Table of ContentsView AllTable of ContentsDefinitionCausesIllegal Substance UsePrescription Substance MisuseOther Commonly Abused SubstancesRisksIdentifying Substance MisuseTreatmentsPrevention

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Table of Contents

Definition

Causes

Illegal Substance Use

Prescription Substance Misuse

Other Commonly Abused Substances

Risks

Identifying Substance Misuse

Treatments

Prevention

A Note on LanguageWhile people commonly refer to problematic substance use as ‘substance abuse,’ the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) no longer uses this term. It is considered stigmatizing, soit is now preferred to use languagesuch as ‘substance misuse,’ ‘substance use disorder,’ or simply ‘substance use.‘The National Institute on Drug Abuse (NIDA) says that ‘abuse’ is no longer used because of its negative connotations and associations with punishment and judgment.

A Note on Language

While people commonly refer to problematic substance use as ‘substance abuse,’ the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) no longer uses this term. It is considered stigmatizing, soit is now preferred to use languagesuch as ‘substance misuse,’ ‘substance use disorder,’ or simply ‘substance use.‘The National Institute on Drug Abuse (NIDA) says that ‘abuse’ is no longer used because of its negative connotations and associations with punishment and judgment.

While people commonly refer to problematic substance use as ‘substance abuse,’ the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) no longer uses this term. It is considered stigmatizing, soit is now preferred to use languagesuch as ‘substance misuse,’ ‘substance use disorder,’ or simply ‘substance use.’

The National Institute on Drug Abuse (NIDA) says that ‘abuse’ is no longer used because of its negative connotations and associations with punishment and judgment.

Substance abuse is typically defined as a pattern of harmful use of any substance for mood-altering purposes. Substances can include alcohol, prescription and over-the-counter drugs, illegal drugs, inhalants and solvents, nicotine, and even coffee.

‘Abuse’ can result from using a substance in a way that is not intended or recommended, or from using more than prescribed. To be clear, someone can use substances and not be addicted or even have a substance use disorder, as defined in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text-Revision” (DSM-5-TR).

At a GlanceExperts characterize substance misuse as repeated use that leads to impairments and negative consequences. Various factors play a role in causing it, including genetics and environmental variables. Addictive substances that can lead to use and misuse include illicit drugs (like cocaine, hallucinogens, and heroin) but can also include prescription medications (like benzodiazepines and pain relievers) and legal substances (like nicotine and alcohol). Being able to recognize the signs of misuse can help people know when to seek treatment, which can involve medications, therapy, and social support.

At a Glance

Experts characterize substance misuse as repeated use that leads to impairments and negative consequences. Various factors play a role in causing it, including genetics and environmental variables. Addictive substances that can lead to use and misuse include illicit drugs (like cocaine, hallucinogens, and heroin) but can also include prescription medications (like benzodiazepines and pain relievers) and legal substances (like nicotine and alcohol). Being able to recognize the signs of misuse can help people know when to seek treatment, which can involve medications, therapy, and social support.

Substance Use vs. Substance Abuse: What Are the Differences?

What Is Substance Misuse?

Health officials consider substance use as crossing the line into substance misuse if that repeated use causes significant impairment, such as:

Examples of Substance MisuseIn other words, if someone:drinks enough to get frequent hangovers,uses enough drugs that they miss work or school,smokes enough marijuana that they have lost friends, oroften drinks or uses more than they intended to use,Then their substance use is probably considered misuse or harmful use.

Examples of Substance Misuse

In other words, if someone:drinks enough to get frequent hangovers,uses enough drugs that they miss work or school,smokes enough marijuana that they have lost friends, oroften drinks or uses more than they intended to use,Then their substance use is probably considered misuse or harmful use.

In other words, if someone:

Then their substance use is probably considered misuse or harmful use.

What Causes Substance Misuse?

Genes, other mental health conditions, developmental factors, and environmental influences all play a role.

“People who drink alcohol or use drugs often initially get started to enhance their sense of well-being, relationships, and social enjoyment. Unfortunately, the downsides to substance use can emerge relatively quickly, depending on which substance and how much and how often it is used,” saysPaul Linde, MD, the medical director for psychiatry and collaborative care at Ria Health.

Dr. Linde notes that family history often plays a significant role, which can include both biological factors and learned behaviors. A person’s susceptibility to substance misuse has a partial genetic basis, but environmental factors play an important role as well.

Growing up in families in which drinking or using drugs is common or normalized also places one at a greater risk for developing a substance use disorder.—PAUL LINDE, MD, MEDICAL DIRECTOR FOR PSYCHIATRY AND COLLABORATIVE CARE AT RIA HEALTH

Growing up in families in which drinking or using drugs is common or normalized also places one at a greater risk for developing a substance use disorder.

—PAUL LINDE, MD, MEDICAL DIRECTOR FOR PSYCHIATRY AND COLLABORATIVE CARE AT RIA HEALTH

Generally, when people talk about ‘substance abuse,’ they are referring to the use of illegal drugs. Drugs of misuse do more than alter mood. They can cloud judgment, distort perceptions, and alter reaction times, increasing the risk of accidents and injury.

These drugs were declared illegal in the first place because they arepotentially addictiveor can cause severe negative health effects. Some believe that any use of illegal substances is dangerous and, therefore, abusive.

In the United States, some of the most commonly used illegal drugs are:

RecapWhen people use the term substance abuse, they are usually referring to the use of illegal drugs such as cocaine, heroin, and methamphetamine. These substances are illegal because of their high risk for abuse and dangerous side effects.

Recap

When people use the term substance abuse, they are usually referring to the use of illegal drugs such as cocaine, heroin, and methamphetamine. These substances are illegal because of their high risk for abuse and dangerous side effects.

Recreational Drug Use

Some people argue that casual, occasional use of some drugs is not harmful and is merely use, not abuse. The most vocal of the proponents of recreational drug use are those who smoke marijuana. They argue that marijuana is not addictive and has many beneficial qualities, unlike the “harder” drugs.

But recent research has shown that even marijuana may have moreharmful physical, mental, and psychomotor effectsthan first believed. Research has found that marijuana can have serious short-term and long-term health risks.

Cannabis use disorder is associated with effects such as memory loss, difficulty concentrating, reduced problem-solving skills, decreased emotional regulation, and problems making decisions.Marijuana use is also associated with an increased risk forpsychosis.

In addition, the National Institute on Drug Abuse (NIDA) reports that people who use marijuana can become addicted. NIDA estimates that 30% of people who use marijuana will become dependent. This risk is four to seven times higher for those who began using the drug in their teens.

Prescription substance misuse has risen substantially over the last few decades. The National Institute on Drug Abuse estimates that between 8% to 12% of U.S. patients who are prescribedopioid pain relieversdevelop a substance use disorder.

In the U.S., three main classes of prescription drugs are commonly misused: Opioids, central nervous system depressants, and stimulants. These include:

RecapSubstance use can also involve misusing prescription medications that have the potential for dependence.

Substance use can also involve misusing prescription medications that have the potential for dependence.

Alcohol

Alcohol is legal for adults over the age of 21 in the United States. However, it doesn’t take much alcohol to reach aharmful level of drinking, and that is when alcohol use can turn into alcohol abuse.

Drinking five or more drinks for men (four for women) in any one sitting is consideredbinge drinking, which can be harmful to your physical and mental health in many different ways.

Nicotine

Nicotineis the single most abused substance in the world.Although smoking has declined in recent years, it is estimated that 28.3 million Americans still smoke cigarettes despite the well-publicized harmful effects.

Again, just because it is legal, doesn’t mean it can’t be abused. The fact that the negative health effects of nicotine take a long time to manifest probably plays a role in the widespread abuse of tobacco.

Caffeine

Whereas nicotine is the most abused drug, caffeine is the most commonly used mood-altering drug in the world. And yes,too much caffeinecan be harmful to your health.

Studies have also found a link between caffeine use and several psychiatric syndromes, including caffeine-induced sleep disorder and caffeine-induced anxiety disorder.

People diagnosed withgeneralized anxiety disorder, panic disorder, primary insomnia, and gastroesophageal reflux are usually advised to reduce or eliminate regular caffeine use.

Synthetics

So-called ‘designer drugs’ and synthetic drugs, such as bath salts and synthetic marijuana, can be abused and can possibly be more dangerous than other drugs.

Other designer drugs that are commonly misused include:

Anabolic Steroids

Anabolic steroids have no mood-altering or intoxicating properties, but they can still be misused. Using anabolic steroids to enhance performance or develop muscles and strength is abusive because of thenegative side effectsof steroid use.

These can range from merely annoying to life-threatening in some cases.If using a substance can cause you harm, it is substance abuse. Theoretically, almost any substance can be abused.

RecapSubstance misuse can involve substances including alcohol, nicotine, caffeine, synthetic drugs, and anabolic steroids.

Substance misuse can involve substances including alcohol, nicotine, caffeine, synthetic drugs, and anabolic steroids.

Risks of Substance Misuse

When society determine that using certain substances is harmful, it places legal prohibitions on their use.This is to protect individuals’ well-being and shield society from the costs involved with related healthcare resources, lost productivity, the spread of diseases, crime, and an increased risk of becoming unhoused (although the impact of criminalization has been open to considerable controversy).

The line between use and abuse is unclear for many legal substances. Is having a couple of drinks every day after work to unwind use or misuse? Is drinking two pots of coffee in the morning to get your day started use or misuse? It also is not uncommon for people to not recognize the impact that their substance use has on their life.

If you are concerned about your substance use, Dr. Linde suggests it can be helpful to ask yourself questions about the negative medical, psychosocial, legal, and financial consequences of drinking and using drugs.

Understanding these risks may help you recognize the signs of a serious problem and improve your motivation to seek treatment.

RecapSubstance use poses both individual and societal risks. For individuals, it can lead to health problems, mental health issues, risky behavior, and legal problems. For societies, substance use can increase the costs associated with health problems and lost productivity. It can also contribute to social problems such as crime.

Substance use poses both individual and societal risks. For individuals, it can lead to health problems, mental health issues, risky behavior, and legal problems. For societies, substance use can increase the costs associated with health problems and lost productivity. It can also contribute to social problems such as crime.

How to Identify Substance Misuse

Has your substance use become harmful? If you think this may be true for you, you are certainly not alone. According to the latest statistics, 21.8% of Americans over the age of 12 (or 61.8 million) have used illicit drugs in the past year, and 8.9 million people over the age of 12 have misused opioids.

Symptoms of a substance use disorder include:

Substance Use DisordersThe DSM-5-TR recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.

Substance Use Disorders

The DSM-5-TR recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.

Treatment for Substance Use Problems

Are you hesitant to seek help for your substance use? Again, you are not alone. In 2023, only around 23.6% received any treatment.

If you have tried to quit or cut back on your own and found you could not do so, you may want to try other options and learn more abouttreatment for substance use.

Treatment for substance use disorders may involve behavioral therapies, medications, or a combination of different approaches.Cognitive behavioral therapy (CBT), contingency management, andmotivational enhancement therapyare a few types of therapy that may be used. Medications can also help people with opioid, nicotine, or alcohol addiction.

How to Prevent Substance Use

Family history, peer pressure, and recreational drug use are all risk factors for substance use. Being aware of these risks can help you take steps to avoid using substances in the first place. Seeking treatment for mental health conditions can also play a role in prevention.

If you use substances for recreational purposes, misuse prescription medications, or take substances for the purposes of becoming intoxicated, talk to your doctor about your treatment options.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

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21 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute on Drug Abuse.Terms to use and avoid when talking about addiction.McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?.Trans Am Clin Climatol Assoc. 2017;128:112–130.McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.National Institute on Drug Abuse.Understanding drug use and addiction.Csete J, Kamarulzaman A, Kazatchkine M, et al.Public health and international drug policy.Lancet. 2016;387(10026):1427–1480. doi:10.1016/S0140-6736(16)00619-XNational Institute on Drug Abuse.Commonly used drug charts.National Institute on Drug Abuse.Cannabis (marijuana) DrugFacts.Stypulkowski K, Thayer RE.Long-term recreational cannabis use is associated with lower executive function and processing speed in a pilot sample of older adults.J Geriatr Psychiatry Neurol. 2022;35(5):740-746. doi:10.1177/08919887211049130National Institute on Drug Abuse.Marijuana research report: Is marijuana addictive?.Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN.Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.Pain. 2015;156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1Centers for Disease Control and Prevention.Prescription opioid overdose death maps.National Institute on Drug Abuse.Misuse of prescription drugs research report: Overview.Conn RB.Inhalant use disorders. In: Avery JD, Hankins D, eds.Addiction Medicine. Vol 2. Springer International Publishing; 2022:57-65. doi:10.1007/978-3-030-86430-9_6National Institute on Alcohol Abuse and Alcoholism.Alcohol’s effects on health.Lachenmeier DW, Rehm J.Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach.Sci Rep. 2015;5:8126. doi:10.1038/srep08126Centers for Disease Control and Prevention.Current cigarette smoking among adults in the United States.Jee HJ, Lee SG, Bormate KJ, Jung YS.Effect of caffeine consumption on the risk for neurological and psychiatric disorders: Sex differences in human.Nutrients. 2020;12(10):3080. doi:10.3390/nu12103080National Institute on Drug Abuse.What are anabolic steroids?.National Institute on Drug Abuse.What are the other health consequences of drug addiction?Substance Abuse and Mental Health Services Administration.Highlights for the 2023 National Survey on Drug Use and Health.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute on Drug Abuse.Terms to use and avoid when talking about addiction.McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?.Trans Am Clin Climatol Assoc. 2017;128:112–130.McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.National Institute on Drug Abuse.Understanding drug use and addiction.Csete J, Kamarulzaman A, Kazatchkine M, et al.Public health and international drug policy.Lancet. 2016;387(10026):1427–1480. doi:10.1016/S0140-6736(16)00619-XNational Institute on Drug Abuse.Commonly used drug charts.National Institute on Drug Abuse.Cannabis (marijuana) DrugFacts.Stypulkowski K, Thayer RE.Long-term recreational cannabis use is associated with lower executive function and processing speed in a pilot sample of older adults.J Geriatr Psychiatry Neurol. 2022;35(5):740-746. doi:10.1177/08919887211049130National Institute on Drug Abuse.Marijuana research report: Is marijuana addictive?.Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN.Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.Pain. 2015;156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1Centers for Disease Control and Prevention.Prescription opioid overdose death maps.National Institute on Drug Abuse.Misuse of prescription drugs research report: Overview.Conn RB.Inhalant use disorders. In: Avery JD, Hankins D, eds.Addiction Medicine. Vol 2. Springer International Publishing; 2022:57-65. doi:10.1007/978-3-030-86430-9_6National Institute on Alcohol Abuse and Alcoholism.Alcohol’s effects on health.Lachenmeier DW, Rehm J.Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach.Sci Rep. 2015;5:8126. doi:10.1038/srep08126Centers for Disease Control and Prevention.Current cigarette smoking among adults in the United States.Jee HJ, Lee SG, Bormate KJ, Jung YS.Effect of caffeine consumption on the risk for neurological and psychiatric disorders: Sex differences in human.Nutrients. 2020;12(10):3080. doi:10.3390/nu12103080National Institute on Drug Abuse.What are anabolic steroids?.National Institute on Drug Abuse.What are the other health consequences of drug addiction?Substance Abuse and Mental Health Services Administration.Highlights for the 2023 National Survey on Drug Use and Health.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

National Institute on Drug Abuse.Terms to use and avoid when talking about addiction.

McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?.Trans Am Clin Climatol Assoc. 2017;128:112–130.

McLellan AT.Substance misuse and substance use disorders: Why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.

National Institute on Drug Abuse.Understanding drug use and addiction.

Csete J, Kamarulzaman A, Kazatchkine M, et al.Public health and international drug policy.Lancet. 2016;387(10026):1427–1480. doi:10.1016/S0140-6736(16)00619-X

National Institute on Drug Abuse.Commonly used drug charts.

National Institute on Drug Abuse.Cannabis (marijuana) DrugFacts.

Stypulkowski K, Thayer RE.Long-term recreational cannabis use is associated with lower executive function and processing speed in a pilot sample of older adults.J Geriatr Psychiatry Neurol. 2022;35(5):740-746. doi:10.1177/08919887211049130

National Institute on Drug Abuse.Marijuana research report: Is marijuana addictive?.

Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN.Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.Pain. 2015;156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1

Centers for Disease Control and Prevention.Prescription opioid overdose death maps.

National Institute on Drug Abuse.Misuse of prescription drugs research report: Overview.

Conn RB.Inhalant use disorders. In: Avery JD, Hankins D, eds.Addiction Medicine. Vol 2. Springer International Publishing; 2022:57-65. doi:10.1007/978-3-030-86430-9_6

National Institute on Alcohol Abuse and Alcoholism.Alcohol’s effects on health.

Lachenmeier DW, Rehm J.Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach.Sci Rep. 2015;5:8126. doi:10.1038/srep08126

Centers for Disease Control and Prevention.Current cigarette smoking among adults in the United States.

Jee HJ, Lee SG, Bormate KJ, Jung YS.Effect of caffeine consumption on the risk for neurological and psychiatric disorders: Sex differences in human.Nutrients. 2020;12(10):3080. doi:10.3390/nu12103080

National Institute on Drug Abuse.What are anabolic steroids?.

National Institute on Drug Abuse.What are the other health consequences of drug addiction?

Substance Abuse and Mental Health Services Administration.Highlights for the 2023 National Survey on Drug Use and Health.

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

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