Overview
Let me start with a question I've put to a lot of clients over the years.
Someone drinks two glasses of wine every night. Every single night, without fail, for years. Are they addicted?
Hold your answer. Here's the second one.
Someone drinks fourteen drinks in a single day, once a week. Nothing the rest of the week.
Same fourteen drinks. Same seven days. I get very different answers to those two questions — and the answers don't split neatly. Some people say the nightly drinker is clearly dependent because it's every day. Others say the once-a-week drinker is obviously the problem because look at the amount in one sitting.
What that tells me is that we don't actually believe addiction is about quantity. We just talk as though we do.
So if it isn't the amount, what is it?
Three things that keep getting collapsed into one
Most of the confusion in this area comes from three separate things being treated as one. They're related, they overlap, and they are not the same.
**Tolerance** is when you need more of a substance to get the effect you used to get from less. That's it. It's a physiological adaptation — your body adjusting to a repeated input. It happens with caffeine, with prescribed medications, with alcohol.
**Physical dependence** is when your body has adapted to a substance being present, and reacts when it's removed. That reaction is withdrawal. Dependence is also purely physiological. It isn't a statement about your character, your choices, or your relationship with the substance. It's chemistry.
**Addiction** — what's clinically called a substance use disorder — is something different in kind. It's a pattern: impaired control over use, use continuing despite it causing problems, use crowding out other parts of life.
Here's why the distinction matters so much: **you can have any of these without the others.** You can be tolerant without being dependent. You can be physically dependent without being addicted — this is extremely common, and I'll come back to it. And you can meet the criteria for a substance use disorder without dramatic physical dependence at all, which is often the case with stimulants.
If you've been asking yourself "am I dependent or addicted," you may have been treating those as two points on one scale. They're not. They're different measurements.
Why everyone is confused (it isn't your fault)
There's a genuinely good reason this is muddled, and it's worth knowing.
The DSM — the diagnostic manual used across mental health — used to split this into two diagnoses: substance *abuse* and substance *dependence*. In that system, "dependence" was the label for the more severe condition. It meant, roughly, addiction.
Which is close to the exact opposite of what "dependence" means physiologically.
In 2013, DSM-5 scrapped that split. Both categories were merged into a single **substance use disorder**, rated on a spectrum from mild to moderate to severe. The words "abuse" and "dependence" were removed as diagnostic labels entirely — partly because the research didn't support the old distinction, and partly because "dependence" was causing precisely this confusion.
But two decades of clinical literature, training material, and public messaging used the word in the old sense. So we have a situation where a doctor might say "you're dependent" meaning *your body has adapted*, and the person hears *you're an addict*, because that's what the word meant for twenty years.
If you've been confused by this, you're in good company. The field confused itself first.
What the diagnostic criteria actually look at
Here's the part that surprises people. The current criteria for a substance use disorder contain **eleven items, and not one of them is about how much you use.**
There's no threshold. No number of drinks, no frequency, no dose. What the criteria look at instead falls into four groups:
**Impaired control** — using more or for longer than you intended; wanting to cut down and not managing it; a lot of time spent obtaining, using, or recovering; craving.
**Social impairment** — use interfering with obligations at work, school, or home; continuing despite it causing problems with people; giving up activities that used to matter.
**Risky use** — using in situations where it's physically hazardous; continuing despite knowing it's causing a physical or psychological problem.
**Pharmacological** — tolerance and withdrawal.
Two or more within a twelve-month period meets the threshold; two to three is considered mild, four to five moderate, six or more severe.[^1]
Notice the shape of that. Nine of the eleven criteria are about **consequences and control**. Only two are physiological. The manual is overwhelmingly interested in how the substance is functioning in your life — not what's happening in your bloodstream.
And now the detail I most want you to see. Attached to both of the physiological criteria is a note stating that they are **not considered met for people taking substances solely under appropriate medical supervision.**[^1]
Read that again if you're on a prescription. The diagnostic manual itself says that tolerance and withdrawal, on their own, in someone taking a medication as prescribed, do not count toward a diagnosis of addiction.
That's not a therapist being kind to you. That's the manual.
So what makes someone an addict?
I'll give you my honest answer, which has two parts.
**The first part: the label is yours.** I don't hand people that word, and I don't withhold it either. Some people find "addict" clarifying and grounding — it names the thing and connects them to a community that understands it. Others find it a weight they'd carry for the rest of their lives over something that was true for three years. Both are legitimate. It's your word to take or leave.
**The second part: for me, it's about how the substance fits into your life.**
If someone is fulfilled — working, connected to people they love, healthy enough, living a life that looks like the one they wanted — then who am I to tell them they're doing it wrong? It's their life. I'm not in the business of deciding how other adults should live, and I'd want the same courtesy extended to me.
But if there are problems — the job is slipping, the relationships are strained, the health is going, the person is doing things they don't feel good about — then there's something to work with. Not because I've decided their life is wrong. Because *they've* run into something that isn't working, and I can help with that.
That's the actual dividing line for me. Not the amount. Not the frequency. Whether it's getting in the way of the life you want to live.
I want to be clear that this isn't a soft alternative to the clinical standard. Look back at those eleven criteria. Nine of them are consequences. "Is it getting in the way?" is a plain-language version of what the diagnostic manual is already asking.
Two ways to get this wrong
Because I've just handed you a framework you can apply to yourself, let me hand you the two ways it goes wrong. I've seen both many times.
**The first is the reassurance trap.** "No consequences, so I'm fine."
The problem is timing. Consequences from substance use are often *lagging*. Liver damage doesn't announce itself early. Cognitive changes are gradual enough that you don't notice from inside them. A marriage doesn't fail on a Tuesday — it erodes over years, and the erosion is invisible until it isn't. Career damage frequently shows up as a slow narrowing of options rather than a single dramatic event.
So *no consequences yet* is not the same as *no consequences coming.* When I'm working with someone, part of my job is helping them see not only what's happening now but what's likely downstream. That's not me telling them how to live. It's making sure the choice they're making is an informed one. The decision stays theirs.
**The second is the reverse error**, and it's the one this article could accidentally feed: using "I'm just dependent" as a way to avoid a harder truth.
If you're physically dependent on a prescribed medication, taking it as directed, and the rest of your life is intact — that's dependence, and the manual agrees with you.
But if you're finding yourself taking more than intended, or you've tried to cut down more than once and it hasn't held, or you've noticed you're organizing parts of your day around it, or things with work or people are getting harder and the substance is somewhere in that picture — those are the control-and-consequence criteria, and no amount of "but it's prescribed" changes what they are.
Being honest with yourself is uncomfortable in both directions. Some people need permission to stop calling themselves an addict. Others need to stop using a technicality to avoid looking at something.
"Not addicted" is not the same as "not harmful"
This one is important enough to have its own section, because the framework I've just given you answers one question and not another.
*Am I addicted?* and *is this harming me?* are separate questions with separate answers.
Go back to the two drinkers from the opening. The person having fourteen drinks in one sitting may not meet a single criterion for a substance use disorder — and is still at real risk of alcohol poisoning, injury, and everything that follows from being that intoxicated. The risk is in the episode, not the diagnosis.
And the nightly two-drink pattern? Also possibly no criteria met. Also carrying accumulating cardiovascular and cancer risk that no functional assessment will ever detect, because it doesn't show up as a life problem until it shows up as a medical one.
So if you work through this article and conclude you're not addicted, that conclusion may well be right. It doesn't tell you the use is harmless. Those are different questions, and only one of them is answered here.
If you're tapering off a prescription
I want to speak directly to one group of readers, because they often arrive at this question in real distress.
If you've been prescribed a medication — benzodiazepines are the common example, but this applies more broadly — and you've developed physical dependence, and you're now facing the difficulty of coming off it: **you are not an addict, and you have not done anything wrong.**
Nearly everyone who takes benzodiazepines beyond about a month develops physical dependence. It's simply what the medication does. Only around 1.5% go on to develop a substance use disorder as a result.[^2] The overwhelming majority of people in your position took a medication as prescribed, by a doctor, for a real problem, and are now dealing with a predictable pharmacological consequence.
That deserves a competent, slow, supervised taper and some support along the way. It does not deserve the addict label, and it doesn't deserve the way some people in medical settings will treat you once "dependence" appears in your notes.
The question worth asking instead
If you came here trying to work out which side of a line you're on, my honest suggestion is that it's the wrong line to be looking for.
The more useful questions are these.
*Is this getting in the way of the life I want to live?* Not the life someone else thinks I should want — the one I actually want.
*And was this the life I wanted before the substance became part of it?* That second one matters, because what we want has a way of quietly reshaping itself around what we're doing. Sometimes the honest answer is that the goalposts moved.
If the answer to the first is no, then it's your life, and it isn't my place to tell you otherwise.
If the answer is yes — even a small, uncertain yes — then you don't need a label to justify getting some help with it. You just need something that isn't working, and a willingness to look at it.
That's always been enough to start.
[^1]: American Psychiatric Association. (2013). *Diagnostic and Statistical Manual of Mental Disorders* (5th ed.). Source for the eleven substance use disorder criteria, the four criterion groupings, the severity thresholds, the removal of the abuse/dependence distinction, and the note that tolerance and withdrawal are not counted for those taking substances solely under appropriate medical supervision.
[^2]: American Society of Addiction Medicine, et al. (2025). *Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits.* Journal of General Internal Medicine. https://doi.org/10.1007/s11606-025-09499-2
*I'm an integrative psychotherapist with fifteen years in the field. This article is educational and is not a diagnosis — the criteria described here are summarized for understanding, not for self-assessment, and applying them properly is something to do with a professional who knows your history. Decisions about any prescribed medication belong with your prescriber.*
*If you're weighing up what level of support you might need, [this article on whether you need rehab to come off a substance](/resources/do-you-need-rehab-to-come-off-a-substance) covers the practical side. If you want to understand what's happening in the brain underneath all of this, [the seven-part series on addiction and the brain](/resources/addiction-series-part-1-disease-or-choice) explains the mechanism in plain language.*