The Difference Between Substance Misuse, Dependence, and Addiction

When it comes to describing drug and alcohol use to a loved one or discussing substance issues, many people often use the words misuse (also called substance abuse), dependence, and addiction interchangeably. They assume the words refer to the same thing or varying levels of the same condition. However, these terms represent distinct concepts. When discussing substance use disorders (SUD), it is essential to understand the differences among these three terms.

Substance Misuse

Substance misuse is often the starting point in a journey toward addiction. It is the point where the misuse of alcohol or drugs becomes more than just an occasional occurrence. Individuals frequently overindulge in these substances to an extent that begins to disrupt their lives. Their frequent use leads to a habit-forming pattern that can cause significant distress or problems. People may continue their destructive substance use despite the problems it causes, such as failing health, strained relationships, neglected responsibilities, or increased risk-taking. They do not care about the consequences of their actions. Their disregard for potential dangers is a critical warning sign that substance misuse has taken hold.

Substance misuse is not just about excessive drug or alcohol use. It is about the shift in behavior and attitude towards substances and the disregard for the harm substance use can cause. Substance misuse lays the groundwork for a potential escalation into dependence and, eventually, addiction. It is important to note that intervention at this stage can prevent the progression to the more severe stages of substance use.


Understanding the difference between dependence and addiction can be challenging, as varying definitions and interchangeable usage by different organizations often confuse the matter. The National Library of Medicine stresses the importance of understanding that drug dependence is not addiction and the terms are not interchangeable. 

Many people who abuse substances spiral downward toward addiction as their tolerance of the substance increases. They need more alcohol or a higher drug dose to reach the same high as before, indicating that the body is adjusting to the presence of the substance. The repetitive cycle continues as the person needs more and more drugs or alcohol. If they stop using the substance or significantly reduce the amount, they experience withdrawal symptoms. Symptoms could range from irritability and restlessness to more severe physical ailments like tremors or seizures. The individual’s everyday life begins to revolve around their substance of choice. Their time is devoted to obtaining the substance, using it, and then battling the after-effects. What was once a leisure activity or an occasional escape has changed into an incessant need. 

Dependence can be physical, psychological, or both. It is not simply an extension of substance abuse. It is a deepening of the relationship the individual has with alcohol or drugs. Their body has now adapted to the continuous presence of the substance. Its absence creates a violent reaction of the body and mind. However, it is important to remember that early intervention at this stage can still prevent the occurrence of full-blown addiction.


The National Institute on Drug Abuse explains that addiction is a condition characterized by persistent and recurring drug use despite the negative effects it brings about. This condition is classified as a chronic and relapsing brain disorder because it alters the functioning of brain circuits involved in reward, stress, and self-regulation.                                                      

Substance addiction is more than an escalation of substance misuse or dependence. Addiction takes over the individual’s life, turning substance use from a desire into an insatiable compulsion. It causes the person to focus their actions and thoughts toward one goal: obtaining and using the substance. They have a compulsive need to seek and use the substance despite the harmful consequences that may result. Their body and mind are in a continuous struggle between the relentless cravings and the harmful effects of substance use. They have no control over the substance. Instead, the substance is controlling their life.

Do You Need Help? 

Are you or a loved one struggling with drugs or alcohol? If you are, we can help. At English Mountain Recovery, located in the Smoky Mountains of eastern Tennessee, our skilled professionals will provide you with the care you need to take back control of your life. At English Mountain Recovery, we offer a gender-specific, 12-step treatment program for your emotional, physical, and spiritual healing. It is time to take the first step on the path to recovery. Contact us today.