensure you receive the most helpful level of care," says O’Neill. Treatment If the person's healthcare provider determines that their substance use is problematic and they have substance use disorder, they may require treatment. Treatment involves a professional assessment and treatment plan to meet the person’s individual needs for sustained recovery, says O’Neill. "The treatment plan can vary depending on several factors, such as severity of use and the person's resources and sources of support." According to O’Neill, treatment for substance use disorder can involve: Detoxification Medication Therapy Support group meetings Treatment in an outpatient, inpatient, or residential setting Aftercare, such as sober living Other forms of education, awareness, or support 8 Common Misconceptions About Substance Abuse Prevention Below, O’Neill outlines some steps that can help prevent substance use and substance use disorder. Preventing Substance Use The best approach to prevent substance use is to provide comprehensive education and support at all opportunities. Maeve O’Neill, MEd, LPC-S, CHC, CDTLF It's important to teach children, adolescents, and adults about the prevalence and dangers of substance use and help them develop resilience skills to avoid using substances. — Maeve O’Neill, MEd, LPC-S, CHC, CDTLF Preventing Substance Use Disorder Substance use disorder is preventable if we build systems of care that help us intervene at earlier stages of use. Schools and communities need to work collaboratively together to actively find and correct the conditions that lead to substance use disorder, in order to prevent it or mitigate its effects. Summary Substance use is a broad term that encompasses every instance of using harmful substances such as alcohol, drugs, nicotine, cannabis, or prescription medications. Substance use disorder, however, is a medical condition that refers specifically to problematic use of these substances, to the extent that the person experiences negative consequences to several areas of their life. Trying a substance or using it occasionally is often the precursor to substance use disorder, particularly if someone is predisposed to it due to genetic, social, environmental, or individual factors. Therefore, it's important to take steps to prevent substance use, particularly among young people, to help prevent substance use disorder. A qualified healthcare professional can diagnose whether a person's substance use is problematic and meets the diagnostic criteria for mild, moderate, or severe substance use disorder listed in the DSM-5. Based on their assessment, they will work out a treatment plan for the person. A Word From Verywell If you’re worried about your substance use and think you might be at risk for a substance use disorder, the best thing to do is to seek help and information, says O’Neill. “There are many counselors, coaches, and support group meetings that can help you understand and learn more about it. You are not alone and recovery is possible." How to Help an Addict: Resources and Treatment 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. McLellan AT. Substance misuse and substance use disorders: why do they matter in healthcare? Trans Am Clin Climatol Assoc. 2017;128:112-130. National Institute on Drug Abuse. Terms to use and avoid when talking about addiction. American Psychiatric Association. Substance-related and addictive disorders. NAMI. Substance Use Disorders. Hasin DS, O'Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: Recommendations and rationale. Am J Psychiatry. 2013;170(8):834–851. doi:10.1176/appi.ajp.2013.12060782 National Library of Medicine. Substance use disorder. Medline Plus. Robinson SM, Adinoff B. The classification of substance use disorders: historical, contextual, and conceptual considerations. Behav Sci (Basel). 2016;6(3):18. doi:10.3390/bs6030018 National Library of Medicine. Drugs and young people. By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.