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Addiction vs. Dependence Explained

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It’s easy to use the terms “addiction” and “dependence” interchangeably. After all, they both relate to substance use and can significantly impact one’s life. However, diving deeper into substance use disorder (SUD), you’ll find that these terms have distinct, albeit related, meanings.

What Is Addiction?

At its core, addiction is about the psychological need for a substance. Despite negative consequences, it’s characterized by a compulsive desire to use drugs or alcohol. The key here is the loss of control and the behavioral aspects that come into play. People with an addiction often prioritize acquiring and using the substance over other important life activities and responsibilities. And it’s not just about “willpower” — addiction alters the brain’s reward and pleasure centers, making it a complex issue that transcends mere choice.

Here are a simplified diagnostic criteria for addiction:

  • Compulsive Use: Can’t stop or control the use even if they want to.
  • Risk Taking: Using the substance even in dangerous situations.
  • Neglecting Responsibilities: Not managing work, school, or home duties because of substance use.
  • Relationship Issues: Continued substance use even when it causes relationship troubles.
  • Loss of Interest: Losing interest in activities once enjoyed.
  • Tolerance: As mentioned in dependence, needing more of the substance to achieve the desired effect.
  • Withdrawal: Experiencing symptoms when not using, as noted in dependence.
  • Time Consumed: Spending a lot of time getting, using, or recovering from the substance.
  • Failed Attempts to Quit: Unsuccessful efforts to quit or reduce the use.
  • Continued Use: Still using, even knowing it’s causing or worsening a physical or psychological problem.

What Is Dependence?

On the other hand, dependence is more about the physical aspect of substance use. When you depend on a substance, your body has adapted to the presence of the drug, leading to tolerance and withdrawal symptoms when the substance is not consumed. In some cases, dependence is actually a part of medical treatment. For instance, a person with chronic pain might depend on pain medication but not necessarily addicted. They don’t have the compulsive, destructive behaviors associated with addiction.

Here’s a simplified diagnostic criteria for dependence:

  • Tolerance: Needing more substance to get the desired effect or feeling a reduced effect when using the same amount.
  • Withdrawal: Experiencing physical symptoms when the substance isn’t taken.
  • Quantity and Duration: Using more substance or using it for longer than intended.
  • Desire to Cut Down: Persistent or unsuccessful efforts to reduce or control substance use.
  • Time Spent: Spending a lot of time obtaining, using, or recovering from the substance.
  • Forgoing Activities: Giving up or reducing important social, occupational, or recreational activities because of substance use.
  • Continued Use: Continuing to use, even when it causes or worsens a health problem.

Difference Between Addiction and Dependence

Dependence refers to the physical or physiological reliance on a substance to function normally. When the substance is not taken, withdrawal symptoms emerge. Dependence can be a normal response to repeated use of some medications. It doesn’t necessarily signify that someone is abusing or addicted to the substance.

Addiction, on the other hand, is a complex brain disorder. It’s marked not only by drug use and seeking but also by behavioral changes, decreased self-control, and an inability to abstain from the drug despite harmful consequences.

While dependence and addiction can co-exist, it’s crucial to note the differences. Many substances that can be addictive may also lead to physical dependence. However, not every individual who is dependent is also addicted. A clear example is a person who relies on insulin for diabetes management. They depend on insulin to maintain healthy blood sugar levels but are not addicted to it.

Physical Dependence vs. Mental Dependence

Physical dependence happens when the body has adjusted to the presence of a substance to the point where it requires that substance to function properly. Stopping the substance suddenly can result in withdrawal symptoms. These might include nausea, shaking, sweating, and more.

Mental (or psychological) dependence is the perceived need or craving for a substance based on emotional or psychological desires rather than a physical need. Individuals might believe they need the drug to relax, escape, or feel “normal.” It’s more about the emotional and mental attachment to the substance.

What Is Tolerance?

Tolerance is a physiological phenomenon where the body needs an increasing amount of a substance to achieve the same effects initially produced with smaller doses. Over time, one might need to consume more of the substance to get the same “high” or feeling as when they first started. It’s one of the body’s ways of adapting to regular exposure to the substance.

When someone says their tolerance has gone up, it means they need to consume more of a particular substance to get the same results they used to get with a lower dose. Here’s what an increased tolerance might imply:

Physiological Adaptation:

  • Your body has adapted to the substance, whether it’s caffeine, alcohol, or medication.
  • This adaptation means your body’s systems have adjusted to counteract the substance’s effects.

Potential for Increased Consumption:

  • With a higher tolerance, there might be a tendency to consume more substance to achieve the desired effects.
  • This increased consumption can lead to potential health risks, depending on the substance.

Risk of Drug Dependence and Addiction:

  • For some substances, especially addictive ones, an increased tolerance can be an early sign of developing dependence.
  • If you find yourself taking more of a substance due to increased tolerance and experience cravings or withdrawal symptoms when not using, it’s essential to be cautious and seek professional advice.

Efficiency of Treatment:

  • If your tolerance increases, medications might not be as effective as they once were in treating your condition.
  • Adjustments to dosage or switching medications might be necessary.

Natural Fluctuations:

  • It’s also worth noting that some fluctuation in tolerance can be natural and doesn’t always indicate a problem.
  • Factors like diet, sleep, overall health, and stress can influence how our bodies react to certain substances.

Potential Health Implications:

  • Consistently increasing the dosage of a substance due to heightened tolerance can lead to adverse health effects.
  • For example, consistently consuming more alcohol to feel its effects can lead to liver damage, while over-reliance on painkillers can affect the kidneys or lead to overdose.

An increased tolerance to any substance, whether coffee, medication, or recreational drugs, is a signal from your body.

Does Tolerance Lead to Dependence and Addiction?

While tolerance is separate from dependence and addiction, it can be a precursor to both.

  • Dependence: As you build tolerance, you might consume more substance to achieve the desired effects. This increased consumption can accelerate the development of physical dependence. Once dependent, if the individual stops using the substance, they might experience withdrawal symptoms.
  • Addiction: Tolerance can also indirectly contribute to addiction. As a person consumes more substance to counteract built tolerance, they might start to display addictive behaviors, such as compulsive drug-seeking, despite negative consequences.

However, it’s essential to understand that while tolerance can lead to dependence and addiction, it doesn’t always. It’s one of many factors involved in the complex progression towards addiction. Always consult a medical professional about tolerance, dependence, or addiction.

Can I Get Addicted to Mental Illness Medication?

The potential for addiction to mental illness medication varies based on the specific drug and its classification. It’s essential to differentiate between addiction and dependence, as these are distinct concepts. Here’s a breakdown:

Antidepressants (like SSRIs, SNRIs, and tricyclics):

  • Risk: Generally low risk of addiction.
  • Note: Some patients might experience withdrawal symptoms (often termed “discontinuation syndrome”) when stopping or reducing the dose, but this isn’t the same as addiction.

Benzodiazepines (like Xanax, Valium, Ativan):

  • Risk: Higher potential for both dependence and addiction if not taken as prescribed.
  • Note: They are typically prescribed for short-term use or specific situations due to the potential for dependence and a challenging withdrawal process.

Stimulants (like Adderall or Ritalin for ADHD):

  • Risk: Possess a potential for dependence and addiction, especially if misused.
  • Note: When taken as prescribed for legitimate medical conditions, the risk is significantly reduced but not eliminated.

Antipsychotics (like Risperdal, Seroquel):

  • Risk: Generally low risk of addiction.
  • Note: While not typically associated with addiction, sudden discontinuation can lead to withdrawal-like symptoms, indicating dependence.

Mood Stabilizers (like Lithium, Depakote):

  • Risk: Generally low risk of addiction.
  • Note: These drugs are not typically associated with addiction, but some can produce physical dependence, and abrupt cessation might lead to withdrawal symptoms.

While many mental illness medications have a low risk of addiction, some, especially benzodiazepines and stimulants, carry a higher risk. It’s crucial to take medications as prescribed, be aware of potential risks, and maintain open communication with health care providers. If concerns about dependence or addiction arise, consult a medical professional promptly.

Can I Get Addicted to My Pain Medication?

When you’re prescribed medication for chronic pain, you may be concerned about the potential for addiction. The answer depends on several factors, like the type of medication, risk factors, and preventive measures.

Types of Pain Medications

  • Opioids: This group includes medications like morphine, oxycodone, and hydrocodone. Opioids are effective for severe pain, but they come with a risk of physical dependence and potential addiction if not taken as directed.
  • Non-Opioids: Examples include acetaminophen, aspirin, and NSAIDs. While these have a lower risk of addiction compared to opioids, they should still be taken as prescribed.
  • Adjuvants or Co-analgesics: Medications like certain antidepressants or anticonvulsants can help with pain, even if pain isn’t their primary use. These generally have a lower risk of addiction.

Risk Factors for Addiction:

  • Personal or Family History: A history of substance abuse or mental health disorders can increase the risk.
  • Young Age: Younger individuals, especially teenagers, are at a higher risk of developing an addiction.
  • Social Environment: Peer pressure or a surrounding environment encouraging drug misuse can elevate risk.

How to Minimize the Risk:

  1. Follow Directions: Always take your medication as prescribed by your health care provider.
  2. Open Communication: Keep an open dialogue with your health care provider. Tell them if you feel your medication isn’t working or experiencing side effects.
  3. Educate Yourself: Understand the potential side effects and risks of your medication.
  4. Avoid Mixing: Never mix pain medication with alcohol or other drugs unless your physician approves.
  5. Regular Check-ups: Regular visits to your health care provider can help monitor and adjust your medication as needed.
  6. Safe Storage: Store your medication securely to prevent unauthorized or accidental use by others.

While some chronic pain medications are potentially associated with addiction, especially opioids, proper management and open communication with your health care provider can significantly reduce the risk. If you ever feel you might be developing a dependence or addiction, seeking medical advice is crucial. Remember, the goal is pain relief and improved quality of life, not adding another problem to tackle.

Getty image by Jose Jonathan Heres

Originally published: October 19, 2023
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