Addiction and Substance Abuse

Discussion of so-called substance abuse and addiction is vexed by ambiguity and disputes over vocabulary, which is caught up in equally vexing disputes about ideology and values. People may distinguish among substance use, misuse, abuse, abuse disorder, dependence, and addiction, but not necessarily in consistent ways.

The American Psychiatric Association defined drug abuse in 1932 as “the illegal, nonmedical use of a limited number of substances, most of them drugs, which have properties of altering the mental state…” Note the oddity that not all drugs are drugs – the second sense meaning therapeutic compounds. This double meaning creates additional confusion. The definition went on to establish as essential conditions violation of cultural acceptability, social norms, or statute; drug abuse was predominantly framed as moral transgression. This moral lens has continued to influence views of substance abuse, but the formulation of addiction or substance dependency as a disease has...