When people hear the terms “alcohol use disorder” or “substance use disorder,” they often think it’s the same as being “dependent” on alcohol or drugs. While they’re related, they aren’t exactly the same thing. Understanding the difference can help people recognize where they (or someone they care about) might fall on the spectrum — and what kind of help might be needed.
Alcohol or substance use disorder (AUD or SUD) is a broad term used to describe a pattern where someone’s use of alcohol or drugs causes serious problems in their life. It’s not just about how much someone uses — it’s about how that use affects their health, relationships, work, mood, and responsibilities.
Someone with a use disorder may:
- Use more than they intended
- Try to cut down but can’t
- Spend a lot of time getting, using, or recovering from alcohol or drugs
- Have strong cravings
- Keep using even though it’s causing problems at work, school, or home
- Give up activities they once enjoyed
- Use in risky situations (like driving)
- Need more of the substance to feel the same effect
- Feel sick, anxious, or shaky when they don’t use
In short, a use disorder means that alcohol or drugs are interfering with a person’s ability to live their life normally.
Now, dependence is a little more specific. It usually means the body and brain have adapted to having the substance around. Over time, the person needs the substance just to feel normal. If they stop suddenly, they may experience withdrawal symptoms — like sweating, shaking, nausea, anxiety, depression, or even life-threatening complications (especially with alcohol or opioids).
You can think of it this way:
- Use disorder is about the overall behavior and the consequences.
- Dependence is about the body’s physical need for the substance.
Interestingly, not everyone with a use disorder is physically dependent, especially in the early stages. For example, someone might drink heavily on weekends, get into legal trouble, and suffer relationship problems — all signs of an alcohol use disorder — but they might not experience withdrawal symptoms if they stop drinking. They have a problem, but their body isn’t “hooked” yet.
On the other hand, someone could develop physical dependence (like needing opioids after surgery for pain management) without having the behavioral patterns of a full-blown use disorder — although dependence often puts people at greater risk for developing one.
In short:
- Alcohol or substance use disorder is about harmful patterns and life problems caused by
drinking or drug use. - Dependence is specifically about the body’s physical need for the substance and withdrawal
symptoms when stopping.
Often, as a use disorder becomes more severe, physical dependence develops too. But they don’t always happen together.
Recognizing these differences helps professionals better diagnose and treat people. Some people need help managing physical withdrawal first (detox), while others need therapy, support groups, or counseling to address the deeper emotional and behavioral patterns behind their substance use.
Either way, both use disorders and dependence are serious, and help is available — recovery is possible at any stage.