Physical dependence on a substance (drug or alcohol) may be a component of addiction, but it does not itself equal addiction. Dependence is characterized by tolerance or withdrawal symptoms, and can be a consequence of many drugs, such as pain medications, stimulants, and antidepressants. Addiction, on the other hand, is a mental disease that includes both physical and psychological dependence and is manifested via behavioral symptoms, most notably continued use of the substance in spite of clear harmful effects on the individual and their family.
What is dependence?
Physical dependence is a natural expected physiological response to drugs such as opioids, benzodiazepines, antidepressants and corticosteroids. It is characterized by withdrawal symptoms with the patient being unable to cope when the drug is stopped.
What is addiction?
Addiction, on the other hand, is not a predictable drug effect, but rather a disease that occurs in genetically, biologically, and psychosocially vulnerable individuals. When genetics, environment, and drug use overlap, addiction may occur.
Watch part one of the documentary Is Addiction Really a Disease? in the video below. To watch the full documentary, see this playlist.
Signs of addiction
Addiction is characterized by the 4 Cs: impaired control, compulsive use, continued use and craving. Signs of addiction, rather than dependence, including drug-seeking behaviors, cravings, preoccupation with obtaining the drug, an interference with normal life functions, such as decreased productivity and motivation, relationship problems and continued use despite negative consequences.
Different Parts of the Brain Affected
While drug addiction affects the reward pathways of the brain (including the mesolimbic pathway and the mesocortical pathway), dependence affects the thalamus and brainstem.
If someone with a drug dependence detoxes, especially by slowly decreasing the amount of the medication they take over a period of time, they may suffer withdrawal symptoms, but can end that physical dependence.
Although someone with a drug addiction can end their physical dependence on the drug through detox, the mental component of the addiction remains, and maintaining sobriety can be an ongoing struggle.
Treating drug addiction can be incredibly complicated. Effective programs usually include many components, designed to help the individual stop using drugs, maintain a drug-free lifestyle, and fulfill their obligations to their family and in the workplace. Most patients require long-term treatment, which can include medications, therapy, and residential programs.
Detoxification treatment may need to be administered to those with substance dependence due to the dangerous nature of some withdrawal symptoms. Research suggests that no treatment method is superior, but that social support is very important and that organizations such as AA and NA have better than average success rates in reducing relapse.