October 30, 2017 Felicia Durling

Abuse vs Dependence

substance dependenceSubstance abuse and substance dependence are often mistaken for one another. The DSM-IV, the diagnostic statistical manual of mental disorders, differentiates the two in great detail but with some similarities, while common language often uses the terms interchangeably. Therein lies the confusion of so many people around the world trying to decide where they stand in their relationship with substances. Both substance abuse and substance dependence demand critical attention from family members, loved ones, and health practitioners. Each provides insight to the suffering happening in someone’s life.

The DSM marks both substance abuse and substance dependence as “a maladaptive pattern of substance use leading to clinically significant impairment or distress”. Each have to be developed as the result of their symptoms within a twelve month period. Substance abuse is gauged by the meeting of one or more criteria, while substance dependence is diagnosed by having met three or more criteria.

Substance Abuse

Substance abuse is highlighted by problems of recurrent demonstration. All of the criteria for diagnosis involve repeated activities which continue to cause problematic situations. Despite these negative consequences, the substance abuse continues. We see this situation so often in addiction denial. We cannot see the damaging effects of our substance abuse on others and the world around us and continue to engage in destructive behavior out of ignorance.

The criteria for substance abuse include:

  • “Failure to fulfill major role obligations at work, school, or home”
  • Use in “physically hazardous situations”
  • “Social or interpersonal problems caused or exacerbated by the effects of the substance”

Substance Dependence

For many, dependence is seen as the landmark of substance use disorder. Psychological and physiological dependence on a substance has taken place, indicating full dysfunction. People often mistakenly assume substance dependence to be the key indicator that substance use is ‘out of control,’ however, substance abuse is equally unmanageable.

The criteria for substance dependence include:

  • Tolerance; needing an increasing amount of the substance to achieve a similar or greater intoxication level or effect
  • Withdrawal; showing signs and symptoms of withdrawal specific to the substance of choice and taking doses of the substance of choice or a similar substance to prevent or alleviate symptoms of withdrawal
  • The period of time using the substance and the amount of the substance being used has exceed original intent or expectation
  • Always wanting to quit or reduce the amount of use, without success


With proper diagnosis and treatment, healing will prevail from either substance abuse or substance dependence. If you are feeling unsure of yours or a loved one’s substance use behaviors, call The Center for Life Change today. We’re here to help. Call (951) 775-4000 for more information.

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