Addiction, substance use disorder or chemical dependency

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs of addiction

Addiction.
Photo courtesy of Pixabay.com

What is the difference between addiction and chemical dependency?

A lot of different terms are applied to the usage of substances and problems that arise when people begin to experience difficulties with their use.

Various professions use different terminology to describe the same or similar problems and we don’t all use the same severity points to identify problems.

One way of understanding these differences is to think of substance use as being on a continuum. Let’s start with something most people are familiar with, alcohol use and then add various drugs to the picture.

Alcohol use might range from no use to chronic daily drinking to the point of passing out. Fully 50% of the people in the U. S, who are old enough to drink, did not have a drink in the last 30 days. Clearly not everyone drinks and among those who do, not everyone has a problem.

Heavy Drinkers.

At the other end of the scale, the 10% heaviest drinkers consume 60% of all the alcohol drunk. The top 20% heaviest drinkers consume 80% of the alcohol sold in America. People at the high end of the drinking scale develop more and more serious alcohol use problems than those who consume less.

Among those who do drink, some people have one or two drinks on a special occasion such as a wedding or New Years. People who drink at this level rarely have any problems. It is possible however to drink only once a year on New Year’s and end up drunk every time resulting in DUI’s or arrests.

The labels that will be attached to the person as their consumption of alcohol increases and problems begin to arise will vary with the profession and the reason the person is being given the label.

The person who has one drink and no ill effects would be considered by most of us an alcohol user but nothing more. The person who only drinks occasionally by when they drink has problems might be thought of as abusing alcohol.

The chemically dependent.

The medical profession often has special units which are called “Chemical Dependency units.” The people who reach these units have the most severe form of substance use disorder. They have reached the point of a physical dependence on their drug of choice. Those who are chemically dependent on Alcohol are at risk to die during withdrawal.

If someone has ever had a stroke, seizure or experienced the D.T,s if there are any hallucinations occurring when the level of alcohol in this person’s bloodstream begins to drop, this person is at high medical risk and should be detoxed in a hospital or other medically managed facility. People can and do die from alcohol withdrawals.

People who are chemical dependent on other drugs may have severe physical withdrawal symptoms. The heroin or opioid user, for example, will have diarrhea, nausea, vomiting, shakes, and goosebumps. The withdrawals from opiates may feel like the person will die but deaths from opiate withdrawals are rarer than from alcohol. Overdose deaths are another issue.

Short of physical withdrawal is a form of substance use disorder that is called Substance Dependence. Clearly, not all cravings for a drug of choice are the result of physical withdrawal.

Someone goes through a 30-day treatment program, they have not used for over a month but the day they are discharged they use again. The craving is not a result of physical chemical dependency but is a psychological need. Therapists would diagnose this as Substance Dependency. For the Therapist, this would include both physical and psychological dependency.

Alcoholism and addiction.

Twelve-step programs draw a different distinction. They would call this problem use of substances, addiction or alcoholism. This addiction level of problem use may be reached even before psychological dependency has occurred. Addiction may begin at the point of wanting, craving and thinking about the drug of choice even before the person has lost the ability to control usage. If you are struggling to control your usage then you have already reached a point of problem usage and probably would fit the description of an alcoholic or addict.

Substance abuse.

The lowest level of problem use would be referred to as substance abuse. This might be binge drinking, drinking more than planned or doing something dangerous after having consumed alcohol or another drug. The person who has a few too many drinks and then drives may be abusing alcohol but may not yet have developed alcoholism.

If this alcohol abuser can realize they have a problem and stop drinking to excess, they may be able to stop their progression to alcohol dependence, alcoholism or chemical dependency.

Substance use disorder makes its debut.

The newer trend, now reflected in the DSM-5, is to avoid making fine distinctions between substance abuse, dependency, addiction, and chemical dependency and call all problem relationship with drugs including alcohol simply a substance use disorder.

Substance use disorder can come in mild, moderate or severe forms.

Wherever the substance use disorder starts, it needs treatment long before it becomes an addiction or chemical dependency.

Whatever happens (It has happened with the DSM-5 and the new OCD-10 as of 10/1/15) with the DSM-5, expect the various professions and the recovery community to cling to their own special perspectives and their preferred terminology.

Did that explanation help with understanding the differences between Substance use, abuse, dependency, addiction, alcoholism, and chemical dependency?

Best wishes on your journey towards a happy life.

David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

How does someone become an addict?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs of addiction

Addiction.
Photo courtesy of Pixabay.com

How to become an addict – The process of addiction.

I haven’t met anyone yet who deliberately set out to become an addict. Some people intended to do all the drugs or drink all the alcohol they could, but mostly they did not expect to really become addicted. How does this thing called addiction develop and why don’t people stop before it is too late?

I don’t remember Alcoholic being on the list of occupations in our school career classes. Even without instruction plenty of people go on to become addicted. You would think that highly educated people would know better than to put themselves at risk. Clearly learning and teaching the process of addiction has been left out of our educational system.

Here is how we teach the process of addiction in substance abuse and co-occurring disorder classes.

You too could become an addict in five easy steps. Not everyone goes through all these steps in exactly this order, but most people do. You could go through all of the steps quickly or slowly. Stay on the using course and you should eventually get to the end point of addiction. After the addition, doctors call this chemical dependency; you will find death, incarceration or psychiatric facilities.

Step One – Experimentation with substances.

At some point, the child or young adult tries a substance. Forget what you have heard about pushers. They are too busy making deliveries to do the startup work of creating a new addict. Most kids get their first drug from their parents or grandparents. (See my post on Grandma as a drug pusher.)

The first time for most kids is sneaking some of their parent’s cigarettes or finishing a parent’s beer. Plenty of kids tell me they drank for years emptying out dad’s bottle of vodka half way and then topping it off with water.

This process even happens in families where the parents don’t smoke or drink. Boys usually are introduced to substances by other male relatives, an older brother, cousin, uncle or friends. Girls are often given something by a boyfriend or would be boyfriend.

For a while, this may go a long hit or miss. The person try’s this or that, likes some things and does more of that drug or does not like the feeling and does not do that again.

People from non-smoking and non-drinking homes are not immune from this process. They may find a friend to mentor them in drug use or they may delay the experimentation till they leave home for college, the military or after marriage.

Step Two – Social substance use.

At some point in this process, the person finds that all their friends are into a particular drug. It might be that their crowd smokes cigarettes. Once the underage smoker has lite up that second cigarette there is an 85% chance they will smoke the rest of their life.

But maybe your group of friends gets together somewhere and drinks a few beers or smokes some weed. That shouldn’t lead to an addiction right? Well not directly. You still have time to avoid that consequence but you are moving closer.

Drug users of any type tend to clump together. Each drug of choice has a culture. Beer drinkers party together and so do weed smokers and heroin injectors.

In the beginning drug use is a social thing. When the group you are in or want to be in gets together they drink this stuff, smoke this stuff, do this drug, you do it also or you stop hanging out with them. Why do you want to spend every Friday night with people who are drinking if you don’t drink?

Step Three – substance use becomes a habit.

One week all your friends are gone, out of town, and here you are stuck at home alone. It is Friday night – this is the night that you drink a few beers or smoke some weed right? So you drink a few or light one up.

At this point using a particular drug has moved from being a social activity you do with others to a habit you have. It may stay there for a long while. You may keep your beer drinking or smoking weed to Fridays nights, only but most people don’t.

If you like the drug you would like to do it more than one time a week. If you don’t like it you may move on and try something else. Maybe find a new group of friends and adopt their drug of choice. You might take up drinking coffee or smoking methamphetamine.

One thing about drugs, mild or strong is that they are reliable. You do them and they chance the way you feel. If you like the head change you want more. If you do not like the change you probably will pick a new drug you do like, or stop altogether. But that means you have to get new friends. So your trip down the addiction road continues.

Psychological dependency develops after a while.

One week you find you are alone, you want to drink or smoke and you have to go somewhere with the family or somewhere there will be no drugs. You get upset, you get angry, you may even pick a fight with your family and storm out. Then it is their fault you had to go get high.

At this point, you want the drug more than ever before. You need the drug to get by. You think about her all the time. And when you don’t get to do your drug you are angry about it – or depressed or anxious – until you get to get high again.

You are not yet physically addicted but you have developed a psychological need for the drug. This is the last stop on the path before you reach full chemical dependency. And you are thinking at this point that the drug is your friend and your helper.

Physical Addiction can be the last house on the block.

One day you can’t get the drug. You become sick, psychically or emotionally ill. You may end up in the hospital, the psychiatric ward or the jail. Suddenly you realize that even when you want to quit when you try to go for a few days without that drug, you just can’t do it.

Beyond addiction, now what?

Once you have reached the point of addiction, doctors’ call this chemical dependency, you have very few choices. You can quit, which turns out to be very difficult without help. You could go to some meetings, get a sponsor and work some steps in the process of change. You might go to a program or see a counselor or you might just decide that you are helpless and you will stay addicted. Lots of people chose to stay addicted.

The A.A. big book tells us that beyond addiction, if you chose not to accept help, you are headed for misery, jails, institutions or death. But as with all the stages before this, the choice is of course yours. Lots of addicted people cycle through psychiatric facilities as the drug addiction warps their thinking. We call this joint problem of addiction and mental illness co-occurring disorders or dual diagnosis.

Any questions about my description of how an addiction could develop, be maintained and result in a co-occurring addiction and mental illness?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.