Addiction Vs. Dependence

What’s The Difference Between Addiction And Dependence?

Addiction refers to the lack of control and inability to resist urges and cravings to use alcohol or drugs despite adverse consequences. Dependence on a substance refers to the biological effects that occur when a substance is taken for weeks, months, or years.

According to the American Psychiatric Association (APA), creators of the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), addiction is also known as substance use disorder and can be diagnosed if an individual presents with the following issues:

Impaired Control

Someone with impaired control may experience intense cravings and urges for a substance, which can lead to the inability to quit using the substance.

Social Problems

Using drugs or alcohol interferes with the ability to fulfill duties at home, work, school, and socially. Someone often gives up activities they enjoy, as they spend more time using substances.

Dangerous Use

Someone with an addiction may continue to use drugs or alcohol while knowing it will worsen existing physical or psychological problems.

Tolerance

When a person develops an addiction, it can happen over time as they build a tolerance to the substance. They must use more of the drug or alcohol to feel the same effects. They may also experience withdrawal symptoms when they go without the substance.

Dependence

Someone can have a dependence on a substance but not have an addiction to it. People can also experience withdrawal symptoms and not be addicted to a substance.

Today, the APA classifies substance use disorders as mild, moderate, or severe. It doesn’t use the terms abuse and dependence to categorize the severity of an addiction. Part of the reason for the change was the confusion surrounding the word “dependence.” The hope is that defining an addiction as a substance use disorder is a more inclusive way to identify people who need help but may not have a debilitating addiction.

Factors that contribute to dependence include:

• Timing and rate of exposure
• Dose
• Drug potency
• The neurotransmitter system in the brain
• Length of exposure
• Gender
• Age

These factors are also crucial in explaining why some people go on to develop an addiction. They may be accompanied by lifestyle, physical, and psychological health.

Example Of Addiction

People often start taking drugs to feel good, thinking they will use them temporarily. However, many find it difficult to stop, and the more they use the substance, the more likely it is that they will develop an addiction. Even if they want to stop, they can’t due to the intense cravings, urges, and withdrawal symptoms that occur due to chemical changes in the brain.

For example, when someone is prescribed opioids by a doctor for pain, the prescription is usually for a few weeks or months. During that time, the person quickly develops a tolerance, and it doesn’t take long for the brain to become dependent on the drug.

When the doctor stops the prescription, the person will experience severe opioid withdrawal effects. They feel they must find a way to continue taking opioids to avoid the negative symptoms. They may seek additional prescriptions, or they may purchase illicit opioids such as heroin, beginning a cycle of seeking and using drugs they can’t stop on their own. They continue this cycle even though it causes relationship, financial, career, academic, physical, and psychological problems.

Not everyone develops an addiction. Many risk factors contribute to a person becoming addicted to alcohol or other substances, including genetics, biology, environment, and life experiences.

Example Of Dependence

Dependence can develop physically and psychologically in a person using drugs or alcohol. Many substances can cause dependence.

For example, if someone has a dependence on prescription opioids, they may feel unpleasant withdrawal symptoms when they stop taking them. However, they may not engage in compulsive, drug-seeking behaviors or use cheaper, illicit drugs to feel good. They can get past the withdrawal symptoms without feeling like they must find a way to use opioids again.

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Mental Vs. Physical Dependence

Mental or psychological dependence is when the use of a substance is a conditioned response to an event or feeling. These are known as “triggers.” Something as simple as driving can trigger a desire to use. These triggers set off biochemical changes in a person’s brain that strongly influence addictive behavior. Triggers can be emotional responses to events, certain people, places, or anything a person associates with using a substance.

Physical dependence occurs when the body becomes accustomed to functioning with the substance present. If a person stops using the substance, the body reacts with noticeable withdrawal symptoms, which may include:

• Nausea
• Vomiting
• Sweating
• Flu-like symptoms
• Headaches
• Sleep disturbances

Withdrawal symptoms vary due to the substance, length of use, amount used, and personal factors. More severe symptoms may occur for those using large amounts for a long time, including seizures, tremors, confusion, or delirium.

Dependence Vs. Tolerance

Dependence occurs when the body adapts to a substance and begins to rely on it to function normally. In contrast, tolerance refers to the reduced effects a substance has on the body over time, meaning more of the substance is needed to achieve the same effect.

When a doctor prescribes a medicine, they start you on a specific dose. After taking the drug for a while, it may not get rid of your symptoms like it did when you first started taking it. In this case, you must increase the dose to feel the same physiological effects.

People can build a tolerance to addictive and non-addictive substances. Continuing to increase the amount of a substance to achieve the same effects can lead to dependence and addiction.

Why Are These Differences Important?

It is essential to understand the differences between addiction, dependence, and tolerance to avoid confusion, misdiagnoses, and stigmas. Each requires a different level of treatment, and if someone doesn’t understand the difference, they may seek an inappropriate level of care or avoid getting help entirely.

Treatment For Addiction

Effective addiction treatment manages withdrawal symptoms and teaches people how to avoid relapse. It is integrative and includes therapies that address multiple issues a person may be facing.

Addiction treatment typically includes therapy, medication assistance, alternative therapies, and  peer support. Standard behavioral therapies include the following:

Cognitive-Behavioral Therapy (CBT)

CBT helps you recognize and identify the thoughts, feelings, and behaviors that lead to drug dependence. You learn effective coping skills to prevent relapse, enhance relationships, manage self-care, and regulate emotions.

Contingency Management (CM)

CM uses rewards and prizes as positive reinforcement for achieving positive goals. For example, when someone attends 30 days of treatment without missing a day, they receive a reward, motivating them to continue their positive behaviors.

Motivational Enhancement Therapy (MET)

MET is a technique therapists use to motivate you to change. Not everyone is ready to stop using substances and may need encouragement.

12-Step Facilitation

Support groups like Alcoholics Anonymous and Narcotics Anonymous have worked for decades due to their structured format and steps. There are also many 12-step family groups, like Al-Anon, to help them deal with the effects of dependence or addiction.

Family Therapy

Couples and family members who have been affected by addiction can benefit from family therapy to work through their issues, learn how to support each other in recovery, and receive support for themselves.

Mindfulness-Based Therapies

Caring for the whole person is the premise for holistic, mindfulness-based therapies. It helps you recognize how physical aches and pains can trigger relapse. You learn specific skills for self-care that will help you know what is happening around you in the present time, with your body, mind, and surroundings.

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Treatment For Dependence

Treatment for those who have a dependence but not an addiction may be less intensive for some people. Often, a doctor can prescribe medications to help you stop using addictive substances. The following treatment medications are available for someone with an alcohol use disorder:

• Naltrexone, which reduces cravings and urges for alcohol
• Disulfiram, which causes an unpleasant reaction when you drink alcohol
• Acamprosate, which reduces cravings and restores brain chemicals disrupted by long-term alcohol misuse

The following medicines are prescribed to those with an opioid use disorder:

• Naltrexone, which reduces the craving for opioids
• Buprenorphine, also known as Suboxone or Subutex, is an opioid medication that reduces cravings and withdrawal symptoms
• Methadone, an opioid medication that reduces cravings and withdrawal symptoms
• Lofexidine, a non-opioid medication that eases withdrawal symptoms

Medications prescribed to aid with withdrawal must be monitored closely by clinical staff. Someone in medication-assisted therapy may be able to participate in an outpatient program, attending daily, weekly, or monthly meetings to receive doses.

When To Seek Treatment

You should seek treatment at the first sign of dependence to avoid harmful mental and physical consequences and to stop substance misuse before it turns into an addiction.

If you feel as though you are dependent on a substance, you can talk to a healthcare provider or mental health professional who can offer assessments to determine if you need treatment. During the evaluation, it is a good time for you to ask questions to learn if the doctor or therapist understands the difference between addiction and dependence and the treatments for both.

If you are struggling with a substance use disorder, inpatient and outpatient addiction treatment options are readily available. Contact a treatment provider or explore our rehab directory to discover your rehab options and start your recovery journey today.