The Substance Abuse Spectrum


It’s really important that we understand substance use as a spectrum.  On one side is no use at all; while on the other side is full-blown addiction.  In between the two ends are progressive stages of substance use that become marked by the level of problems the user experiences as a result of the substance use.  The reason for the emphasis is that, in order to disrupt the progression, treatment providers (or friends and family) must develop awareness in the substance user of the association between the substance use and the experienced problems.

To me, non-use and moderate, non-problematic use is relatively easy to understand.  If a person doesn’t use substances or does so moderately, that person probably won’t experience too many problems.  However, as substance use increases, so then do the problems.  Although there are people who can use a substance rather heavily, they still may not experience too many health and/or social problems.  I would argue, however, that continued heavy use will lead to problems that begin as moderate but then escalate towards serious health problems and eventual addiction.

Two adverse consequences that indicate full-blown addiction (as a reminder addiction is marked by the three (3) C’s: Control, Consequences, and Compulsion) are tolerance and withdrawal upon stopping use.  Tolerance is the need to increase substance use to attain desired results.  Withdrawal is a set of physical symptoms that emerge when the used substance is no longer present within the body.

For example, withdrawal from opiates in marked by chills, diarrhea, sever body aches and pains, anxiety and/or depression, and nausea.  Opiate users must maintain opiate levels within their bodies such that they do not withdraw.

When we understand substance use as a spectrum, we can eliminate the “either/or” mentality towards substance use.  That is, not all people who use substances are addicted to them.  Also, there are levels of functioning that must also be taken into account when looking at substance use.  Substance use and addiction is a topic that must be viewed with a wide lens such that we can eliminate judgment and shame from an already complex issue.