ALCOHOL AND SUBSTANCE ABUSE
Edward A. Dreyfus, Ph.D.

Difference between Abuse,
Dependence and Addiction

Alcohol and drug use ranges on a continuum from use to dependence characterized by increasing loss of control and increasing functional impairment. The term abuse is a broad term that refers to any maladaptive use of a psychoactive substance. There comes a point where the use of the alcohol or drug is no longer voluntary and becomes involuntary and beyond the individual’s control. When it reaches the stage where alcohol or drug use is no longer voluntary and interferes with daily functioning, we call it an addiction. Dr. Alan Leshner, Director of the National Institute on Drug Abuse, stated that the condition of addiction is a “biobehavioral phenomenon” characterized by a movement from a state in which use is at least under some degree of voluntary control to a state in which use is both compulsive and uncontrollable. He characterized addiction as a different state from abuse. Leshner states that with addiction there are fundamental brain changes that occur with increased use. These brain changes create a need in the individual for increased, compulsive use of the substance. In addiction there is a loss of control and increasing use despite negative consequences. The term dependence refers to a more severe form of abuse characterized by habitual use of a substance that is taken more frequently and in larger amounts over time, leading to increasingly negative consequences.

Historically, there have been two camps regarding the understanding of drug and alcohol addiction. One camp, dominated by physicians, holds to the belief that addiction was based on a disease model. It states that there is a genetic and/or bio-chemical basis for addictions and that the individuals cannot consistently control their drug-alcohol behavior without total abstinence. They claim that there is no cure because addicts cannot escape the biochemical predisposition. The other camp, dominated by psychologists, believes that alcohol and drug abuse is a learned behavior and, as such, can be unlearned, change or controlled through behavioral-learning models of treatment.

Increasingly, addiction workers in the field are coming to the realization that neither approach alone may be sufficient for treating a large number of addicts. For some individuals there may be a biochemical basis for their addiction, for some a behavioral basis, and for still others, both may be involved. Furthermore, these workers are recognizing that treatment isn’t based on a “one size fits all” model. While the abstinence model may be appropriate for some individuals, a moderation approach may be effective for others. Addiction is a multi-variate disorder with no simple solutions. By offering only one approach we put addicts in the position of either adopting the only available treatment approach, whether or not it works for them, or not receiving any treatment at all. Most professionals in the field recognize that treatment of addiction must focus on the addictive behavior itself rather than on the cause of the addiction.

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