Addiction vs Dependence

The terms ‘addiction’ and ‘dependence’ are often used interchangeably to describe an individual whose drug use or abuse has spiralled beyond their control. Even though both terms are often used to imply the same meaning, there are very important differences between addiction and dependence.

Medically speaking, dependence refers to when the body has physically adapted itself to the presence of a drug. That is, the human system has over time self-modified to work with the abused substance that led to dependence. Without the presence of the abused substance in the system, a dependent person will feel they cannot function normally until having taken a fresh dose.

If you’ve developed a physical dependence and attempt to suddenly quit using your substance of abuse, you’ll most likely experience withdrawal symptoms. How severe these will be is often dependent on what substance you were abusing and the duration of dependence.

Feeling like you cannot physically cope without using a particular substance may sound like addiction to you, but it is actually more representative of dependence. Thus, dependence can be defined as you requiring a steady concentration of a specific substance in order to prevent the onset of withdrawal symptoms. Said substances could be alcohol, prescription medication, narcotics and so on. In summary, even though dependence can lead to addiction, they are not the same.

So, what is addiction?

Progressing from dependence to addiction doesn’t happen overnight. Unlike dependence, addiction is distinctly characterised by how it affects you socially and emotionally, not just physically. That is, when addicted to a substance, your behaviour and mindset changes, which in turn leads you to act unlike yourself if you’re unable to consume or access your substance of abuse. One common symptom of addiction is the willingness of an addict to lie, steal or even engage in violence to get their ‘fix’.

How addiction and dependence affects a person will vary from individual to individual. Factors such as mental and physical health, environment and type of drug will all affect the progression of dependence into addiction. Keep in mind that addiction is literally an illness that an addict has no control over once it takes hold.

While dependence is evident in the need for a fresh dose of drugs (and withdrawal syndrome if the dose isn’t taken), a person can be considered an addict only if the following symptoms are present:

• Exhibiting risky behaviour
• Developing withdrawal symptoms when not using the substance in question
• Repeatedly using the substance in higher doses and for longer periods of time than intended
• Intense and frequent cravings for the substance of abuse
• Unsuccessful efforts to quit the substance or reduce doses
• Inability to focus on (or complete) work, home, or school obligations
• Recurring usage, despite negative impact on health, as well as social and personal disputes.

Psychological dependence vs. physical dependence

Physical dependence is commonly evident in individuals who have been chronically abusing an addictive substance. However, in certain scenarios and depending on the substance, psychological dependence can also manifest. Physical and psychological dependence can dominate the body and mind of an addict; the two can occur in tandem, but there’s a difference in how they each affect your life and health.

Physical dependence refers to how an addiction affects your physiological state. Prolonged and continued use of an addictive substance will result in the body becoming accustomed to the presence of that drug in the system; subsequently, it will eventually come to rely on the influence of the drug to function normally.

If you attempt to quit the substance after physical dependence has set in, you will experience cravings and other more intense physiological withdrawal symptoms. The severity and duration of these symptoms will depend on the longevity and severity of your addiction.

Psychological dependence, on the other hand, describes an addict’s mental and emotional need for the substance of abuse: i.e. when the use of a certain substance is a conditioned response to a feeling or event. Unlike physical dependence (where your system revolts when you try to quit), psychological dependence will result in an emotional struggle with letting go of the drug habit.

Psychological dependence is brought about by your brain’s reward system believing that the drug (or other substance) is required to enjoy or experience a desired effect. The effects of psychological dependence can be as intense as physical dependence and its symptoms are usually longer-lasting.

During rehab, a recovering addict will be helped to re-establish physical, mental and emotional equilibrium, as they are guided towards living an abstinent and healthier life.

How tolerance differs from addiction and dependence

Tolerance can be medically defined as an individual’s diminishing response to a drug, due to repeated usage. Tolerance doesn’t happen overnight, but rather gradually builds up over time as the influence of the drug in question on the body is diminished, leading an addict to use a higher dose to experience the desired effect. Tolerance can be developed to either an illicit drug or prescription medication if it is used for long enough.

Tolerance is not necessarily a sign of addiction. For instance, people who are prescribed certain pain medication may develop tolerance to the drug over time without actually developing an addiction to it, but this all depends on the type of medication. For instance, when it comes to opiates, stimulants or benzodiazepines, developing tolerance can be a major indication of the onset of addiction. Therefore, if you notice that your medication is having less of an effect at the dose you’re accustomed to, it’s best to speak to your physician about it, rather than arbitrarily decide to increase your dose.

The most important distinction between tolerance and dependence is the physical consequences of the two states. Addiction is a descriptive term that indicates a person’s urge or need to abuse a drug, while tolerance refers to the body adapting to the continued use or presence of a substance in the body.

Determining whether you’re dependent or addicted

It is not necessary to be physically dependent on a substance before an addiction forms. In such cases, the addiction is mostly psychological in nature, meaning that although the body doesn’t actually need the substance, the brain believes that the body cannot do without it. One example of such an addiction is a process addiction (such as a gambling or sex addiction).

Dependence can also occur without addiction. With some drugs – especially prescription medication – an increase in tolerance will gradually lead to a physical dependence and experiencing withdrawal if there’s an attempt to quit, but this doesn’t necessarily mean such an individual is addicted to the substance in question.

Determining whether a person is substance dependent is relatively easy in comparison to trying to figure out if a person is addicted to the drug in question. For instance, if you’re dependent on opioids, you will experience withdrawal if you attempt quitting, but you can’t be considered an addict if you aren’t actively or compulsively seeking out opioid medication to satisfy your cravings.

Therefore, unless changes in behaviour are evident (such as developing an opioid-seeking habit or experiencing family problems or job loss brought on by compulsive drug-seeking behaviour), you likely haven’t yet developed an addiction and are simply just drug dependent.

A simple analysis of your behaviour will reveal if your drug use has crossed the threshold from dependence to addiction. If drug use is causing problems at school or work, hurting your relationships or getting you in trouble with the authorities, addiction may well have set in. However, if you are simply feeling cravings and experiencing withdrawal without any of the previously mentioned behavioural changes, then you’re likely only dependent.

How does the delineation between dependence and addiction impact treatment?

Many individuals believe that alcoholism and alcohol dependence are related, and this causes alcoholics who need help to deny they’re dependent and require assistance, thus making it difficult for them to get professional help in time. Contrary to what many think, alcohol dependence doesn’t imply that you spend every hour of every day drinking excessively from dusk to dawn. If you are simply not fully in control of how much you drink, for how long you drink and how often you drink, you need help.

As already stated, it’s not mandatory that physical dependence and addiction co-occur. Dependence and addiction have different levels – none of them good. If you’re suspicious that you have any form of substance dependence or addiction, you should seek professional assistance promptly.

When should addiction and dependence be treated?

Substance abuse isn’t something that should be continued until it reaches the point of addiction or dependence. However, if this does happen, seek professional help immediately.

If you are unsure if you’ve developed an addiction, simply check yourself for the following symptoms:

• Failed attempts at trying to quit or cut back your substance abuse
• Consuming more of an addictive substance or using it for longer than intended
• Substance abuse negatively impacting your social and professional life
• Feelings of remorse when you are abstinent

Also, if you are experiencing withdrawal symptoms, your use of an addictive substance has clearly spiralled out of control and you need to check yourself by getting professional treatment.

• Stay calm, regardless of what happens. Drug users are often on edge, so you need to stay calm in order to keep them at ease. It’s also important that the conversation doesn’t turn into a shouting match or an opportunity to vent your frustrations concerning the addict. Furthermore, avoid being drawn into an argument by the addict.
• Avoid being accusatory. Being accusatory can lead to the addict being defensive. Keep in mind that drug abuse is very similar to a disease and you need to show compassion when trying to convince the addict to get help.
• Try to communicate to your loved one (who’s suffering from addiction) how their condition is affecting family and friends. This is important, because most times, the addict is only focused on the desired ‘high’ and fails to recognise the damage they are causing to themselves and their loved ones. You can help the addict get past denial by showing clear examples of how their actions have negatively impacted those around them.
• For best results, it’s better to confront a loved one about their substance abuse during moments of abstinence. If they aren’t ‘high’ or too strung out, they’ll be better able to focus on what you have to say.
• Don’t do it alone. Not only is confronting a drug user alone unsafe, it might also not yield satisfying results. A confrontation or intervention is more powerful when the most important people in the life of the user are there to tell them the truth.

Other tips that can help with a confrontation include:

• Listen to the drug user’s side of the story. Sometimes, there is an underlying cause for a person’s drug dependence. By identifying what led that person to drugs in the first place, you will have a better idea of what triggers to remove from the life of the addict that could drive them again to hide under the influence of drugs. Also, giving the addict a chance to speak makes them more comfortable with confiding in you.
• It’s rare that confrontations work on the first try, but don’t give up, no matter how long it takes. However many times you confront an addict, make sure your story stays the same.
• Put your foot down. Whilst being sympathetic and compassionate, you also have to let an addict know that there will be consequences for their continued drug use. Make sure you aren’t simply bluffing, because if the promised consequences don’t occur, the addict will likely not take you seriously afterwards.

If staging an intervention seems too much for you, you can always hire the help of a professional interventionist. There are people who specialise in offering such assistance and can help you arrange an intervention as soon as you need it.