The terms dependence and addiction are sometimes used interchangeably when discussing the potential challenges and consequences of substance use, often leading to confusion about their distinct meanings. Even the website for the American Psychological Association (APA) provides a definition of addiction that acknowledges how often the two are used simultaneously (emphasis ours):
Addiction is a state of psychological or physical dependence (or both) on the use of alcohol and other drugs. The term is often used as an equivalent term for substance dependence and is sometimes applied to behavioral disorders, such as sexual, internet, and gambling addictions).
However, while both concepts involve a person’s potential reliance on a substance or behavior, addiction and dependence can differ significantly in their underlying mechanisms, effects, and implications for treatment and resolution.
Read on as Clear Behavioral Health looks to provide clarity on the difference between dependence vs addiction, along with exploring the intricacies of physical and psychological addictions and their ramifications for your life.
Defining Dependence and Addiction
While both dependence and addiction describe a person’s relationship with a substance (a drug/alcohol) or even certain behaviors (like gambling) and are inherently related, their meanings are in fact not the same:
Dependence
Dependence typically refers to the psychological and/or physiological adaptations that occur when the body is exposed to a stimulus over time. It frequently involves developing a tolerance, where larger amounts of the substance or reoccurrence of the behavior are needed to achieve the same effect as previous usage brought, along with potentially experiencing withdrawal symptoms when the substance (or behavior) in question is reduced or stopped entirely.
It is possible to be dependent on a substance but not to be addicted to it. For example—and as will be explored later in the blog—the body can develop a dependence on certain medications targeting depressive symptoms, such as selective serotonin reuptake inhibitors (SSRIs). However, SSRIs are not in themselves habit-forming nor understood to be physically or psychologically addictive—rather, our bodies simply adapt to their presence over time, which can sometimes lead to lessening their effect. As such, individuals who have a dependence on SSRIs are not addicted to their prescribed medications (nor that they will suffer the same withdrawal symptoms as someone using opioid-based medications): it only means that their bodies have adapted to the medication’s presence over time.
Addiction
Addiction, on the other hand, often encompasses the elements of dependence and also includes a host of other considerations across life domains. It’s characterized by a compulsive and uncontrollable urge to seek and use a substance, even when it causes you harm to do so.
Let’s turn to the American Society of Addiction Medicine for their definition:
Addiction is a chronic, treatable condition that involves complex interactions among brain circuits, genetics, the surrounding environment, and life experiences. Individuals with addiction use substances or engage in behaviors that become compulsive and frequently endure despite negative consequences.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a reference published by the American Psychiatric Association that provides a standardized classification and diagnostic criteria for mental health disorders. The DSM-5 defines substance use disorder as a problematic pattern of use of a substance (such as alcohol, drugs, or medication) leading to clinically significant impairment or distress.
Struggling with addiction often results in a loss of control and negative consequences to health, relationships, and daily life. Many addictions can involve dependence, such as opioids or alcohol, but not all addictions necessarily have this component.
What’s the difference between physical and psychological addiction?
Physical addiction primarily involves tolerance, or the body’s adaptation to a substance’s presence, often marked by accompanying withdrawal symptoms upon discontinuation of the substance use. People who are physically dependent require increasing amounts of the substance to achieve the same effect and experience discomfort when trying to quit due to withdrawal symptoms.
Psychological addiction, on the other hand, focuses on the mental and emotional aspects of reliance on a substance. It’s characterized by intense cravings and a preoccupation with obtaining and using the substance, often driven by pleasurable sensations or relief it provides. Psychological addiction can lead to obsessive thinking about the substance and difficulty managing life without it.
How does tolerance fit in?
Tolerance can be a critical factor in both dependence and the development of substance use disorder. It occurs when the body becomes accustomed to a substance’s presence, necessitating higher doses for the same effects. Tolerance develops due to various physiological mechanisms, including changes in receptor sensitivity and neurotransmitter levels in the brain. It’s a hallmark of physical dependence and is commonly observed in addiction scenarios.
However, tolerance can often look quite different, depending on the substance in question: as referenced above, a tolerance to SSRI-based medications can require working closely with your prescriber to explore potential avenues to taper off the medication or switch to a new one; tolerance for opioid-based medication or alcohol can necessitate a medical detox to successfully navigate the physical and psychological consequences of withdrawal, along with other complications that can lead to an addiction which requires professional treatment.
Let’s look further at how dependence and addiction factor in (or don’t factor in) to a few groups of substances:
Which Substances Are Addictive?
Addiction and dependence on SSRIs
Current research does not indicate SSRIs as addictive. However, if an individual takes an antidepressant of this category for long enough, they can experience negative symptoms or experience discomfort when they stop—especially if they stop abruptly. It’s always recommended to work in conjuncture with your prescriber to safety make any medication management changes to SSRI medications safely.
Addiction and dependence for opioid-based medications
Opioid-based pharmaceuticals, often used for pain management, can present a complex picture of both dependence and addiction, as both can develop even with proper use. The body adapts to opioids, leading to tolerance and potential withdrawal symptoms when their use is reduced. However, addiction can also result from the potentially-euphoric side effects of opioids—be they prescribed or purchased illegally—leading to compulsive usage and other harmful consequences.
Addiction and dependence for benzodiazepines
Benzodiazepines, prescribed for anxiety and sleep disorders, can also lead to dependence and addiction with regular use. Withdrawal symptoms and the need for higher doses can arise, and some individuals may also develop an addiction when misusing these medications for their sedative effects, be they prescribed or purchased on the street.
It’s also important to note that benzodiazepine withdrawal can be deadly, and cessation should always be handled in the care of a professional.
Addiction and dependence for alcohol
Alcohol addiction and dependence are deeply intertwined. Regular alcohol consumption can lead to physical and psychological dependence over time, along with potentially deadly withdrawal symptoms. As such, alcohol addiction can result from prolonged and ongoing use, and may require treatment intervention to begin the recovery process.
Addiction and Dependence for Illicit Drugs
Several illegal drugs can often lead to both addiction and dependence. The often euphoric effects of these substances can drive compulsive use, which in turn can lead to addiction. Simultaneously, physiological adaptations from ongoing usage can lead to tolerance and withdrawal upon discontinuation, highlighting the interplay between both concepts as they pertain to potential addiction.
What are the criteria for diagnosing substance abuse disorders?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the current criteria for diagnosing substance use disorders. According to the current version, substance use disorders span the following eleven criteria, of which at least two are required for a diagnosis:
- Taking a substance in increasing amounts or for longer than you intended
- Wanting to cut down or stop using a substance and not being able to
- Spending increasing amounts of time to obtain, use, or recover from the substance
- Cravings and/or urges to use the substance
- Falling behind in your roles at home, at school, or at work as a result of ongoing usage
- Continuing to use a substance, even when it causes issues
- Giving up important social, work, or recreational activities because of the substance
- Using substances even when it’s dangerous to do so
- Continuing to use the substance even when a physiological or psychological dependence is noted
- Tolerance, or needing more of the substance in question for the desired effects
- The development of withdrawal symptoms, which can be alleviated by taking more of the substance
Are you struggling with alcohol or drug addiction?
Distinguishing between alcohol or drug dependence and addiction is essential for informed discussions about substance use and prescribed medication alike. Recognizing the difference between them can help you to speak with your providers, and also help you reach out if you have concerns. It takes courage to ask for help, and Clear Behavioral Health is here to provide you with multiple treatment options to fit your specific needs. Contact us today to learn more about our residential detox and rehab for withdrawal management and stabilization as well as our dual diagnosis outpatient programs for ongoing support.
Give us a call today to speak with one of our representatives about how Clear Behavioral Health can help you begin the healing process from alcohol or drug abuse and or mental disorders.
