Dependence vs addiction

Physical dependence = tolerance to a chemical + withdrawal when you lower dosage or quit. Addiction = compulsive substance use despite negative consequences. More on dependence vs addiction here.

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There is a difference between physical dependence and addiction. This distinction can be difficult to understand, particularly with prescribed pain medications. With pain pills, the need for increasing dosages for pain relief can be indicate either addiction or physical dependence. We review the basic clinical criteria for each so that you can identify an addict from a chemically dependent person here.

What is drug dependence?

Physical dependence can occur during the use of many drugs – even if you are taking the drugs appropriately, as prescribed or medically instructed. In fact, physical dependence in and of itself IS NOT addiction. Here, we’ll review the two characteristics of physical drug dependence. But before that, you need to understand the principle of homeostasis.

Homeostasis is the body’s survival mechanism

The human body automatically adjusts to make compensatory changes which support its physical and psychological functions. This process or self-adjusting is automatic, and not something that we can control. So when you add any type of foreign chemical, substance, or drug to the body, the body compensates by producing highly complex interactions to maintain balance or return systems to functioning within a normal range. The process is called homeostasis.

Tolerance and withdrawal

During physical dependence on a drug or substance, the body adapts to drugs in order to maintain homestasis so that it can continue to function. Changes take place in the brain and internal organs so that the body can adjust to the presence of the chemical and still operate. For example, less natural dopamine is produced in the brain in order to compensate for huge amounts of dopamine triggered by drugs.  And when you stop taking drugs, you experience feelings of dysphoria, or depression, because the body needs to increase levels of dopamine to normal levels again.

Over time and chronic use of a drug or substance, two things occur.

1. Tolerance – The body becomes tolerant to substances and needs more of them to achieve a certain effect (Ex. the need for more OxyContin for pain relief).

2. Withdrawal – During withdrawal, drug-specific physical or mental symptoms manifest if drug use is cut back or abruptly ceased.

Tolerance and withdrawal are the two defining features of physical dependence. But although physical dependence often accompanies addiction, it is not the only indicator of addiction. Psychological compulsion and cravings should also be present in order to characterize drug use as “addiction”.

What is addiction?

During any addiction, addicts seek out and their drug of choice compulsively. But what makes addiction different than dependence is that psychological impairment or distress is present. Although tolerance and withdrawal are diagnostic indicators of addiction, they must be accompanied by mental problems. In order to be diagnosed with addiction, you must manifest three or more of the following characteristics in the same 12 month period:

1. Tolerance, as defined by

a. A need for increased amounts of the substance to achieve intoxication or desired effect -OR-

b. Diminished effect with continued use of the same amount of the substance

2. Withdrawal, as defined by

a. Withdrawal syndrome when the substance is taken in lower doses or stopped -OR-

b. Using a substance to relieve or avoid withdrawal symptoms

3. The substance is often taken in larger amounts or over a longer period than was intended (difficulty controlling use)

4. There is a persistent desire or unsuccessful efforts to cut down or control substance use

5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

6. Forfeiting or reducing important activities related to social, occupational, or recreation obligations because of substance use

7. Continued use of the substance use despite knowing that it causes or worsens persistent or recurrent social, physical or psychological problems

In sum, the clinical criteria for addiction especially accounts for continued use of drugs or substances despite harmful consequences. Addiction erodes a person’s self-control, while dependency is limited to the physical manifestation that drugs has on the body.

Confusion in the clinical diagnosis of addiction

Currently, the American Psychiatric Association (APA) holds the standard for addiction diagnosis. Doctors within the APA have created a Diagnostic and Statistical Manual of Mental Disorders (DSM), which is now between its 4th and 5th revision and which outline the characteristics required in order for someone to be diagnosed with an addiction. What is confusing is that the manual defines addiction as “substance dependence”. While the term “dependence” has been used in the past to refer to uncontrolled drug-seeking behavior, it now has an alternative meaning to define the physical adaptation that occurs when medications acting on the central nervous system are taken over time. These dual meanings have led to confusion that we hope we’ve cleared up here.

Questions about addiction

We welcome all of your questions about addiction. We can either point you to an existing resource, or even respond to your question in a new article. Either way, we invite your feedback below.

Reference sources: Principles of Drug Addiction Treatment: A Research Based Guide
DSM-IV criteria for substance dependence
NIDA pages: Understanding drug abuse and addiction
NIDA pages: The science of addiction
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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