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What is Substance Abuse Disorder and is it a Disease?

What is substance abuse?

Can you keep a secret? Everyone you know, outside of your oddly wholesome third-grade teacher, abuses substances. Honestly, she probably did too. The vast majority of people are able to moderate their substances but will have times of abuse. Think about some of your New Year’s Day mornings; the rising sun was probably not a welcomed friend. If it’s not alcohol or “harder drugs”, you’ve probably drank too much coffee or eaten too much sugar. However, why is it that some people will wake up on that New Year’s Day and go on without a drive and preoccupation with consuming substances? This is where things get a little more murky.

So how is substance abuse defined? According to Google Dictionary, substance abuse is the overindulgence in or dependence on an addictive substance, especially alcohol or drugs.

Is Substance Use a Disease?

In the past professionals have classified substance abuse and substance dependence as distinct categories, but this shifted in recent years and was more or less combined to be called substance use disorder. The idea behind this seems to be that problematic substance use seems to occur on a spectrum. Some people could have relatively mild issues related to their substance use while others could have much more severe issues.

However, none of this directly answers the question of rather or not substance use is a disease. The notion of substance use as a disease has a long history but was first medically classified as a disease in 1954 by the New York City Medical Society. There were a variety of reasons for this, but one reason seems to be the need to shift the focus from alcoholism/addiction being framed as a moral failing and instead, as a medically-treatable issue.

There are probably a lot of reasons to debate the use of the word “disease” when describing addiction, but, like every word, it’s simply a word used to attempt to convey something. One of the benefits of framing it as a disease that impacts the brain’s ability to “make better choices” is we can remove it from the realm of morality and focus on how to help people.

In my opinion, one of the benefits of framing substance abuse as existing on the spectrum we now call Substance Abuse Disorder is that it better maps onto reality. Remember the example above of the New Year’s Day hangover? If that person doesn’t have unmanageable cravings to continue to engage in substance abuse, then it would be a stretch to say that person has an addiction. Let’s suppose this person’s use was to escalate to include more and more substances and more and more consequences? On the spectrum of substance use disorders we could begin to identify that person on the mild, moderate, or severe categories. Why does this matter? Well, for a lot of reasons, but primarily because it lets everyone share a framework for approaching the issues.

Something to consider when seeking treatment options for substance use issues is trying to match the level of treatment with the level of issues. Professionals will often look at a set of 11 symptoms associated with substance use disorders and diagnose a person as mild, moderate, or severe on the substance use disorder spectrum.

Here are some paraphrased examples from those 11 patterns to be on the lookout for if you become concerned about a potential substance use disorder in a family member:

  1. Your loved one makes promises to cut down but struggles to do so. 
  2. The person begins to miss obligations or performs poorly in work, school, family functions, managing money, etc.
  3. Your loved one gives up things that used to be meaningful. 
  4. They become preoccupied with obtaining the substances, or become irritable and show mood swings when substances aren’t available.
  5. Withdrawal symptoms if the person can’t use substances for some reason (nausea, increased anxiety, shaking, sleep loss, etc).

The more symptoms a person presents, the higher the level of care that person may need. Depending on the severity the person could do just fine in an outpatient program or transitional living program or, if the symptoms are worse, they could need something that’s more residential and includes medical care. A treatment and placement expert can be a giant help in navigating these needs and finding the right level of care for the right level of issues.


Marcus Shumate of Green Hill Recovery

About the Author

Marcus Shumate, LCMHC, LCAS previously led a young men’s treatment program, provided direct clinical care, and supervised staff. Marcus is the Clinical Outreach Director at Green Hill Recovery, a transitional living and outpatient treatment provider in Raleigh, NC, which serves young men with substance use and co-occurring mental health disorders. Green Hill’s programs not only treat addiction, but also address the academic, career, and life skills necessary to prepare young men for wellness beyond their days in treatment. At its core, Green Hill empowers individuals to live with profound purpose. To learn more visit our website at​​​​​ or call 984-204-1106.