Core Concept Human Health Published: March 20, 2024

The True Meaning of Addiction (And How To Talk About It!)


Many of us have heard the saying “words matter”. This is especially true when talking about substance use disorders and addiction. Substance use disorders affect millions of people, including adolescents and young adults. Addiction is a long-term medical condition. In many cases, people with addictions want to quit but find it difficult. For example, many of us know someone who would love to quit smoking but is having trouble because they are addicted to nicotine. People who use substances may feel judged by others, which can make them hesitant to talk openly about their substance use or its effects on their lives. It is important that we all know how to talk about addiction non-judgmentally, which starts by knowing the correct words to use.

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.

Do you find that you need a lot more alcohol or substances to become drunk or high than you used to?
Have you ever developed the shakes, nervousness, or otherwise felt sick for a full day or more after you cut down on your drinking or substance use?
When you drink/smoke/use substances do you often find you use more or for a longer time than you meant to?
Have you been thinking about cutting down or quitting alcohol or another substance? Have you ever tried to cut down on your drinking or substance use, but could not?
Do you spend a lot of time drinking/smoking/using substances, like a hobby?
Have you ever craved a substance or had a desire or urge to use a substance?
Does your drinking or substance use interfere with your responsibilities at home, at work, at school, or other responsibilities such as extra-curricular activities or volunteering? Has this happened more than once?
Is drinking/smoking/substance use impacting your physical health or mental health?
Does drinking/smoking/substance use ever cause you to have problems with your family, friends, or people at work or school, or has it led to any physical fights?
Has drinking/smoking/substance use impacted your grades, hobbies, sports, or job?
Have there been times when you were under the influence of a substance when you could have gotten yourself or others hurt, or put yourself or others at risk? Has this happened more than once?
  • Table 1 - Diagnosis of a substance use disorder over the past 12 months.

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.

Figure 1 - Level of substance use disorder based on DSM-5 criteria.
  • Figure 1 - Level of substance use disorder based on DSM-5 criteria.
  • This figure shows the number of “yes” answers required to be diagnosed with each level of substance use disorder.

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).

Avoid Instead use
Addict, user, and abuser Person with a substance use disorder
Substance abuse Substance use, substance misuse, and substance use disorder
Treatment failure Treatment attempt
Clean Not using substances, abstinent, and in recovery
Dirty Person who uses substances
  • Table 2 - Medically accurate terminology.

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!

Figure 2 - Study results comparing how people felt when hearing that a person was a “substance abuser” vs.

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”.


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.


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.


[1] Substance Abuse and Mental Health Services Administration. 2022. Key Substance Use and Mental Health Indicators in the United States: Results From the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Available online at: (accessed November 16, 2023).

[2] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Association.

[3] Kelly, J. F., and Westerhoff, C. M. 2010. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int. J. Drug Policy 21:202–7. doi: 10.1016/j.drugpo.2009.10.010

[4] Kelly, J. F., Dow, S. J., and Westerhoff, C. 2010. Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. J. Drug Iss. 40:805–18. doi: 10.1177/002204261004000403