In the United States, college is often thought of as a time to experiment. Everything is new: classes, friends, living away from home. It’s natural that many students take advantage of the freedom to try new things, including drugs and alcohol. Occasional or relatively innocuous use of these substances, however, can be a gateway to misuse or abuse.

What is a substance?

In the medical world, “substance” is an umbrella term for any outside ingredient that interacts with the body’s chemistry or structure. It can do your body good (like a properly used pain reliever) or harm. It can be illicit, available with a prescription, or sold on the shelf at the nearest drugstore. It can be grown in the backyard or manufactured in a lab. There are countless substances out there, and all of them, legal and illicit, are classified into one of three categories: depressants, stimulants, and hallucinogens. These classifications are determined by how the drug interacts with the body’s chemistry.

What counts as a substance?

• Pharmaceuticals are prescribed to cure, treat, or prevent an illness. Proper use of legal substances can help maintain good physical health and mental well-being. Note that some people obtain their prescriptions legally from doctors but resell the substance after they fill their prescription. Doing so is illegal.
• Over-the-counter (OTC) medications, such as cold or allergy medicines, are available without a prescription. OTC drugs can help you get temporary relief from symptoms before you can see a doctor.
  • Depending on where you live, OTC recreational drugs (alcohol, nicotine, and/or marijuana) may also be available at your local corner store or dispensary. You must be 21 to buy, possess, or use alcohol legally. When it comes to buying, possessing, or using tobacco, state and local laws may require you to be 21 years old, though the federal minimum age is 18. States that require you to be 21 include Arkansas, California, Delaware, Hawaii, Illinois, Maine, Massachusetts, New Jersey, Oregon, Utah, Washington, and Virginia. Some cities have raised the minimum age to purchase, possess, and use tobacco as well. Marijuana is not legalized in all states, but some areas have legalized it for medical and/or recreational use. If you are thinking about trying marijuana, make sure you know the laws in your state.
• Illegal drugs are substances that are forbidden because their side effects have been found to outweigh their benefits. Examples of substances that are illegal in all 50 states are heroin, cocaine, methamphetamines, and MDMA. There are dozens of others. Some states outlaw marijuana.

What is substance misuse?

Substance misuse describes the use of a drug for anything other than its intended purpose. This is easy to judge when it comes to illegal drugs: They are not on the market for any medical reason, so any use of an illicit drug, such as heroin or meth, is considered a misuse. With marijuana (and a smattering of synthetic drugs illegal in some states but not others), what may be considered substance use in one state is considered substance misuse in another.

Legal, regulated substances can also be misused if they are taken for a nonmedical or illegal purpose. Using a pharmaceutical that wasn’t prescribed to you is substance misuse. For example, taking or buying Valium or Adderall without a prescription is a misuse of the drug. Even if you have your own prescription, increasing your dosage without a doctor’s approval is considered misuse.

Over-the-counter substances can also be misused. The intended purpose of cough syrup or glue, for example, is not to get high. If you are not using a product as directed, you are misusing the substance.

How can alcohol be misused if there are no directions on the label?

Alcohol walks a tricky line because there are no directions for use on the package. Instead, all regulated bottles are stamped with a government warning: “(1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.” A clear and dangerous misuse of alcohol would be to drink while pregnant or to operate heavy machinery while under the influence, but besides that, there are no directions on a bottle that tell you how much to drink or when to stop.

That’s where health institutes come in. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines alcohol misuse as heavy or frequent consumption that increases the risk of negative health and social consequences. Because bodies, metabolisms, and tolerance levels are different, the NIAAA suggests that excessive daily consumption is about four or more drinks per day for men and three or more drinks per day for women. In a week, a man who is misusing alcohol will have had 14 or more drinks. A woman will have had seven or more.

The Centers for Disease Control and Prevention (CDC) is much stricter in its definition of alcohol misuse. If a woman has more than one drink per day or a man has more than two, this is alcohol misuse.

Unfortunately, no consumption guidelines are currently available from the NIAAA or the CDC for the trans and nonbinary communities. Bodies are different, so check with your doctor to see how your sex, height, weight, and metabolism will affect your use of alcohol. In fact, this is a good idea for anyone who does or might consume alcohol, regardless of your sex or gender identity. Take charge of your own health and know your limits.

What is the difference between substance misuse and abuse?

Substance misuse and substance abuse are very similar; some experts might even argue that the two terms can be used interchangeably. Others do draw a fine distinction between the two, including the director of the Food and Drug Administration (FDA).

According to the FDA, your intentions and motivations indicate whether you are misusing or abusing a substance. If you take a drug to relieve a medical ailment but disregard the instructions on the box or the doctor’s orders, you are misusing a drug. For example, if you have bad cramps, but you pop a leftover painkiller your mom was prescribed after surgery, you are misusing the drug, even though you are genuinely trying to treat a symptom. If OTC allergy medication indicates that you should take two pills every six hours, but you double your dosage or take the drug more often, you are misusing the drug.

Some experts consider substance abuse to be a type of misuse, and it’s typically more dangerous than the occasional self-diagnosis and home treatment. It indicates the development of adverse habits or patterns of behavior. This means that while substance misuse can affect your physical health, substance abuse can affect your physical health and your mental well-being. Misuse crosses into abuse when you take a substance to get high, to lose control, to numb pain or trauma (not as directed by a doctor), or to avoid withdrawal. Abuse is often a fast track to emotional addiction and physical dependence.

All substance misuse can be harmful, but abuse leads to patterns of dangerous behaviors.

What does substance abuse look like?

Depending on the drug, the amount consumed, the period of time it has been used, and a person’s body, substance abuse manifests differently. The user could display any number of general signs of substance abuse or specific habits associated with certain substances:

• Alcohol abuse and alcoholism
• Nicotine
• Recreational drug abuse

Page last updated: 04/2019