While the current DSM-5 focuses on the level of substance use disorders as mild, moderate, and severe, it can still be valuable to look at alcohol and drug use in these three categories: use, misuse, and addiction.
What Does Use Look Like?
Use is the category of social users of a substance, such as a social drinker. Social users do not have any problems related to the use; they:
- Can ‘take it or leave it.’
- Have no desire to become intoxicated
- Use because they enjoy the taste, the ritual, and perhaps, just feeling a bit more relaxed from the use
- Don’t use the substance to cover up emotions.
For example, they may have a glass of wine with dinner. At this stage, drinking one glass of wine doesn’t cause personality changes. Nor does it lead to any type of consequences. Some social users may only partake at a wedding or a toast on New Year's.
What Does Misuse Look Like?
This category is often tricky. At times, one may present as a social user. At other times, he appears to be sliding into a problematic use.
One hallmark sign of misuse is a personality change such as anger or depression.
For example, Jason may have started as a social user of marijuana, but begins to slip into misuse. He finds that using heavier helps him to cope with emotional or physical pain, and starts using more heavily. As he likes the feeling it gives him, he begins making up physical health problems in order to get his medical marijuana card so that he can use legally.
Similarly, for those who misuse alcohol, they may find start missing work due to a hangover, having more fights with a spouse, and perhaps, getting a drunk driving charge.
We see the similar mood changes and increased dosage with substances like pain pills. Karon was prescribed Norco after a knee surgery. She quickly learned that she liked the feeling of the drug. It helped help her deal with the emotional trauma of being a sexual assault survivor. Because she continued to use it after her recovery for non-prescription use, she began to doctor shop. When that didn’t work, she got her drugs from a dealer. Her misuse had grown into an addiction.
What Is Addiction?
“An addiction is an unhealthy relationship with or to a mood-altering substance, event, person, or thing that has life-damaging consequences.” - Unknown
This is a pertinent definition as one has to meet three criteria; unhealthy relationship, mood-altering, and life-damaging. Here we find that the use of substances (as well as other addictions such as eating disorders, self-harm behaviors, codependent relationships) has now turned significantly problematic.
The woman who used to drink occasionally is now drinking up to 2 bottles of wine a day. Her personality changes through her isolation and anxiety. She may have had a couple of drunk-driving charges and ended up in jail, with her kids taken away from her.
Those using highly addictive drugs such as crack, often quickly move from use to misuse to addiction. Others may skip the misuse category. So many variables affect this progression, including family history and addictiveness of the substance.
Fortunately, there are many ways to recover if one is in the abuse or addiction stage. Counseling, 12-step meetings and other support groups, treatment centers, and healthy living practices can help. If you feel you or someone you love is in danger, please follow up with help in your local community.
Carol Anderson, D.Min., ACSW, LMSW, is a licensed clinical social worker with over 25 years of experience in the fields of mental health, addictions, and co-occurring disorders. Her other specialties include grief and trauma, women’s issues, chronic pain management, holistic healing, GLBTQ concerns, and spirituality and transpersonal psychology. Dr. Anderson has been educated and trained in the fields of education, social work, and spirituality, and she holds a Doctor of Ministry degree (non-denominational/interfaith) specializing in spirituality.