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Dependence and Addiction: Is There a Difference?

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Dependence and addiction are often used interchangeably, but they do not mean the same thing. There are differences between the two.

Some people wonder if one is worse than the other or if one can lead to the other. These are common questions some ask to determine how far along a person is in their substance use and what it means or could mean in the future.
To answer if there is a difference between dependence and addiction, we have to look at what they mean. It is essential to know the difference between the terms because you will have a better idea of where a person is in their substance use and what to expect.

Dependence

There are two essential things to know about dependence, according to the National Institute on Drug Abuse (NIDA). First, it indicates that a person has used a substance for a considerable time, for example, a person who uses a prescription medication daily for months or years.

Second, dependence is apparent when users experience physical and mental changes when they stop taking a substance or reduce their usage. If a person stops using medication, they have been using regularly and experiences withdrawal symptoms; this is an indication that they are dependent on it. 

Withdrawal symptoms range in intensity, from mild to life-threatening, depending on the substance. Opioid and benzodiazepine medications, as well as alcohol and stimulants, all have life-threatening symptoms, so professional medical detox is advised to manage them safely.

Mild withdrawal symptoms include headaches and nausea, while life-threatening symptoms include seizures. The symptoms someone experiences can depend largely on the drug they are using. An individual’s physical health is also a factor in how mild or severe withdrawal symptoms can be.

Many people think that the presence of withdrawal symptoms means a person is addicted to a substance. However, NIDA says dependence on a medication or drug does not mean a person is addicted to it. It does mean, however, that stopping use of that substance requires a tapering procedure. This method gradually reduces the use of a substance to give the body time to adjust to having less of the substance in its system.

Tolerance

It also would be appropriate to mention tolerance here and how it relates to dependence. When a person develops tolerance of a substance, it means they no longer feel its effects when they take their usual dose. This can happen over time, or quickly the more a person takes a substance. It also can depend on the potency of the substance used.

People who wish to experience the initial feelings they had when first taking a substance may decide to take more of it or take it more frequently. This is problematic because taking a high dose of a medicine or illegal drug can put one at risk of developing an addiction.

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Addiction

As NIDA explains, addiction differs from dependence and tolerance because it is a disease, a complex one that can be treated. 

“As a result of scientific research, we know that addiction is a medical disorder that affects the brain and changes behavior,” the federal agency writes.

However, a person who develops tolerance to a substance can become dependent on and develop an addiction. Those first two things must occur first before a person reaches the point where they abuse a substance and cannot stop themselves from doing it, regardless of what happens.

“If a person keeps using a drug and can’t stop, despite negative consequences from using the drug, they have an addiction (also called a severe substance use disorder),” NIDA writes.

The medical term health professionals use when talking about addiction is “substance use disorder,” which can range from mild to severe. 

To sum it up, someone can become dependent on a substance, whether they are abusing it or not. However, someone who is addicted to substances will struggle to control their behavior as it relates to their use of it. They will do whatever they can to get their hands on it.

What Causes Substance Use Disorders?

Scientists do not fully understand why some people develop addictions, while others do not. NIDA says so itself, writing, “Despite these advances, we still do not fully understand why some people develop an addiction to drugs or how drugs change the brain to foster compulsive drug use.”

Several factors play a role in who struggles with substance use disorders. Healthline notes the following are among those factors:

  • Genetics
  • Mental health disorders 
  • Environment (home environment or school environment)
  • Age one begins using substances
  • Drug(s) of choice
  • Method an individual uses when doing drugs

How Can You Tell If You Have an Addiction?

Everyone’s experience with substance use is different. However, there are ways to tell if addiction is the challenge one is facing. Among them are:

  • Intense cravings for addictive substances
  • Persistent thoughts about using drugs or alcohol throughout the day
  • Feeling out of control and unable to stop using drugs or alcohol after multiple attempts
  • Engaging in drug or alcohol use more than once intended (taking more of a substance or using it longer than one wants to)
  • Feeling like life is not manageable without using addictive substances
  • Strained relationships with loved ones
  • Increased isolation to hide substance use from others
  • Taking addictive substances to avoid withdrawal symptoms after chronic use

All of these are signs that one is struggling with substance misuse issues. If you find that you cannot control your substance use, you may be putting yourself and your loved ones at risk. It is time to consider getting help.

A mental health professional can confirm if problematic substance use has crossed the line into something more serious that requires medical treatment. Before determining a person’s condition, they will first consult with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (or the latest version available) to compare one’s symptoms to those listed in the manual.

“The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified,” Verywell Mind writes.

If a person has up to three symptoms on the list, they are said to have a mild disorder. If they have up to five, their substance use disorder is moderate. If they have six or more, then their substance use disorder is considered severe. All substance use disorders can be treated. People in the moderate-to-severe range may have greater urgency to get help right away so that they can start working on their addiction.

Treatment Available for Dependence and Addiction

Whether someone is physically dependent on a drug or physically and mentally dependent on a drug to the point where consequences do not matter, professional addiction treatment is available that can address both conditions.

If you decide to enter an addiction treatment program, you likely will start with medical detox, especially if your substance use disorder is further along. From there, medical and addiction care professionals will assess your needs further and recommend a treatment setting for you that involves evidence-based approaches to treatment, including therapies, counseling, and medications, if those are needed.

Your placement can fall anywhere along the continuum of care, as the American Society of Addiction Medicine explains. Once you have completed treatment, your facility can connect you with aftercare services that can help you adjust to life after treatment and support you as you rebuild your life.

If you would like to learn more about treatment programs that can help you leave addiction behind, The Palm Beach Institute can help. Give us a call today.

Sources

Tolerance, Dependence, Addiction: What's the Difference? (n.d.). from https://archives.drugabuse.gov/blog/post/tolerance-dependence-addiction-whats-difference

Drug Addiction (Substance Use Disorder).” (October 2017). Mayo Clinic. from https://www.mayoclinic.org/diseases-conditions/drug-addiction/diagnosis-treatment/drc-20365113

“How Science Has Revolutionized the Understanding of Drug Addiction.” National Institute on Drug Abuse (NIDA). (July 2020) from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface

Risk Factors for Addiction. Healthline. (n.d.). from https://www.healthline.com/health/addiction/risk-factors

ASAM. (n.d.). What is the ASAM Criteria? from https://www.asam.org/resources/the-asam-criteria/about

Hartney, E., Ph.D. (2020, March 21). The Symptoms Used to Diagnose Substance Use Disorders. from https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

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