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Substance Abuse vs. Addiction: What's the Difference?

By WebMD Connect to Care Staff
Medically Reviewed by Arpan Parikh, MD, MBA on July 12, 2021
"Substance abuse" and "addiction" are closely-related terms, but there are key distinctions between them. Learn how to recognize the differences between the two.

In everyday conversation, the distinction between substance abuse and drug addiction can sometimes be ambiguous. However, while both substance abuse and addiction can have detrimental effects on your life, not everyone who abuses substances will go on to develop an addiction. Recognizing early warning signs of substance abuse can alert you to the need for treatment before a full-blown addiction occurs.

What is Substance Abuse?

Substance abuse is not the same thing as addiction, though it is still a cause for concern. Both overusing a substance and using a substance in a manner other than its intended use are signs of substance abuse. For example, if you are prescribed a painkiller but you take it more often, or in higher doses, than your prescription dictates, this is a sign of substance abuse. 

Behavioral signs of substance abuse include:

  • Regularly missing work, school, or social events
  • Failing to fulfill obligations
  • Irritability and moodiness
  • Denying the severity of the drug use problem
  • Isolating oneself from family and friends

What is Addiction?

According to the National Institute on Drug Abuse, addiction differs from substance abuse in that it is a chronic disease that is incredibly difficult to control. Abuse of certain substances, such as alcohol or prescription drugs, can cause chemical changes in the brain that lead to addiction. These changes compel someone to keep using the substance that they are addicted to, no matter what the negative effects may be.

“Drug addiction has a more severe presentation than drug abuse,” Sabrina Romanoff, PsyD, a clinical psychologist at Lennox Hill Hospital in New York City, tells WebMD Connect to Care. “With the physical symptoms [of addiction] comes the psychological element of feelings of helplessness and hopelessness in having control over addiction behaviors,” Romanoff says.

Common symptoms of drug addiction include:

  • Developing a tolerance to the drug
  • Experiencing withdrawal symptoms when you try to stop using
  • Being unable to stop, even when you want to
  • Constantly thinking about the drug, how to get it, and how it makes you feel
  • Inability to complete daily tasks
  • Relationship problems with friends, family, and coworkers
  • Sleeping too little or too much
  • Changes in appetite
  • Changes in appearance including bloodshot eyes, weight gain or loss, tremors, and shakes
  • Lack of personal hygiene
  • Mixing drugs and alcohol
  • Stealing or borrowing money to pay for drugs
  • Abusing prescriptions to get more of certain drugs
  • Irritability, agitation, and changes in motivation

What’s the Difference Between the Two?

According to the National Institute on Drug Abuse, the hallmark feature of addiction is substance use that is compulsive and difficult to stop—even in the presence of negative consequences. In contrast, someone with a substance abuse problem will typically find that it is relatively easy to stop using the substance they are abusing. 

Although substance abuse is not yet an addiction, warning signs must be closely observed. “While there is a nuanced difference between the two, it is helpful to remember that substance abuse can exist without addiction. However, abuse often leads to addiction,” Romanoff says. The challenges associated with substance abuse are much easier to overcome before someone becomes dependent upon or addicted to a substance.

Don’t Wait. Get Help Now.

Experts from the National Institute on Drug Abuse explain that drug addiction is a chronic health condition that requires ongoing treatment. A wide variety of treatment options are available to help beat substance abuse and addiction. 

If you or a loved one are struggling with addiction, WebMD Connect to Care Advisors are standing by to help.

Treatment & Resources: General Information