When we talk about substance misuse, of whatever kind e.g. alcohol, illegal or prescription drugs, the words “addiction” and “dependence” can sometimes be used interchangeably. However, there are differences between being addicted to something and being dependent.
In this article, we will look at what the differences are between addiction and dependence. We will also look at how they fit into the overall umbrella of what are “substance use disorders”.
When looking at the definition and diagnosis of substance misuse it is most common in the English-speaking world to turn to a book called DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders – fifth edition). This manual, published by the American Psychological Association, gives definitions and criteria for diagnosis for all the currently recognised mental health disorders.
The term “addiction” was never used in the DSM because it was considered too negative. Instead of this, the editors opted for the term “substance abuse”.
In the last edition of the DSM, substance abuse and substance dependence were defined as two separate disorders. However, in the new edition (published in 2013), both terms were dropped in favour of “substance use disorders”.
Today, “substance use disorder” is the term used in the medical world and categorises the disorder in an individual as either mild, moderate, or severe. Due to the confusion behind the previous terms, the words “dependence” and “addiction” are not used.
Yes, there is, and it is important that they do not get confused.
Dependence refers to the physical need the body develops towards a particular substance. Addiction, on the other hand, refers to the altered behaviour of someone who has developed a psychological requirement of a particular substance as a necessary part of their life.
Let’s look at these definitions a bit more closely.
Dependency is a physical state in which our body cannot function normally without a particular substance in its system. When the brain gets used to having a substance in the body, it adapts itself to think of that substance as part of what is normal for the body.
When the substance is no longer there or even just starts to decrease, for example after a few days of drinking alcohol, the body reacts by going into a state of withdrawal, this is simply the body indicating that it is lacking something that it had got used to having.
Dependency is experienced commonly when people drink too much caffeine and then stop drinking it as part of a health regime. The body responds to not having the chemical it was used to buy a painful headache.
Dependency can occur with many different substances, and some are more likely to cause a dependency than others. Whilst removing caffeine might result in a headache, other dependencies, such as alcohol, can cause life-threatening reactions if someone stops drinking after a prolonged period, without medical assistance.
Addiction also refers to changes in the brain but this time to the brain’s system of reward. When a person is addicted to something, the brain’s reward system begins to associate that particular “thing” (substance or behaviour) with an enormous release of dopamine that cannot be achieved so easily in other ways.
This reward for using the substance begins to lead the person to behave in ways that prioritise the addiction above everything else. This is what begins the patterns of behaviour that start to negatively affect relationships, jobs, and health.
In early addiction, there may not be a physical dependency, and so the person does not suffer physical withdrawal symptoms if they are unable to get their substance or if they try to stop using it.
The mental pressure to get the substance is what can be hard to imagine for those who have not suffered an addiction. The person suffering from addiction can experience “cravings” that sometimes make unhealthy decisions seem perfectly reasonable.
Tolerance is what occurs as the use of a particular substance increases. As the body becomes used to some substances it can require more and more of the same substance to produce the desired effect.
People see this clearly in someone who has been consuming large amounts of alcohol over a prolonged period. The person becomes more and more tolerant of the alcohol in their system and so requires more alcohol in order to experience the same ‘buzz’ they used to receive after much less alcohol.
Tolerance certainly does lead to dependence as the increased tolerance leads to more consumption of the substance which, in turn, gives the body more time to adapt to having the substance in its system. This then results in the body requiring the substance in order to function normally.
Tolerance is an extremely dangerous element of substance misuse as it can lead to overdose. Whilst more of the substance might be required to get the same ‘hit’, other effects of the substance are also therefore increased.
For example, with depressant drugs such as alcohol and opiates, as the person uses increasing amounts to get the desired feeling, the respiratory inhibiting effects of the drug are also increased, resulting in lowered oxygen levels and ultimately death.
If you are concerned that you may be addicted to or dependent on particular substances, it is always best to seek out advice from a GP or addiction treatment service to talk about your concerns.
You can also look at certain things for yourself to see if you can spot any signs of addiction or dependency.
Dependency is a physical need for a substance that results in some form of withdrawal if the substance is not in your system. For example, someone who is prescribed certain opioid-based medication for pain relief over a long period of time will develop a physical dependency.
In the case of such a dependency, when it comes to stop taking the drug it is important to reduce gradually under medical supervision rather than stopping abruptly. The body will be used to having the drug in its system and so might react badly to it being suddenly removed.
Where this becomes an addiction is if there is a psychological inability to face living without the drug. Addiction results in negative behaviours such as being secretive or telling lies in order to facilitate your substance use, or not wanting to talk about it with others. Problems can then start to arise in relationships and around work responsibilities.
If someone can honestly say that there are none of these negative behaviours related to their substance use, then they are probably not addicted. If you are feeling uncertain, it is always advisable to speak to a professional.
Because dependency is a physical issue, the needs of the body and the effects of the substance have to be considered when dealing with it.
The best advice is always to deal with a dependency with the help of a professional so that you can be sure that you will not suffer any ill-effect from coming off the substance too quickly.
There is also medication available to help with treating dependency on substances such as alcohol. This medication works to reduce the effects of withdrawal which otherwise can be extremely dangerous.
Addiction involves not just the body but also the mind and therefore treatment is more complex. Whilst it is complex, however, it is still very possible and different treatment options are available.
Treating addiction will require time and professional assistance. Residential rehab might be an option, but it is not the only way and there are many forms of addiction recovery systems open to trying.
It is really important to reach out for help in order to be able to discuss the most effective way to help you and it is possible to speak to trained specialists online, over the phone or by asking a medical professional.
Dealing with addiction is not something that can be done alone, even though most sufferers would much rather that be an option. Addiction is a recognised medical condition and is not something anyone should be ashamed of.
Acknowledging your need for help is often the most difficult part and reaching out for support is the beginning of a new stage of life free from the battle of addiction. Do yourself the kindness of not trying to put it off and let yourself receive the help that is waiting for you.