Drug abuse is a behavioral pattern of harmful, non-medical substance use, in which a person takes a legal or illegal drug in amounts, frequencies or circumstances that damage health, obligations, relationships or safety. It names what a person does with a substance. It does not name a state of the body.
The pattern is defined by consequence rather than by quantity. Two people taking the same amount of the same drug are described differently once one of them is missing work, driving impaired or continuing after a hospital visit. SAMHSA's 2023 National Survey on Drug Use and Health counted 70.5 million people aged 12 or older in the United States, 24.9 percent of that population, who used illicit drugs in the past year, and 27.2 million with a past-year drug use disorder. The gap between those two figures is the whole subject of this page.
The term itself has been retired from clinical use. The DSM-5 dropped substance abuse as a diagnosis in 2013, and the National Institute on Drug Abuse now directs clinicians away from the word entirely, on evidence that it carries a high association with negative judgments and punishment.
What Is Drug Abuse?
Drug abuse is the use of a psychoactive substance outside medical guidance in a way that produces measurable harm. The substance is legal or illegal, prescribed to the person or not, and the pattern is recognized by what it costs rather than by what it is.
Four behaviors recur inside that pattern: taking a prescribed medication in larger amounts or for longer than the prescription allows, taking a medication prescribed to somebody else, using an illicit substance for its psychoactive effect, and combining substances in ways that raise the risk of each. The distinction between a drug, a medication and an illicit substance is set out in the guide to drugs and their classification.
Harmful use is also distinct from the phase before it. Experimentation and harmful use are different behaviors, and the first precedes the second where the sequence occurs at all. The markers of that earlier phase are set out in the guide to drug experimentation.
Is Drug Abuse Still A Medical Diagnosis?
No. The DSM-5 eliminated substance abuse and substance dependence as separate diagnoses in 2013 and replaced both with one diagnosis, substance use disorder, scored against 11 criteria in a 12-month period and graded mild at 2 to 3 criteria, moderate at 4 to 5, and severe at 6 or more.
SAMHSA records the three changes that arrived with the merge: the legal-problems criterion of the old abuse diagnosis was eliminated, a craving criterion was added, and severity became a symptom count. Abuse survives as a description of behavior, and it appears in the names of federal institutes and in clinical records written before 2013. The full history, the criteria-by-criteria mapping and the question of which term applies to a given person are set out in the comparison of drug abuse vs drug dependence.
How Common Is Harmful Drug Use In The United States?
Illicit drug use reached 70.5 million people aged 12 or older in the past year in 2023, 24.9 percent of that population, on SAMHSA's national survey. Marijuana accounted for 61.8 million of those people, hallucinogens for 8.8 million, and prescription pain reliever misuse for 8.6 million.
The 4 rows below carry SAMHSA's own past-year illicit drug use figures for 2023, and they show where the rate concentrates.
| Age group | Used illicit drugs in the past year | Number of people |
| 12 to 17 | 14.7 percent | 3.8 million |
| 18 to 25 | 39.0 percent | 13.3 million |
| 26 or older | 23.9 percent | 53.5 million |
| 12 or older, all ages | 24.9 percent | 70.5 million |
Set the disorder figures beside those. SAMHSA counted 48.5 million people aged 12 or older with a past-year substance use disorder in 2023, 17.1 percent of that population, including 28.9 million with an alcohol use disorder and 27.2 million with a drug use disorder. Past-year illicit drug use at 70.5 million and past-year drug use disorder at 27.2 million are counts of different sizes, which is the arithmetic behind the clinical position that use and disorder are separate questions.
What Are The Symptoms Of Drug Abuse?
The symptoms of drug abuse are physical changes in appearance and function, behavioral changes in secrecy and obligation, and social changes in who a person spends time with. No single symptom establishes the pattern, and the physical signs vary by substance class.
The 3 symptom groups below separate what is visible on the body from what is visible in behavior and in relationships.
- Physical signs, including changed appetite, disrupted sleep, bloodshot or glassy eyes, pupils larger or smaller than expected, slurred speech, tremor, impaired coordination and a decline in grooming.
- Behavioral signs, including secrecy about whereabouts, obligations left unmet at work, school or home, dishonesty about use, mood swings and irritability, and a loss of interest in previously chosen activities.
- Social signs, including a changed circle of friends, rising conflict with family and colleagues, withdrawal from family activity, and isolation.
Those signs describe a pattern that is already established. What starts it is a separate question with its own evidence.
What Causes Drug Abuse?
Harmful drug use is driven by inherited vulnerability, the developmental stage at which use begins, and the environment that supplies both the substance and the reason to take it. The National Institute on Drug Abuse estimates that genes, including the effects environmental factors have on gene expression, account for between 40 and 60 percent of a person's risk of addiction.
Age of first use carries measured weight of its own. NIDA states plainly that early use of drugs increases a person's chances of becoming addicted, and gives the developmental reason: the parts of the brain that control judgment and decision-making do not fully develop until people are in their early or mid-20s, and using drugs at that age has more potential to disrupt brain function in areas critical to motivation, memory, learning, judgment and behavior control. SAMHSA's 2023 figures put past-year illicit drug use highest in exactly that window, at 39.0 percent among people aged 18 to 25.
DSM-5-TR excludes tolerance and withdrawal from the criteria when they arise under correctly taken prescribed medication, so a person who is physically dependent on a medicine their clinician prescribed does not meet a diagnosis on that basis alone. Environment supplies the third input. NIDA records in its Understanding Drug Use and Addiction DrugFacts that no single factor can predict whether a person becomes addicted, and that a combination of genetic, environmental and developmental factors influences the risk, which is why an assessment records a person's history and setting rather than the substance alone.
How Does Drug Abuse Affect The Brain?
Repeated drug use floods the reward circuit with dopamine, and the brain answers by producing fewer neurotransmitters in that circuit or by reducing the number of receptors that receive the signal. The drug's effect falls, and the dose climbs to restore it.
The National Institute on Drug Abuse describes the consequence in one line: large surges of dopamine teach the brain to seek drugs at the expense of other, healthier goals and activities. The counter-adaptation that follows is the effect known as tolerance, in which larger amounts are needed to produce the familiar high. That adaptation is the doorway from a behavior pattern into a body state, and it is covered in full in the guide to drug dependence and tolerance.
What Are The Effects Of Drug Abuse?
The effects of harmful drug use are organ and system damage, cognitive and psychiatric change, social and financial loss, and an acute risk of fatal overdose. The first three accumulate across months and years. The fourth arrives in a single episode.
Call 911 immediately for any suspected overdose, and call Poison Help at 1-800-222-1222 for any ingestion or overdose. The over-the-counter NARCAN label has a bystander give a dose for a suspected overdose, then stay until the ambulance arrives even if the person wakes up. Overdose risk rises sharply at the resumption of use after any break, because the National Institute on Drug Abuse records that a person who uses as much of the drug as they did before quitting can easily overdose, since the body is no longer adapted to the previous level of exposure.
The chronic effects are distributed rather than concentrated. Substance-related damage reaches the cardiovascular, respiratory, hepatic and nervous systems depending on the substance and route. Cognitive effects reach memory, attention and decision-making. Social effects reach employment, education, housing and family relationships. Which of those a person carries depends on the substance, the route and the duration, which is why an assessment records the substance by name rather than recording drug use in general.
Why Do Clinicians Avoid The Word Abuse?
Clinicians avoid it because the word measurably changes how a reader judges the person it is applied to. The National Institute on Drug Abuse records that the term abuse was found to have a high association with negative judgments and punishment, and directs clinicians to write "use" for illicit drugs and "misuse" for prescription medications instead.
The 5 substitutions below are taken from NIDA's own terminology guidance for health professionals, with the reason NIDA gives for each.
| Instead of | Use | Because |
| Abuse | Use, for illicit drugs. Misuse, or used other than prescribed, for prescription medications | The term was found to have a high association with negative judgments and punishment |
| Substance or drug abuser | Patient | Person-first language. NIDA lists this substitution without a separate rationale |
| Addict | Person with a substance use disorder | Person-first terms avoid eliciting negative associations, punitive attitudes and individual blame |
| Habit | Substance use disorder, or drug addiction | It inaccurately implies that a person is choosing to use substances or is able to choose to stop, and it risks undermining the seriousness of the disease |
| Clean or dirty | Testing negative or testing positive for a toxicology screen. In remission, in recovery, abstinent, or not currently using in other contexts | Clinically accurate, non-stigmatizing terminology is used the same way it would be for any other medical condition, and stigmatizing slang is linked to negative and punitive implicit cognitions |
The word choice is not cosmetic. It changes which clinician a person is willing to tell the truth to, which is the step everything after it depends on.
What Are The Treatment Options For Harmful Drug Use?
Treatment is matched to a criteria count rather than to the label a person arrives with. A clinician scores the 11 DSM-5-TR criteria, grades the result mild, moderate or severe, and sets a level of care against that grade and against withdrawal risk.
The National Institute on Drug Abuse records medication as the first line of treatment for opioid addiction, combined with behavioral therapy or counseling, and records medications as also available for alcohol and nicotine. Where tolerance and withdrawal are present, the physiological side needs its own plan, because the FDA records that stopping benzodiazepines abruptly can result in withdrawal reactions including seizures which can be life-threatening. The levels of care, the assessment that assigns them and the therapies delivered inside each are set out in the guide to addiction treatment options.
What Are The Most Common Questions About Drug Abuse?
The 6 questions below cover the difference from addiction, prescription medications, whether harmful use always progresses, testing, the correct terminology, and what a family does first.
What Is The Difference Between Drug Abuse And Drug Addiction?
Abuse describes a pattern of harmful use. Addiction is diagnosed as a substance use disorder, scored at 2 or more of 11 DSM-5-TR criteria in a 12-month period and graded severe at 6 or more. The pattern is evidence for the diagnosis rather than the diagnosis itself.
Does Taking A Prescription Wrongly Count As Drug Abuse?
Yes. NIDA defines legitimate use of a prescription medication as use as prescribed, by the person to whom it was prescribed. Consumption outside those parameters is misuse, which is the term NIDA directs clinicians to write.
Does Harmful Drug Use Always Progress To Addiction?
No. SAMHSA counted 70.5 million past-year illicit drug users aged 12 or older in 2023 against 27.2 million with a past-year drug use disorder. The two counts are not the same size, and no single factor predicts which people move between them.
Do Drug Tests Detect Drug Abuse?
A toxicology screen detects a substance, not a pattern. NIDA directs clinicians to report the result as testing positive or testing negative, and the diagnosis is made from a criteria count rather than from a screen.
What Word Should Be Used Instead Of Drug Abuse?
Use for illicit drugs, misuse for prescription medications, and substance use disorder for the diagnosis. NIDA publishes those substitutions for health professionals and records the evidence behind each one.
What Does A Family Do First?
Call 911 for any suspected overdose and Poison Help at 1-800-222-1222 for any ingestion. Once the immediate risk is handled, the useful step is an assessment by a licensed clinician against the 11 criteria rather than an argument about which word applies.