What is the difference between use and addiction?

The world of addiction treatment has undergone a major change in recent years. The traditional approach to battling substance use is exemplified by the “Just Say No” campaign in the 1980s, in which drugs were viewed as an absolute evil, and those with addiction disorders as morally flawed. The war on drugs, as it was often called, used binary terminology, regarding anyone who consumed drugs as an “addict,” while ignoring the fact that consciousness-altering substances exist on a broad spectrum. Public policy in the field was designed in accordance with this approach, and treatment was based on the notion of abstinence as the one and only goal for all patients. In addition, many institutions required patients to abstain from any substance use as a condition for entering treatment or rehabilitation programs, and many therapists were critical and judgmental of these patients.

In recent years, however, there has emerged a more nuanced understanding of what we call “addiction,” a loaded term that does not always accurately describe what is a very complex phenomenon. Several developments in the modern world – such as the widespread use of social networks and fluctuations in the labor market – have also impacted addiction patterns, prompting the need for the development of new definitions and a different approach to addiction, both in the clinical and therapeutic sense, and in terms of social attitudes about this complicated issue.

Given this background, in 2013 the American Psychiatric Association published new definitions for the field of addiction medicine. The clinical terms “misuse” and “substance dependence” were replaced by a new term: “use disorder.” A person with a use disorder is someone who has experienced any degree of disruption to his normal functioning as a result of using a certain substance or engaging in a certain behavior, and yet continues the same pattern of use or behavior. These use disorders are categorized according to degree of severity as mild, moderate or severe, on the basis on 11 criteria described in the DSM-5 (psychiatric diagnostic manual). The criteria are presented in the form of questions about the nature of the substance use, feelings of self-control and self-regulation with regard to the substance use, difficulty with various kinds of normal daily functions, and so on. This scheme results in an entire spectrum that can be used to describe addictions, and thus allows for more precise and multi-dimensional evaluations of individual patients.


Harm Reduction



The approach to addiction treatment has also changed. The “use disorder” conceptualization, with its range of severity, allows for a pragmatic approach that can be tailored to fit a patient’s needs. As mentioned, traditional treatment programs often require an absolute commitment to abstinence. When this is the only alternative, many people who are interested in getting help will refrain from doing so out of misgivings about total abstinence and about being judged for not complying with this condition.

The harm reduction approach was developed in order to enable the provision of assistance to each patient according to their individual needs, challenges and preferences. This approach recognizes that addictive behaviors and substances, whether legal or illegal, are an integral part of the world we live in, without ignoring their serious consequences and the danger of addiction, and the need to try to minimize their harmful effects.

The treatment itself is based on listening to the patient, and then adapting treatment to the patient’s unique needs. The initial phase of treatment deals with understanding the patient’s world, mapping their needs, and raising awareness of the problems and possible harms generated by the substance use. At the completion of this phase, shared goals for treatment are set: decisions are made about the needed changes, and a plan is devised for reducing the harm that has been identified. During therapy, patients acquire tools and methods for self-control and self-regulation. They learn to recognize their own limitations and how to regain control over the behaviors that harm them.


Our Clinic for Addiction Treatment



Substance use disorders can harm a person’s health, performance at work, marital and family relationships, and may even be fatal. Early intervention can prevent much of the harm that impacts the individuals suffering from these disorders and their close circles, whose lives are also often significantly impacted.

We at the Israel Center on Addiction have therefore established a clinic for addiction treatment. Our clinic, which operates in cooperation with the Lev HaSharon Medical Center, offers an integrative framework in which the treatment program is tailored to each patient according to the pace, method and path that is appropriate for them. Our main objective is to improve the health and quality of life of our patients and their families. In line with our mission statement and our harm reduction approach, our clinic promotes open and authentic relationships with our patients, and a shared, respectful dialogue. We offer our clients a safe and non-judgmental space in which to receive assistance in returning to their normal functioning and regaining control over their lives.