Addiction Vs. Dependence
The terms addiction and dependence are often used interchangeably to refer to the physical and mental health impacts of substance use that occur for some people. However, there are some differences between these terms. Understanding the differences can be a step toward reducing stigma and improving personal and public understanding of addiction and substance use.
Addiction vs dependence: What's the difference?
Dependence and addiction refer to a person’s reliance on a substance or behavior, often in reference to drug or alcohol use. Learning the difference between dependence vs. addiction, as well as substance use and the outdated term “substance abuse” may help you start the road to recovery. Dependence and addiction can be challenging, but there are treatment options available.
Addiction vs dependence according to the APA
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), addiction and dependence are not the same. While some people may use these terms interchangeably, they refer to different stages of substance use and reliance. The DSM-5 serves as a guideline for diagnosing mental health disorders and can be a useful starting point for those with mental health issues.
In 1964, the World Health Organization (WHO) proposed using the word “dependence” instead of “addiction” as a medical designation. This decision may have contributed to the uncertainty, especially as people used the words interchangeably. Today, the two concepts are considered different stages or aspects of potentially problematic or dangerous behavior or substance reliance.
What is dependence? Physical dependence and withdrawal
Dependence refers to becoming physically reliant on a substance and is characterized by tolerance and physical withdrawal symptoms. For example, individuals using prescription medicines may become physically dependent on these prescriptions, putting them at risk of withdrawal symptoms if they suddenly stop use. Physical reliance can also occur with recreational drugs and many other substances.
Substance use disorder and physical dependence
In addition to physical reliance, substance use disorder can cause psychological symptoms, such as anxiety and obsessive thinking. These symptoms can be a sign of dependence, considered an early stage of a substance use disorder. Addiction occurs when physical and mental reliance escalates.
What is addiction? Mental health and substance use disorder
Addiction refers to a chronic disease characterized by addictive behavior that is caused by fundamental changes in brain circuitry as a result of physical dependence over time. Addiction can cause distorted thoughts, uncontrollable behavior, and impulsive choices stemming from a person’s chemical drive to keep a substance in their system. Addiction and substance use disorder are the preferred terms for this process, as substance abuse is no longer used in the scientific community.
A person can develop a dependence on a substance without being addicted. However, consistent dependence on a substance over time is likely to turn into a drug addiction if not curbed. Although a person can be dependent without being addicted, a person cannot have an addiction without also experiencing dependence.
Dependence and addiction are symptoms of substance use disorders, which the American Psychological Association (APA) classifies as “varying degrees of excessive use of a substance.” Substance use disorders can include alcohol use disorder, cannabis use disorder, opioid use disorder, and others. These conditions are diagnosed when someone is experiencing an active addiction to a substance. However, you can get help at any point, including when experiencing dependence.
What does dependency look like with drug use?
Physical dependence often happens gradually and may include physical adaptation to a substance. Adaptation or tolerance requires a person to receive more of a substance to achieve the same result, which can make this process dangerous. Physical dependence may occur without a person realizing it.
Substance dependencies stem from biochemical changes in the body caused by drug use. Eventually, an individual may reach a point where their body can only function normally when a specific substance is present. In some cases, long-term dependence on a substance is deemed medically necessary or beneficial by a doctor. Examples might include medication for managing seizures or an illness like diabetes. In situations like these, the benefits of long-term use of the drug may outweigh any drawbacks.
Drug dependency effects
Drug dependence is not necessarily harmful, but individuals may experience adverse effects if they cease use. These cases often do not escalate into addiction and are not categorized as substance use disorders. In other cases, a harmful dependence on a legal substance may begin in a doctor’s office, as with prescription opioids. The National Institute on Drug Abuse (NIDA) details how the opioid epidemic is a prime example of how this legal debilitating addiction began for many people in the US.
The addiction or dependence resulting from the opioid epidemic refers to the widespread addiction of people to a class of drugs that often starts with a legal prescription from healthcare providers—such as to manage pain after surgery. Even regular use of these drugs as prescribed can lead to dependence, and addiction can follow this dependence.
Because dependence often refers to the physical effects of substance use, dependence is characterized by symptoms of withdrawal once an individual no longer consumes the substance. Withdrawal symptoms can be different depending on the substance. For some drugs, symptoms may include physical symptoms like vomiting, tremors, chills, and low blood pressure, and psychological symptoms like moodiness and irritability.
Some providers make a distinction between physical and psychological dependence, which may coexist. Psychological dependence involves the thoughts and emotions related to a physical dependence on a substance. For example, one might experience anxiety, obsessive thoughts, or irritability.
What does substance and drug addiction look like?
Substance dependencies frequently lead to addiction (formerly known as substance abuse). Whatever a person’s motivation for consuming a substance initially, using becomes a conditioned response: the avoidance of withdrawal symptoms and the biological and physiological drive for the substance once the level of addiction is reached.
True addiction in a severe form is often characterized by a person resorting to more extreme measures to continue using a substance because their body and brain now depend on or rely on it. For this reason, addiction often impacts a person’s family, social, and work life. Addiction may negatively affect their ability to fulfill their responsibilities and obligations since they’re under the strong influence of both dependence and addiction, which may lead them to act irrationally.What causes dependence and addiction?
An individual can become dependent on or addicted to a substance for various reasons. They may start using it due to curiosity, social pressure, a desire for gratification, or a desire for pain relief or escape. It’s also important to note that genetics can play a significant role to identify people who may be at risk for developing dependence or addiction.
If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
The negative effects of substance use on mental health
Substance use that escalates is dangerous and can have many negative consequences (including addiction and dependence). The consequences may vary depending on the individual, their life circumstances, and the substance(s) they are dependent on or addicted to, but can include the following:
- Inability to function without the substance
- Obsessive and impulsive behaviors related to obtaining or using the substance
- Neglect of responsibilities (work, family/children, self-care)
- Strained relationships with loved ones
- Mental health effects such as depression, anxiety, paranoia, psychosis, and other mental disorders depending on the substance
- Risk of cancer from some substances
- Hormone imbalances
- Potential legal consequences associated with illicit substances
- Risk of overdosing on some substances
- The strain on organs and body systems; potential long-term health consequences
How to find treatment for dependence or addiction
Given the negative connotations often surrounding drug use, seeking help might be challenging for some people. Any substance use problem can be difficult for an individual and their loved ones or family members. However, recovery is possible.
Treatment options for dependence or addiction can vary widely depending on the individual and their state of health, the substance in question, and the degree of dependence. The first step in seeking proper treatment is often to get an evaluation by a medical professional. They can identify whether a substance use disorder is present and may refer the individual to another professional for further support.
Professional treatment for substance use disorders often involves several components since the disorder can affect so many parts of a person’s health and life. Physical detoxification in a hospital may be a preliminary step for some individuals. Enrolling in an intensive outpatient or residential inpatient rehabilitation program or treatment center may be recommended for others. Mutual aid groups like Alcoholics Anonymous (AA) may also be helpful. For further support, one might connect with a psychiatrist or therapist to explore the psychological aspects of addiction.
The role of therapy in recovery
Treatment for substance use disorders varies widely depending on the situation and often includes multiple components. According to the National Center on Drug Abuse (NIDA), therapy and substance use counseling can be one of these helpful components. If a mental health condition like depression contributed to an individual starting to misuse a substance, a trained therapist can help them identify the condition and propose strategies for managing symptoms. If past trauma is a contributing factor to why someone developed a dependence on or addiction to a particular substance, a mental health professional can help the individual address and work through those experiences.
Some people may avoid in-person therapy due to concerns about cost, distance, or accessibility. Research suggests that virtual therapy and support groups through platforms like BetterHelp are effective and practical treatment methods for those who are experiencing depression, anxiety, and other challenges related to mental or emotional health. Those with loved ones who are experiencing substance use problems may also benefit from therapy to sort through and validate their potentially complicated emotions related to the situation.
Online therapy allows individuals to seek support from the comfort of their own homes. In addition, online interventions may be more cost-effective for those looking to connect with a mental health professional, which might be helpful for those whose financial lives have been impacted by their substance use or addiction.
Takeaway
Understanding addiction and the difference between dependence and addiction may be a way to notice when you or a loved one is struggling with substance use. Education on symptoms and presentations can lead to being able to seek early intervention.
Substance use disorders are complex but treatable conditions. There is no shame in asking for help in overcoming addiction or dependence on substances of any kind. Consider seeking support from a therapist online or in your area to build a personalized treatment plan.
See below for frequently asked questions on dependence and addiction:
- Is dependence a form of addiction?
- Is psychological reliance the same as addiction?
- What are the two types of substance use disorder?
- What are examples of substance use disorder?
- What are 4 different forms of addiction?
- What is the best definition of substance use disorder?
- What is the correct definition of substance use disorder?
- What are the two 2 kinds of drug reliance?
- What is reliance in psychology?
- How do you know if you are relying on something or someone?
- Is reliance ever a good thing? Or is it only bad?
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