Addiction vs. Dependence

Addiction is a disease characterized by behavioral issues, and dependence refers to a physical reliance on a substance. The two conditions often occur at the same time, but a person can be dependent on a substance without being addicted to it.

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Addiction is synonymous with substance use disorder, and abuse means the same thing as misuse. But the terms dependence, addiction and abuse are not interchangeable. The distinctions between the words are important to understand because addiction is often a misunderstood disease. Section Menu Dependence and addiction are caused by changes to different parts of the brain. Addiction is caused by changes to the pleasure and reward system of the brain. Dependence affects different parts of the brain called the thalamus and brain stem, according to the National Institute on Drug Abuse. That’s why you can be dependent on a drug but not addicted to it. For example, when a person drinks alcohol repeatedly for several days or weeks, the brain adapts to the presence of the substance. He or she becomes dependent on alcohol and relies on it to feel normal. When that person quits drinking, withdrawal symptoms occur. When people who are dependent on alcohol stop drinking, they will usually overcome withdrawal after seven days. Some people are unable to quit drinking because they have a disease called alcohol addiction that makes it difficult for them to stay sober. Tolerance is another phenomenon that’s closely associated with dependence. As people become more dependent on a drug, their tolerance tends to increase. High tolerance and dependency on a substance are warning signs for addiction, but they are not the sole indicators of addiction.

Definition of Dependence

The National Institute on Drug Abuse defines dependence as “a state in which an organism functions normally only in the presence of a drug.” Drugs disrupt the balance of chemicals in the brain. The brain adapts by changing its natural chemical production. As it adapts, it becomes more tolerant to the substance. Over time, the brain begins to rely on the presence of the drug to function. When someone who is dependent stops taking the drug, the chemical balance is thrown off, and the person experiences symptoms of withdrawal. Dependence can be a warning sign for addiction, but it may simply be a sign of drug abuse.

Definition of Addiction

Addiction is often defined as compulsive substance abuse despite negative consequences. Unlike dependence, addiction doesn’t affect every person who is repeatedly exposed to an addictive substance. A combination of genetic and environmental factors affects addiction risk. Like dependence, addiction is caused by physical changes in the brain. These changes affect the reward and motivation parts of the brain. They make people value the addictive substance and receive unrivaled pleasure or happiness when they consume the substance.

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History of the Terms Dependence and Addiction

The American Psychiatric Association used to divide the term substance use disorder into two categories: abuse and dependence. Substance use disorder is the medical term for addiction. Abuse was a mild form of addiction, and dependence was a moderate or severe form of addiction. That terminology was problematic because in biology — the study of organisms — dependence refers to a physical adaptation to a substance. Today, the APA classifies substance use disorders as mild, moderate or severe. It doesn’t use the terms abuse and dependence to categorize the severity of an addiction.

Different Severities of Dependency

In general, the longer people consume an addictive substance, the more dependent they’ll become. The method of abuse can also increase the severity of dependency. For example, injecting or snorting a drug may make a person more dependent than swallowing the same drug. Injecting or snorting a drug also decreases the time it takes to become addicted to the drug because the brain feels the full dose of the drug suddenly instead of gradually feeling a smaller dose over time.

Dr. Kevin Wandler of Advanced Recovery Systems warns that addictive drugs, such as nicotine, can cause dependence.

Some drugs cause more dramatic withdrawal symptoms than others. For example, withdrawal from stimulants usually results in fatigue, irritability and trouble focusing. In severe cases, withdrawal can cause depression, anxiety and paranoia. Tolerance and dependence to stimulants, such as crystal meth or cocaine, build rapidly. People who go on cocaine or meth benders often take increasing doses of the drugs to feel the same effects. Eventually, they’re so tolerant to the drugs that they’re unable to achieve the high that they desire. When they stop taking the drugs, they experience a devastating crash. However, they can often overcome these symptoms of withdrawal within a few days. Withdrawal from other types of drugs, such as alcohol and benzodiazepines, usually occurs more slowly. Abuse of these substances can cause tolerance to build quickly, but most of the time dependency gets worse over months or years. Unlike stimulant dependency, you can’t overcome alcohol or benzo dependency in a few days. It usually takes several days or multiple weeks to overcome the immediate symptoms of alcohol or benzo withdrawal. It can take months to overcome the late withdrawal symptoms of these drugs, such as sleep problems or fatigue. It’s important to talk to your doctor if you think you’re dependent on a drug because some withdrawal symptoms can be life-threatening.

Determining Whether You’re Dependent or Addicted

It’s easy to determine when people are dependent on a drug. If they stop taking the drug, they’ll experience noticeable withdrawal symptoms. But it isn’t always easy to determine if a person is addicted to a drug. For example, patients who receive opioids for severe cancer pain may be dependent on opioids. They’ll experience withdrawal if they suddenly stop receiving the medication. But they aren’t addicted if they aren’t compulsively seeking the medication despite obvious harms. Determining whether opioid-seeking behavior is caused by addiction or the desire for pain relief is complicated. If people aren’t experiencing noticeable consequences of prescription drug addiction, such as family problems or job loss, they probably aren’t addicted. You can determine if you’re addicted to a drug by analyzing your behaviors. If drug use is hurting your relationships, causing problems at school or work or getting you in trouble with law enforcement, you may be addicted. If you feel cravings or withdrawal when you quit a drug but you can prevent yourself from using the drug, you probably aren’t addicted. If you think you have a problem with alcohol or other drugs, it’s important to tell a loved that you may be addicted. They can provide support and help you find treatment to overcome your condition.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer,
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.

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