The difference between drug abuse, addiction, dependence, and other related terms
18 November 2021
Healthy Pilipinas

In observance of Drug Abuse Prevention and Control Week (November 15-21), let us review the different terminology that are often used—and misused—in conversations relating to drug use, abuse, and prevention.

The first is “drug abuse.” In simple terms, this refers to the problematic use of a drug—meaning, in amounts or methods that are already harmful to an individual or other people. It is important to make that distinction because drug use, including the use of illegal drugs, is a daily fact of life; however, in most instances, such use does not result in harmful consequences.

In popular conversation, drug abuse often pertains to the harmful use of substances like methamphetamine (or shabu), cocaine, heroin, and a range of other illegal substances—but it is equally important to note that drug abuse also includes the harmful use of alcohol (i.e. alcoholism) and even pain medications.

Drug abuse—which refers only to harmful use—is different from “drug addiction,” which is the biopsychosocial disorder. The key elements of drug addiction are “compulsion” and “reward”: It refers to the compulsive or repetitive use of a substance because such use entails rewarding stimuli (e.g. pleasure), even if it also has harmful consequences. Like drug abuse, drug addiction can also involve a range of substances, from illegal drugs like shabu to legal and popular substances like alcohol and painkillers.

Relevant to the ideas of harmful use and addiction are three terms: “tolerance,” “withdrawal,” and “dependence”. Tolerance pertains to the diminishing effect produced by the repeated use of a substance, which means an individual now needs to use higher amounts of the same substance in order to achieve the same “rewards” or effects.

Withdrawal, on the other hand, refers to the constellation of unpleasant symptoms (physical and/or psychological) that an individual experiences when he or she abruptly stops the use of a substance, or even just decreases the amount taken.

Finally, dependence pertains to functionality—or the need to take a particular substance in order to function properly in daily life. When an individual experiences withdrawal upon cessation of or decreased substance use, that individual can be said to be dependent upon the substance.

Under the International Classification of Diseases, drug dependence—which is under substance dependence—is recognized as a mental and behavioral disorder. And in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the main reference text used by psychiatrists, drug abuse and drug dependence are classified under the general umbrella of “substance abuse disorders.”