Addiction vs. Dependence
The other day my daughter informed me, "I'm totally addicted to M&M's." I smiled and told her that I love them too. Later, however, it got me thinking about how loose we are with our different relationships with the things in our lives that we are attracted to. To me, as a doctor, addiction is a serious thing. At the psychiatric hospital where I work, these problems are a daily staple, as the relationship takes rather than gives. The problem is huge in our society as well.As such, I feel it is important to better understand these adverse relationships.
Addiction is a behavior. People enter into an addictive relationship with something when use continues despite the emergence of negative consequences. In other words, the positive attributes of the substance have become overshadowed with problems caused by the substance. While this sliding off from the status quo may be noticed by the person in the grips, it is readily apparent to others, as work/school performance may wane, hygiene may lack, or personal relationships may become problematic.
"Red flags" may herald the presence of an addiction. The compulsive, perceived need for continued use of a substance is concerning. Also, use other than that intended is indicative of addiction. An example of this behavior would be using a pain medication to sleep. The presence of cravings or an emotional difficulty in stopping would also raise suspicion.
Most people associate addiction with substances such as drugs or alcohol. While these are definitely common examples, other issues can fit within the criterion of such behavior. Internet use, video games, sex, food, or smoking are other examples of behaviors that can create negative consequences and constitute addictions.
The term dependence is better qualified as physical dependence. This means that the body has developed a functional need for the substance. The best evidence for physical dependence are tolerance and withdrawal. Tolerance occurs when the body gets used to something and the initial effect is not seen. More potent or higher doses are needed to get this initial effect. Withdrawal is a constellation of unpleasant symptoms seen when the body is no longer exposed to the substance.
Examples of physical dependence include nicotine, narcotics, heroin, certain antidepressant medications, or alcohol. These substances meet the criterion of the development of tolerance and the presence of withdrawal after chronic use.
Can addiction and dependence co-exist?
It is common for addiction and dependence to be present at the same time. Many substances that have a potential for addiction can also cause the body to grow dependent. It is debatable as to whether the two happen separately from one another, although it is known that some of the same neurohormones are involved in the processes.
What drives addiction and dependence?
As a behavior, much of addiction is dependent on the person who is exposed to the substance. Much study is underway on the "addictive personality." What may drive addiction for one may not drive an addiction for another. In contrast, physical dependence is less user-dependent. Different substances have different potentials for dependence as evidenced by the velocity of tolerance developed.
Why are the differences important?
Distinguishing between addiction and dependence is important in order to combat these problems. Treating the behavioral patterns that drive addiction involves many complicated facets in therapy. Often, this is best approached by a team involved in helping a person regain freedom from their addiction. Coaches are present in the person's life helping with decisions, group therapy solidifies these choices, and medical therapy identifies any physical or emotional stumbling blocks to recovery.
Dependence is also best approached with a team approach although the emphasis is on treating the mechanics of the body's pangs from releasing the grip of the substance. Often, the substance is slowly tapered under supervision, or other medications are used to help the body reset itself. Withdrawal from alcohol (unlike narcotics or heroin) can be fatal if not treated properly so close supervision is essential.
Addiction and dependence are serious and growing problems in America. While the two often coexist, it is important not to lump them together synonymously. They are distinctly different and should be approached uniquely in their treatment.