Understanding the Difference: Addiction vs. Dependence
Addiction and dependence are often used interchangeably, but they don’t mean the same thing.
When people misunderstand the difference they might avoid taking the medications they need for certain health conditions. It can also make it harder to find the right treatment plan — especially when struggling with substance use issues.
Dependence and Substance Abuse
The definitions of addiction and dependence have undergone a lot of changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In the DSM-4, substance abuse and substance dependence were considered separate disorders. Then 19 years later, they were combined in the DSM-5 into one disorder that ranges from mild to severe, now called substance use disorder.
While the DSM-5 may link addiction and dependence, it does not mean they are the same thing.
The older DSM-4 criteria for addiction and dependence led to misdiagnosing patients, which created a false relationship between addiction and dependence (labeling dependence worse than addiction).
The DSM-5’s change in definition eliminated these issues; although, it created a confusing divide and some clinicians still struggle to differentiate addiction and dependence.
Medical terms are always evolving, and official categories in the DSM-5 take a long time to update. The American Psychiatric Association typically releases a new manual after 10-15 years. The criteria and definitions of mental health issues may not match the way we think and talk about things now.
Currently, most healthcare providers consider drug addiction and drug dependence as separate issues with different treatment options.
What Is Addiction?
According to the National Institute on Drug Abuse, drug addiction is a mental health disorder that involves chronic, compulsive drug seeking. These compulsive behaviors continue despite any negative consequences.
Diagnosing Addiction
Addiction can look different from person to person, but some common symptoms indicate it may be time to seek help.
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- A desire or attempt to cut down or control alcohol or drug use.
- Spending a lot of time using drugs or alcohol or trying to obtain them.
- Spending less time on important social, occupational, or recreational activities, or giving them up completely, in favor of drug and alcohol use.
- Continued use despite negative consequences to your physical or mental health.
- Increased tolerance, or needing more of the substance to feel its effects.
- Physical withdrawal symptoms when you try to stop using drugs or alcohol.
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What Is Substance Dependence?
Dependence can happen with or without addiction. If you use drugs consistently, your body adapts to the substance and becomes reliant on it. It is a natural response to drug use, including many prescription drugs.
Prescription opioid use (such as morphine) may not always lead to an addiction, but long-term use can build dependence. This means that someone may not crave the drug, but they can suffer from withdrawal syndrome when they stop.
Substance dependence is much more common than you might think, as it does not automatically mean the person is addicted. For example, anyone having a headache or not feeling well after skipping their daily cup of coffee displays a physical dependence on caffeine. They may not crave it or have a caffeine addiction, but they experience physical symptoms when they do not have it in their system.
Side Effects of Physical Dependence
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- Increased tolerance
- Physical withdrawal symptoms
- Difficulty sleeping
- Restless limbs
- Exhaustion
- Sweating
- Aches and pains
- Irritability
- Seizures
- Mood swings
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Different Substances Cause Different Levels of Dependence
Not all substances cause the same level of dependence.
For example, cocaine addiction can be severe, but it is more likely to cause psychological dependence than physical dependence. While you may experience cravings, build up a tolerance, and feel irritable and restless when you stop using, it may not be as severe as someone who is physically dependent on a substance.
Alcohol use and opioids can cause intense physical dependence. Withdrawal from both of these substances can be dangerous if not monitored correctly. This is why many treatment plans for certain kinds of substances involve tapering or medical interventions to make the physical symptoms of withdrawal more manageable.
Types of Addiction Treatments
Detoxification
Detox helps you overcome physical dependence safely. For alcohol addiction and opioid addiction, supervised detox may be necessary depending on the severity of physical dependence.
In a medically supervised detox program, healthcare professionals monitor your symptoms and provide aid when necessary. In some cases, they use medications like buprenorphine to avoid discomfort and dangerous symptoms.
Support Groups
In support groups like Alcoholics Anonymous, you receive support from people in similar situations as you. A supportive community improves your chances of recovery and reduces feelings of isolation and stigma. This can make the mental aspect of addiction much easier to handle.
Psychiatry and Talk Therapy
Psychiatrists who specialize in addiction use evidence-based treatments and therapy to help you overcome the mental aspects of substance use disorders.
Often psychiatric disorders such as anxiety and depression are co-occurring with substance use disorders. This can complicate your recovery and make it much more difficult to manage long-term. Working with a therapist helps you navigate the challenges of addiction while treating any co-occurring mental health issues at the same time.
Find the Path to Recovery
Knowing the difference – addiction vs. dependence – helps you find the right treatment plan, whether you need support with detoxification or help developing healthy coping skills for the mental challenges of addiction. Effective treatment relies on medical advice and care alongside therapeutic and community support.
By addressing both the physical dependence and the psychological aspects of substance use, you can develop a comprehensive strategy for long-term recovery. Remember, reaching out is the crucial first step. A better tomorrow is possible with the right support today.