What Does Addiction Mean?

When people use substances, like drugs or alcohol, to the point that a substance has significant effects on their lives, they are diagnosed as having a substance use disorder. More than 16% of people ages 12 years and older in the United States have a substance use disorder, which means substances have a significant effect on their lives. This is more than 46 million people [1]! When substance use leads to changes in a person’s brain, they have an addiction. Addiction is a disease and a long-term medical condition. People with addiction lose control over their substance use and often have problems with memory and motivation. These problems are due to changes in the parts of the brain that control behavior.

People with addiction can decide not to use a substance at a given moment, but they find themselves returning to use later. For example, people who are addicted to nicotine may refrain from smoking in a restaurant, but they may smoke a cigarette the minute they leave. For people with nicotine addiction, deciding not to smoke is like trying to hold your breath. You can do it for a little while, but after a few minutes, your brain forces you to breathe again (and thank goodness for that). When a person is addicted to smoking, their brain has been hijacked into thinking it needs nicotine, which makes it very tough to quit.

How is a Substance Use Disorder Diagnosed?

Substance use disorders are diagnosed using criteria listed in a book used by doctors and other healthcare providers to help define things clearly, called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [2]. Diagnosing substance use disorders involves 11 questions, and answering yes to 2 or more of them qualifies a person as having a substance use disorder (Table 1). All substance use disorders are diagnosed by these criteria, including for alcohol, nicotine, and other substances.

If the answer is “yes” to 2 or 3 questions, the person is diagnosed with a mild substance use disorder. When “yes” is the answer to 4 or 5 questions, the person has a moderate substance use disorder, and when the answer is “yes” to 6 or more questions, the person has a severe substance use disorder (Figure 1). People with severe substance use disorders often (but not always) have addiction. Sometimes people with mild or moderate substance use disorders also have addiction.

Choosing the Right Words

When talking about substance use disorders or addiction, it is important to use the right words. Language is powerful, and certain words express judgment or make people feel fear or shame. Stigma is another word for judgment toward a group of people, such as people with substance use disorders. People who feel stigmatized may be less likely to get the treatment that can help them get better. This means it is important to use medically accurate terminology—words that identify disorders and diseases without judgment or stigma (Table 2).

While the phrase “substance abuse” is commonly used, the word “abuse” indicates fault or a choice to do something wrong, instead of correctly identifying a substance use disorder as a medical problem. In fact, in one study, when healthcare providers heard patients described as substance abusers, providers were more likely to blame the person for their disorder and believe they deserved a punishment of some kind [3]. When similar patients were described as having a substance use disorder, healthcare providers were less judgmental. Non-medical people are also more likely to judge people who are referred to as “substance abusers” (Figure 2) [4]. In these studies, the people referred to as having a substance use disorder were more likely to be given sympathy and more likely to be viewed as having a medical condition needing treatment. These studies are examples of how using certain words can lead to judgment or stigma, even when we do not mean for them to. The words we choose can have a huge impact!

One example of using the right words involves using “person first” language. People are much more than their diseases. Using “person first” language avoids defining a person by a disease or disorder. To use “person first” language, put the person before other words used to describe them. For example, say, “person with an addiction” rather than “addict”.

Prevention

The brains of adolescents and young adults are still developing and can be damaged by substance use. Substances such as alcohol, cannabis, nicotine, and others can disrupt connections in the brain and cause problems with memory, motivation, and the ability to control substance use. The best way to prevent the development of substance use disorders and addiction is to never use substances at all. The younger a person is when they begin to use substances, the more likely they are to develop a substance use disorder later in life. Providing education on the dangers of substance use is one strategy to prevent young people from becoming addicted. Some adolescents are more likely than others to lose control over their substance use. Further research will continue to identify risk factors that lead an adolescent to develop a substance use disorder or addiction.

Recognizing Addiction as a Disease

Substance use disorders are ongoing medical problems that people can recover from with the appropriate treatment. However, people may feel judged for their substance use, often due to stigmatizing words. People who feel judged are less likely to seek treatment, and thus less likely to recover. When talking about people with substance use disorders, use person-first language (focus on the person and not on their disease). Make sure not to use words that imply the person is making a bad choice, such as “habit” or “abuse”. Most importantly, talk about addiction as you would talk about any other disease, such as diabetes or asthma. Recognizing addiction as a disease can encourage people to seek out treatment and increase their chances for recovery.

Glossary

Substance Use Disorder: ↑ Problematic use of substances identified by meeting at least two of 11 substance use disorder criteria over the past 12 months.

Addiction: ↑ A disease in which substance use leads to changes in a person’s brain, causing issues with memory, motivation, and an inability to control their substance use.

Stigma: ↑ A form of judgment toward any group of people, such as people with substance use disorders.

Medically Accurate Terminology: ↑ Words that identify disorders, diseases, and treatment without judgment or stigma.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.