According to NIDA (the National Institute on Drug Use and Health), addiction and physical dependence are not terms that can be used interchangeably.
Physical Dependence Definition
Per the NIDA definition of addiction, the compulsive use of a substance – whether alcohol, prescription medications, or illicit drugs – is characterized by an inability to stop, despite adverse consequences caused by substance use. Additionally, addiction interferes with the ability to meet social, professional, and family commitments.
Now, depending on the substance, addiction often involves tolerance building and withdrawal symptoms manifesting in the absence of the substance. Tolerance and withdrawal are indicative of physical dependence.
The chronic use of many substances can lead to physical dependence developing. This happens not only with illicit substances, but also with legal substances like alcohol, and even with prescription medications like opioids or benzos taken exactly as directed.
So, while physical dependence does not always constitute addiction, it often manifests alongside addiction.
This distinction can sometimes be challenging to discern with prescription opioid painkillers. While increasing dosages can point toward the development of an addiction, this can also represent tolerance building – physical dependence – or it could suggest that the underlying problem is worsening.
What is Physical Dependence?
Dependence is a term typically used to express physical reliance on a substance. The two most common symptoms of physical dependence are:
- Tolerance: more of the substance is required to achieve the same effects as your body becomes accustomed to the substance.
- Withdrawal: If you abruptly discontinue the use of a substance, you will crave more of the substance and experience acute withdrawal symptoms if you are dependent on the substance.
Just like addiction, dependence unfolds as a result of chronic substance use, but dependence is characterized by physical symptoms (tolerance and withdrawal).
Dependence on an addictive substance develops in your brain and then works its way throughout your body. When the substance is not present, symptoms of physical dependence manifest. Symptoms also present when tolerance builds, and you do not achieve the desired effects with the same dose.
Tolerance is a phenomenon that occurs when you consume a substance so frequently that your body adjusts to its presence.
When physical dependence develops, you need more and more of the substance to keep withdrawal symptoms at bay.
If you are physically dependent on a substance, you would benefit from a supervised detox in a medical detox center. Medications can help mitigate the physical withdrawal symptoms and psychological cravings that occur during detox. You will also benefit from around-the-clock clinical supervision, reducing the chance of complications.
Physical Drug Dependence vs. Addiction
Addiction, by contrast, has a powerfully psychological component in addition to the possibility of physical dependence. Someone in the grip of addiction may be aware of the negative outcomes, yet they compulsively continue using the damaging substance.
Although dependence is sometimes viewed as a precursor to addiction, this correlation does not always apply. It is possible to be dependent on a substance without being addicted – when taking opioids or benzos short-term, for instance. Similarly, it is possible to be addicted to a substance without exhibiting physical withdrawal symptoms upon discontinuing use.
The primary difference between the concepts of dependency vs. addiction is this:
- Addiction is behavioral rather than involving a bodily response.
- Dependence involves physical and/or mental withdrawal symptoms when the substance is removed from the equation. Dependence is also characterized by a growing tolerance for the substance.
Dependence, then, is a consequence of sustained substance abuse that often but not always coincides with addiction. That said, it is not always the cause of addiction, nor is always the result of addiction.
Ultimately, substance use triggers a chain of physiological and emotional responses that impact people differently. Many variables come into play here, principally the type of addictive substance.
Addiction and dependence have one thing in common: both respond favorably to treatment in an alcohol or drug rehab. The key to successful evidence-based addiction treatment is the treatment of dependence through medical detox and ongoing therapy, while using MAT (medication-assisted treatment) and psychotherapy to address the psychological addiction.
The clinical term for addiction is substance use disorder (drug addiction) or alcohol use disorder (alcoholism).
Substance use disorders are diagnosed according to the criteria laid down in the APA’s Diagnostic and Statistical Manual of Mental Disorders. Per DSM-IV, abuse and dependence were classified as separate disorders.
In 2013, the APA released DSM-5, the fifth edition of this diagnostic tool. This distinction between abuse and dependence no longer applies. The terms substance dependence and substance abuse are replaced by substance use disorder.
Previously, abuse was a mild form of addiction while dependence indicated a moderate or severe addiction. As the scientific understanding of addiction has evolved, so have the diagnostic criteria. Per DSM-5, substance use disorder is diagnosed as mild, moderate, or severe according to the number of symptoms present. Part of the reason for this change was the confusion surrounding the terminology.
Mental dependence occurs when using a substance is a compulsive and conditioned response to a trigger – an event or a feeling. This could be driving past a bar, smelling weed in the air, or a stressful life event. These triggers then induce biochemical changes in your brain, strongly influencing addictive behaviors.
Triggers, then, are people, places, things, and feelings you associate with using substances.
You may experience the following symptoms when you encounter a trigger for addiction:
- Powerful cravings for the substance
If the symptoms of physical and mental dependence are present, this typically indicates the presence of an addiction. Having said that, the distinguishing difference between addiction and dependence is that addiction – substance use disorder – combines both types of dependence with the additional presence of compulsive and uncontrollable substance use.
Physical Dependence Marijuana
The scientific understanding of marijuana continues to evolve. Marijuana use can become problematic, with research indicating that around 30% of those who use marijuana may develop marijuana use disorder. This risk is significantly increased if marijuana use begins before the age of 18.
Marijuana use disorder is often but not always associated with dependence. Many people who frequently use marijuana report the following cannabis withdrawal symptoms upon discontinuing use:
- Mood changes
- Decreased appetite
Marijuana dependence occurs when the brain undergoes changes, producing less endocannabinoid neurotransmitters, according to this study.
Overcoming Addiction at The District Recovery
If you have been taking any addictive substance and you’re ready to commit to sober living instead, we can help you here at TRDC.
At The District, we specialize in the outpatient treatment of alcohol use disorder, substance use disorder, and co-occurring disorder (addiction with co-occurring mental health disorder).
Research shows that most mild and moderate substance use disorders respond just as well to intensive outpatient treatment as to inpatient treatment. If even an IOP (intensive outpatient program) doesn’t provide you with enough support, we also offer PHPs (partial hospitalization programs). This is the most intensive form of treatment before residential rehab.
Regardless of the level of time commitment that best suits your circumstances and your addiction, we’ll help you combat the physical dependence on a substance that’s holding you back. Through a personalized array of medication-assisted treatment, counseling, and psychotherapy, you can build the firmest foundation for ongoing recovery.