Substance Disorders

In the rehabilitation arena, substance abuse refers to over-consumption of natural or chemical drugs, including alcohol and addictive medication, which is detrimental to the wellbeing of the abuser and, most often, unsettles other people. The person may abuse the substance occasionally or persistently. Abuse often leads to dependency and, ultimately, an addiction which is a scenario better avoided.

There are very complicated clinical definitions for abuse, and in some respects, the options differ from the definitions used in other contexts, but for the sake of simplicity, this summary is a down-to-earth look at the everyday use of the term substance abuse and how it relates to dependency and addiction.

Consequences of substance use disorder

Many people use alcohol now and then, or even experiment with drugs. Many manage functionally for a fairly long time. That once-off fun event can introduce you to substances that compel you to use them again and again because they make you feel “good”.

You may not even be aware of an underlying emotional constraint that withholds you from enjoying life, but a single encounter with a substance suddenly opens a new door for you. It enables you to joyfully do things you avoided in the past. Alternatively, you may feel a heavenly relieve from stress or anxiety. This is the lure of drugs – it gives us a false sense of wellbeing for a short while and tempts us to revisit it.

Even as an occasional exercise, substance abuse is a bad idea because it exposes us to embarrassment, arguments, clashes with the law, accidents and injuries. The worst part is that it can easily become repetitive, with the potential to destroy the abuser.

Abuse is a known gateway to addiction, which causes relationship problems, financial hardship, poor mental and physical health, loss of employment and myriad other complications. Death becomes a reality for most abusers who develop an addiction.

What is substance abuse / use disorder?

When it comes to drugs, the word abuse is often used as a synonym for dependency and addiction. Although there are differences, the three words are used interchangeably by the mainstream media and by society in general. In clinical circles, there are complicated discussions about their exact definition, but for practical purposes this overview will suffice:

Abuse is a complex word. In general terms, it simply means over-indulgence, regardless of whether it is occasional or habitually persistent. In essence, the word is generally applied to any form or pattern of irresponsible drug usage. Even moderate use of so-called “hard” drugs is seen as abuse, because of the extremely high inherent risk of these illegal substances.

Dependency develops when a user becomes reliant on a drug to achieve a state of comfort under specific conditions. Although it may cause concern, users have a measure of control and only turn to the drug when a situation calls for it. In the early stages it is usually not seen as a big problem, but it is a known passage to addiction. Because it is difficult to draw a clear line between dependency and the onset of addiction, the more “neutral” word dependency is often used in place of the “harsher” addiction.

Addiction is when abusers lose control and become intensely focused on obtaining and using a drug. Their bodies develop a tolerance to the drug and require ever-larger volumes of the drug to attain the same level of relief. Addicts will sacrifice things dear to them and take risks to satisfy their cravings. They persist with this, regardless of the negative consequences, mainly because they fear the unpleasant symptoms that reduction or termination of the drug will cause.

Prevention and action

Prevention is the fundamental and most desirable solution to all disorders, but in matters of abuse there are complex challenges. No addict starts off with the intention of becoming addicted. They believe that they can control the situation forever. Unfortunately, the worldwide drug problem proves that the opposite happens more often than we think.

A single pleasant interaction with a drug can trigger a process that overtly sneaks into your life with deadly precision and stealthily drives you into a corner. As it progresses, you try to hide it and even promise yourself that you will stop sometime soon. Eventually, you are so dependent on the drug that you will do anything to avoid being without it. You will also resist any attempt to help you to get rid of the addiction.

There is, however, only one lasting solution. You have to get proper professional treatment that will not only get you over the initial withdrawals but will also arm you with the skills to cope with life afterwards – such as dealing with embarrassing or uncomfortable situations, as well as actually enjoying life without the need for drugs and without the constraints that initially drove you to addiction.

If you want more advice about substance abuse, feel free to call the number at the top of this page for more comprehensive guidance or a confidential appointment with an experienced counsellor.

It can be difficult for the untrained eye to draw the line between abuse and addiction which is why so many help centres for substance abuse exist in South Africa.

If any three, or more, of the following symptoms exist, then abuse has progressed to addiction:
  • User has strong, unpleasant physical and/or emotional feelings when the desired effect of the substance wears off.
  • A “booster fix” is taken to overcome the unpleasant withdrawal effects.
  • User continues to use the substance, despite knowing that it is harmful.
  • User fails to reduce or stop the long term habit/usage of the substance.
  • User takes bigger quantities (or takes it at shorter intervals) to get the desired effect.
  • User’s thoughts are so focused on the substance that it is hard to pay attention to anything else.
  • Using the substance is more important than the feelings of other people or the fulfilment of responsibilities.
Read more about what we treat here and rehabilitation options for substance abuse disorders.

Abuse is when something is used excessively, but abusers are not necessarily addicted to the item. An abuser may use a substance in excessive volumes at occasional events or they may use small volumes more frequently than the average person, but essentially an abuser is in control of the overall situation. They are not driven by an urgency to repeat the action, in contrast to the way in which an addict behaves. Although their actions are sometimes embarrassing or harmful, it is not as destructive as addiction.

The word abuse is usually applied when there is doubt about whether someone has progressed to addiction, with the benefit of the doubt in favour of the person with the problem.

However, in a certain sense, the word abuse is somewhat vague. It may indicate a singular event or it may refer to an ongoing pattern. Also, the degree of abuse is often not defined. If it is ongoing or severe, then it indicates an addiction or, at the least, susceptibility to addiction. Some addicts actually indulge only in periodic binge sessions, rather than daily sessions.

The word is often used as a distraction to cover up (or hide) an addiction. It is a convenient way for addicts to manipulate arguments and to avoid being forced into discontinuing an addiction. It allows them to buy time, usually by making promises to reign in the habit, which invariably fails to materialise after a while.

As a result, in a manner of speaking, substance abuse has become almost synonymous with addiction and is often used in lieu of substance addiction.

Regardless of which word is used, if the behaviour causes a problem in any way, it is essential to consult a trained therapist or medical adviser, as the eventual outcome of this behaviour pattern poses an enormous risk that many people tend to under-estimate.

Dependency often overlaps with abuse and addiction. Some people legitimately need habit-forming medication, administered in a controlled environment, to treat an illness or disorder – they are dependent on it, but not necessarily addicted to it. However, they may, at times, abuse it.

On the other hand, many people become dependent on things without the presence of clinical treatment – they turn to alcohol and habit-forming drugs for pleasure, or to get temporary relief from discomfort without seeking professional help. It can be an indicator, or forerunner, of addiction. In the early stages, this “self-medication” can turn into strong dependency – a stage where it is often not yet identified as a problem. From there, it develops into full-blown addiction.

Addiction is when a person has become so dependent on a substance, that it becomes an overwhelming, destructive part of their lives. They feel an urgency to take it in excess, in a repetitive, ongoing manner, to prevent discomfort or withdrawal symptoms.

They persist with the pattern, despite knowing that it is harming them (and those around them) and despite protests from other people. It is extremely difficult for them to reduce their intake or to stop taking it. They have lost control over the situation.