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Addiction Versus Dependence Versus Tolerance When It Comes to Substance Abuse

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When you hear various substance abuse terms thrown about – tolerance, dependence, addiction, etc. – how do you know which ones applied to YOU and your situation?

According to the Substance Abuse and Mental Health Services Administration, MILLIONS of Americans admit to abusing alcohol, using illicit drugs, or misusing prescription medications. In 2016, for example, one survey found that roughly 49% of all US residents age 12 or older have used an illegal drug within their lifetime.

Approximately 1 in 9 people have done so within the past month.

Leaving out moral or legal considerations, when does substance use become a real problem?

Addiction – The Progressive Disease

Although they are often used interchangeably when describing intoxicating substances, the terms of use, misuse, abuse, tolerance, dependence, and addiction all have different individual meetings.

Because the horrific tragedy of drug overdose deaths in the United States continues to skyrocket – 2017 will see an estimated 71,000 substance-related fatalities – knowing how a Substance Use Disorder (SUD) develops and progresses can literally be the difference between someone “experimenting” and living or overdosing and dying.


What Is Substance Use and Misuse?

“Misuse” is typically reserved as a term for the non-medical use of prescription or over-the-counter medications, such as:

  • Opioid painkillers – OxyContin, Vicodin, codeine, fentanyl, etc.
  • Benzodiazepine tranquilizers – Xanax, Klonopin, Valium, Ativan, etc.
  • ADHD stimulants – Adderall, Ritalin, etc.
  • Cough medicines, especially those containing dextromethorphan
  • Motion sickness pills containing diphenhydramine

“Substance use”, on the other hand, can refer to any level of recreational use of ANY intoxicant, including:

  • Prescription and OTC drugs
  • Alcohol
  • Marijuana, legal or not
  • Heroin
  • Synthetic “designer” drugs
  • Methamphetamine
  • Cocaine
  • Inhalants
  • Certain herbal supplements
Substance use

Stage One – Experimentation

The National Institute on Drug Abuse reports that initiation of use, or experimentation, is very common, particularly during the teenage and young adult years. By the time the average American teenager is a high school senior:

  • 70% will have tried alcohol
  • 50% will have used an illegal drug
  • 40% will have smoked a cigarette
  • 20% will have misused a prescription

Here’s the thing – because the adolescent brain continues to develop until the person is in their early 20s, ANY substance use has a profound effect on the individual. The earlier the initiation of use, the more likely a future SUD diagnosis becomes.

For example, teenagers who initiate alcohol use before they turn 15 are SIX TIMES greater risk to develop an Alcohol Use Disorder within their lifetime than those who wait until they are of legal drinking age.

John Daily, LCSW, CADC II, the author of Adolescent and Young Adult Addiction: The Pathological Relationship to Intoxication and The Interpersonal Neurobiology Underpinnings, wrote, “… teenagers often experience a far more rapid progression from experimentation to addiction than is true for adults. Denial manifests differently, too, in that young people are more likely to glorify their use, while adults are more likely to minimize theirs.”

Stage Two – Regular Recreational Use

A significant portion of people who try an intoxicating substance go on to occasional or regular use.

According to the National Institute on Alcohol Abuse and Alcoholism:

  • Over 86% of US adults have tried alcohol.
  • More than 70% have used alcohol within the past year (occasional use).
  • 56% report drinking within the past month (regular use).

A Yahoo survey revealed a similar trend with marijuana:

  • Over half of US adults report lifetime use.
  • Of those, approximately 22%almost 55 MILLION people – have done so within the past year.
  • 35 MILLION American adults report past-month marijuana usage.
  • At least 8.4 MILLION do so DAILY.

From SAMHSA, frequency of ALL illicit drug use (including marijuana) among Americans age 12 and older:

  • Lifetime – 48.5%
  • Past year – 18%
  • Past month – 10.6%

Stage Three – Substance Abuse

“Substance abuse”, as the name implies, is when “use/misuse” escalates, resulting in negative consequences. The difference is in the amount consumed, the frequency, and the impact to other areas of their life.

It is a matter of degree. For example, a teenager who tries a beer or takes their first hit off a marijuana cigarette is not yet a “substance abuser”. Likewise, most adults who enjoy a single nightly cocktail would not be considered “problem drinkers”.

However, binge drinking or regular/daily illicit drug use – including legal marijuana – could be considered substance abuse.  Because of the extreme risk of overdose, all prescription drug misuse also qualifies and substance abuse.

Signs of Substance Abuse

Besides the qualifiers of amount and frequency, substance abuse can also be recognized by negative consequences that don’t generally occur with experimentation or infrequent or moderate use. Problems that might arise as a result of substance abuse include:

  • Legal difficulties
    • Impaired driving charges
    • Public intoxication
    • Possession
    • Disorderly conduct
    • Attorney’s fees
    • Court costs
    • Fines
    • Jail or prison time
    • Probation
  • Health concerns
    • Blackouts
    • Hangovers
    • Accidents
    • Injuries
    • Overdose
  • Problems at work or school
    • Excessive tardiness
    • Absenteeism
    • Poor performance
    • Disciplinary warnings
    • Suspension
    • Demotion
    • Termination or Expulsion
  • Relationship issues
    • Arguments
    • Separation
    • Divorce
    • Infidelity
    • Domestic violence
  • Financial strain
    • Spending money needed for bills on alcohol and/or drugs
    • Repossession
    • Eviction
  • Criminal activity
    • Falsifying prescriptions
    • Fraud
    • Theft
    • Embezzlement
    • Drug dealing

Here’s the thing – when you see evidence of these kinds of problems, and behaviors, it highlights the progressive nature of addiction.

Signs of Substance Abuse

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Stage Four – Tolerance

Somewhere during either Stage Two or Stage Three, the person will notice that they have to take more and more of their drug of choice to achieve the same level and duration of pleasurable effects. Just to maintain their accustomed level of intoxication, they will have to gradually increase how much and how frequently they drink or use.

This is known as tolerance.

When an intoxicating substance is consumed, it triggers a massive release of dopamine. This is the body’s neurotransmitter that is associated with pleasure, memory, and learning. Dopamine is the biological response to any activity that promotes survival, such as eating or sex. It produces the pleasurable “reward” for that activity.

Drugs of abuse trigger the brain into releasing artificially-high levels of dopamine. For example, methamphetamine use causes a flood of dopamine that is over six times greater than is released during the peak of orgasm.

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By |2019-11-04T18:43:34+00:00January 14th, 2018|

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