What is a Substance Use Disorder?

Have you ever blacked out at a bar? Lost control at a party? Popped too many pills?

If you relate to the above statements, you will find the Chat 2 Recovery blog helpful.


This will be the first of what I hope to be a regular series of blogs about substance use disorders and their effective treatment.  I hope to share my views with an interested community who are willing, in turn, to share their questions and comments.  I begin by sharing my understanding of what it means to have a substance use disorder (SUD).

 According to our current understanding, there are two types of SUDs; Substance Abuse and Substance Dependence.  Substance Abuse is considered to be less severe than Substance Dependence.  The predominant factor in both of these disorders is the degree to which one loses control over the use of a substance.  The greater one’s loss of control over a substance, the more severe the disorder is considered to be.  Substance Abuse is characterized by irregular loss of controlSubstance Dependence is characterized by regular loss of control.  Loss of control is defined here as either consuming more than one sets out to consume or using the substance for a longer duration than anticipated.  The frequency with which this loss of control occurs determines the type and degree of an SUD.

 Let’s look at an example of an individual with a Substance Abuse Disorder.  Joe typically goes to a bar after work on Fridays for a few drinks with co-workers.  Most Fridays, Joe has a few drinks and then goes home to his family without incident.  However, periodically and unexpectedly, Joe goes to the bar and overdrinks to the point of blacking out.  From this blacked-out state, Joe, one evening, drives his car and gets arrested for Driving While Intoxicated (DWI).  In another unexpected instance, Joe drinks so heavily that he has his wallet stolen losing a great deal of money.    While, yet, another time he over drinks and gets himself into a physical fight with injuries severe enough to be taken to the hospital emergency room.  While these negative consequences of overdrinking appear significant, they occur without much consistency and intermittently over the course of a year.  The irregular loss of control, as characterized in this example, would be an example of the SUD known as Substance Abuse.  The irregularity of this person’s loss of control is what makes it Substance Abuse. 

Substance Dependence is characterized by regular loss of control.  Generally speaking, the substance is controlling the person rather than the other way around.  The person shows little ability to control how much or how often to use the substance.  While it’s common for individuals with Substance Dependence to use daily or quite regularly, frequency of use doesn’t matter as much as quality of use.  In other words, what happens when the person uses is the primary factor.

You should now try to assess your own control or loss of control over your substance use.  Ask yourself:  Am I setting limits on consumption and frequently not following those limits?  Am I setting limits on how long I use or how much I spend and frequently not following those limits? Do I determine days when I will not use substances and frequently break those rules?  

 Ironically, it is often easier to treat a person with Substance Dependence than with Substance Abuse. Because of the intermittent nature of loss of control with Substance Abuse, a person can easily develop excuses and rationalizations for their episodes of using too much.  For example, “I didn’t eat that day” or “the drug was more potent than usual.”  On the other hand, the person with Substance Dependence has a hard time denying their regular loss of control and can more easily admit to problem use.

While loss of control is the essential symptom of an SUD, there are other symptoms which need to be mentioned.  Clearly, the substance use must bring some level of impairment to the individual’s life in such areas as social, occupational, legal, medical, or financial.  In addition to negative consequences of use, the individual may also exhibit signs of preoccupation to use (e.g., thinking obsessively about using).  For some with signs of Substance Dependence, the individual may exhibit signs of physical dependence on the substance.  (Physical Dependence will be explored in a future blog.)

In my next blog, I will review ways of determining if you are exhibiting symptoms of a Substance Use Disorder.  Let me know if this description of SUD’s makes sense to you.  Please feel free to comment and ask questions below, and I will respond as soon as I can.

Look forward to hearing from you.

Stay well,

Nick Lessa

Chat2Recovery.com Offers Innovative Online Substance Abuse Treatment in New York State


  Contact: Maria Gross                                                                  FOR IMMEDIATE RELEASE

Email: MGross@Chat2Recovery.com

Phone: 212-532-0303


Chat2Recovery.com Offers Innovative Online Substance Abuse Treatment in New York State

New York, NY (January 17, 2013) – The Internet has already revolutionized many industries, with other industries now beginning to fully adopt new telecommunications technologies. One such industry is addiction treatment. Conventional rehabilitation requires that a patient with a substance use disorder needs to attend sessions face-to-face. However, addiction specialists are now finding online treatment for substance use disorders to be an effective alternative.

One addiction treatment website that is getting a lot of attention recently is Chat2Recovery.com, a new company created to treat people with substance use disorders in New York State. Chat2Recovery, also known as C2R, takes the innovative approach of treating people for their substance abuse problems completely over the Internet through videoconferenced group and individual sessions. The management team, in the addiction treatment industry for over twenty years, has gained a substantial reputation for its high standards of care and successful recovery methods.

The C2R program generally lasts for six weeks, although it can be extended if the client feels that he or she needs to do more work. The program consists of twice weekly group therapy sessions conducted pseudonymously online, some individual sessions with a counselor, and emergency access to counseling staff.  Clients can choose whether they would prefer their individual sessions to be conducted on the phone, via video conferencing, or face-to-face.  The program also gives clients access to readings and written exercises designed to educate them about the recovery process.

A spokesperson for the site said: “Substance abuse counseling over the Internet may seem like an unusual idea, but it has been found to be incredibly effective. We find that the fact the entire program can be done anonymously really helps our clients. It gets people involved who might not otherwise be willing to go through treatment, and it also helps break down barriers. When people are anonymous they are much more likely to be honest about the extent of their drug use, and that helps us to help them. Of course we provide an option where our clients can meet counselors in person for a one on one session, but the entire program can be conducted completely online if the client chooses. Nick Lessa and Maria Gross, two highly trained, highly accomplished addiction rehabilitation specialists, founded Chat2Recovery. They have gained extensive experience in working with people with substance abuse problems at Inter-Care, a highly reputed outpatient rehab facility in NYC.”


About Chat2Recovery.com

Chat 2 Recovery (C2R) is an online, outpatient, substance abuse treatment center treating adults 21 years or older who wish to abstain from or reduce their use of mood-altering chemicals or alcohol.

For more information please visit http://www.Chat2Recovery.com

Welcome Note

It’s been a dream of mine for over 10 years to provide substance abuse treatment online. I have been operating my own outpatient treatment centers for substance use disorders for over 20 years. Back in 1991, when I saw a website for weight loss, I knew it would be something people would respond to for substance abuse treatment. In those days, the cost to get an online program off the ground was prohibitive. Today, with technology advancing so rapidly and the costs of providing this technology decreasing, the time has come.

To see this dream come true is astonishing. Over the past year, my business partner, Maria Gross, and I have been spending inordinate hours preparing for this opening. We believe to have developed a program that will provide effective, quality-oriented and affordable treatment for those who choose to obtain treatment services online as opposed to face-to-face treatment or in addition to traditional outpatient treatment. We strive to provide you with the best team of clinicians possible in an atmosphere of respect and genuine warmth. I am always available to hear your suggestions to improve our services. Please don’t hesitate to contact me.

I have developed Chat2Recovery to bring you all the experience and wisdom for effective treatment that I have accumulated over the years. My weekly blog will provide a forum to share these experiences, communicate interesting news from the industry, and to gain more inspiration from your comments. Please join me in this journey.


Nick Lessa, LCSW-R, CASAC, MA
President and Clinical Director