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Substance Use Disorder vs. Substance Misuse

Recently, the term substance misuse has been gaining in popularity, and can even be found on governmental websites. What does this term mean? Is it different from substance use disorders? How does this impact those needing services? We will attempt to shed some light on the numerous questions that surround this term.



Substance Use Disorder


Substance Use Disorders are the current diagnosis for common terms like substance abuse or addiction (to substances). This diagnosis has three different severity levels, mild, moderate, or severe. This diagnosis came to be in 2013 when the DSM-5 became final. Prior to this, substance abuse and substance dependence were the two diagnoses, with abuse being more problematic behavior, and dependence being more like addiction. This current definition has unified these diagnoses under one set of criteria and has drastically simplified diagnosis. These include diagnostic criteria that can be used by a professional to make a formal diagnosis.



Substance Misuse


What is substance misuse? At minimum, we can take this term at face value. A misuse of substances. However, this is highly subjective outside of the scope of taking prescription medication other than in the way it was prescribed. The main problem with substance misuse would be using it outside of this scope. There needs to be criteria to make this a useful definition, but there is none, because this is not a diagnosis. Unfortunately, this is starting to show up on the internet, even on governmental agency websites.


Which substances does this term apply to? Realistically, any substance that you can ingest. In our research, we saw mention of tobacco, which also brings in caffeine, and ultimately misuse of behaviors could be captured under this umbrella. Interestingly, if someone meets any of these many definitions that we found in our research, they could also qualify for a substance use disorder.



Appropriate Recreational Use


What is appropriate recreational use? There are some guidelines, but very few. These guidelines are primarily for alcohol, as this is a legal substance, but there is no guideline for appropriate recreational use of cocaine. Therefore, there is no clear delineation between recreational use and misuse. However, there is a line between substance user disorders and not-substance use disorders, as there are diagnostic criteria. What we can do though, is use the diagnostic criteria to see if someone is on the path of developing a use disorder. A professional can also use assessments to assist in this process. In this way, early intervention can be used to hopefully prevent a substance use disorder from actually developing.



Does Substance Misuse Help or Hurt Clients and Clinicians


Substance misuse does not appear to have any practicality outside of early prevention. Prevention is clearly more effective than remediation, but only if done legitimately. This would need to be utilized only within legitimate diagnostic criteria and substance misuse would need to be in the DSM. This is not currently the case and it likely makes it more difficult for individuals to receive treatment. Realistically, what this is doing is providing a platform for minimizing and justifying behavior. Substance misuse can hurt if an individual is already in denial about their substance use. However, if there is already the need for a term to describe behavior, the individual is most likely in dangerous territory. 


Furthermore, does this minimize the legitimacy of substance use disorders as a medical condition? If people continue to feel ashamed of their use disorders, it reinforces the public perception that substance use is a moral-based choice, rather than a disorder of choice. Consider individuals with diabetes or cancer.  While they do not necessarily broadcast this information, they are not living in guilt and shame about it and looking for a different term to describe their situation. We are not advocating for individuals to broadcast their substance use disorder, but we are encouraging individuals to embrace it as a medical condition that they need to manage, and it does not make them a bad person, despite symptoms of substance use appearing at times to be problematic or bad behavior. Unfortunately, until such a label exists, treatment typically cannot begin, at least if a client expects to go to inpatient treatment and utilize services through insurance. Private counseling is different, but diagnoses remain important. If you do not think this term applies to you, but misuse does, you may want to reconsider and take a serious look at your substance use or behaviors. 



Independent Recovery's Stance on Substance Misuse


At Independent Recovery, we do not understand the need for this term, particularly as it is not a formal diagnosis. This brings us backwards into pre-2013 diagnostic territory, and there is no need for this. The only way we would be in support of this would be if it we're a formal diagnosis in the DSM. We are not sure who coined this phrase either. Perhaps it was a lawyer attempting to get clients off of a sentence, or perhaps it was some bureaucratic organization. Regardless, it would appear to be an effort to avoid taking accountability and responsibility for one's own actions and the severity of a problem. Misuse has the potential to completely eliminate any thought of an individual having a problem, as they simply misused the substance this day or the last week. At Independent Recovery, we are advocates for responsibility and accountability. We do not believe that this term supports that, and will only be in support of this if it becomes a legitimate diagnosis in the DSM. If this discussion sparked interest in you, or is making you question the behavior of yourself or a loved one, please feel free to contact us for free consultation. Head on over to our Get Started page, and we will be in contact with you shortly.