Though dependence and addiction are often used to mean the same thing, they are not. Addiction can be thought of as the "psychological" need for a substance, behavior, or activity, while dependence refers to the "physical" need for a substance.
Addiction is a physiological or psychological need for a habit-forming substance, behavior, or activity. This need is chronic and compulsive and has harmful physical, psychological, or social effects. When addicted to a substance, a person cannot stop using it despite the negative consequences it has on their life.
These negative consequences may include missed work, neglected relationships, financial issues, trouble with the law, failure to attend family obligations, compulsive drug-seeking behavior, and dependency.
Dependence, on the other hand, includes physical symptoms associated with using or not using a substance. When someone is dependent, his or her body adapts to a drug and requires more of it to achieve the same effect. No longer taking that drug produces measurable symptoms, including withdrawal syndrome.
You can be addicted without being dependent and be dependent without having an addiction. However, it’s common for physical dependence to accompany addiction.
It’s possible to be both physically dependent and psychologically dependent on a substance. Psychological dependence is another way of saying a person is addicted to something. They might not experience physical withdrawal symptoms when they stop using, but their brain processes have changed.
There are some drugs you can be addicted to without developing physical dependence. For example, cocaine doesn’t trigger physical withdrawal symptoms in some people, but addiction is possible.
Some argue that all substances trigger a physical withdrawal, but it’s not always the flu-like symptoms that accompany certain drugs.
Symptoms of withdrawal might also include:
These all indicate that the body is out of balance and is struggling to adjust to life without the substance.
It’s also possible to abuse a substance without ever becoming physically dependent on or addicted to the substance. However, misusing a substance always puts someone at a higher risk for developing an addiction or physical dependence.
There are many definitions of substance abuse, ranging from broad to specific. For example, the World Health Organization's definition is simple and broad:
"Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs."World Health Organization (WHO)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook created by the American Psychiatric Association. It is used in the United States and some other parts of the world as the authoritative guide for diagnosing mental health disorders.
In the fourth edition (DSM-IV), substance abuse was defined as:
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
In the fifth edition (DSM-5), the diagnostic manual was updated and substance abuse was essentially turned into a new category called "Substance-Related and Addictive Disorders." Rather than having one sweeping definition, each substance now receives it's own classification and description of abuse, dependence, and addiction.
You can misuse substances and not be dependent. You can also be dependent on substances without misusing it or being addicted to it. However, prevention from dependence must occur at the substance abuse stage.
Addiction is a chronic, relapsing disease that affects the way your brain works. A person can become addicted to behaviors (such as sex or gambling), or substances (drugs and alcohol). Drug addiction is now referred to as a substance use disorder (SUD) by medical professionals)
Certain prescription drugs, illicit drugs, and behaviors increase the amount of dopamine in the brain. As a result, the brain needs to produce less dopamine naturally. When the intake of the substance stops, the brain isn’t immediately able to return to producing dopamine as it once did. And since dopamine is one of the neurotransmitters responsible for pleasure, the person can’t experience pleasure, at least while the brain is healing, without the drug.
Addiction is characterized by an individual's inability or refusal to stop their drug use or behavior despite negative consequences on themselves or others.
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Drug dependence is easier to determine than addiction. If you stop taking the drug and experience withdrawal symptoms, you are dependent.
It’s not as easy to know if you are addicted. It’s even possible to be dependent on a drug without being addicted to it. A good example is someone managing cancer-related pain with opioids. That person might be dependent on the drug and experience withdrawal symptoms if they suddenly stop taking it. However, it’s not an addiction because there is no compulsion to use the drug despite harm.
The line between physical dependence vs. addiction blurs when someone is dependent on a drug because of chronic pain. The patient may seek pain medication to relieve their painful symptoms, but is it caused by addiction? In most cases, the presence of an addiction is determined by noticeable negative consequences.
If the use of a substance is hurting you, damaging your relationships, interfering with school or work, or causing legal problems, and you continue to seek the drug, this is likely considered an addiction. On the other hand, if you crave the drug or experience withdrawal when not using it (dependence), but you can prevent yourself from taking it, it’s probably not an addiction.
Addiction treatment is the best way to get help and overcome your dependency or addiction.
Substance abuse treatment usually involves:
Treatment programs occur in a variety of settings for different lengths of time. They are based on different theories and incorporate different philosophies. Treatment might include behavioral therapy, medication, or a combination of the two. It could also include support for dealing with addiction to prescription medications, illicit drugs, or alcohol.
Many treatment providers also address co-occurring disorders (a substance dependence and a mental health disorder). There might be individual and group therapy, and the loved ones of the addicted person might attend counseling. Finding a treatment program that is right for you is an important part of recovery.
It’s also important to realize that addiction is a chronic disorder that can result in relapse. Short-term or one-time treatment options are rarely effective. Treatment must address withdrawal if it occurs, addiction, relapse, and other issues. Success is most often experienced when a person opts for a long-term treatment program with ongoing support.
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Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. American Psychiatric Association, 2000, https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/DSM4/index.html
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, 2017, https://www.psychiatry.org/psychiatrists/practice/dsm
National Institute on Drug Abuse. “Is There a Difference between Physical Dependence and Addiction?” Drugabuse.Gov, 2019, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence
“Physical Addiction or Psychological Addiction – Is There a Real Difference?” Psychology Today, https://www.psychologytoday.com/us/blog/all-about-addiction/201007/physical-addiction-or-psychological-addiction-is-there-real
National Institute on Drug Abuse. “What Is Drug Addiction Treatment?” Drugabuse.Gov, 2019, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment