Addiction Vs. Dependence

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated May 20, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

Dependence and addiction refer to conditions in which someone becomes reliant on something in their life, often in reference to drug or alcohol use. Learning the difference between dependence vs. addiction can help you start the road to recovery. It's important to understand the distinctions between substance use, abuse, addiction, and dependence. Dependence and addiction can be hard to grapple with, but there are many treatment options available.

While some use the two terms interchangeably, they actually refer to different aspects of substance use and reliance, according to the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders. This diagnostic and statistical manual serves as a guideline for diagnosing mental health issues and disorders and can be a useful starting point for various health issues.

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Are you dependent on or addicted to a substance?

Dependence vs. addiction

There has been some confusion over the years in regard to the differences between dependence and addiction. In 1964, the World Health Organization proposed using the word “dependence” instead of “addiction” as a medical designation.

This decision by the World Health Organization may have contributed to the uncertainty, especially as people used the words interchangeably. Today, it’s generally understood that the two concepts are different stages or aspects of potentially problematic or dangerous substance reliance. 

When it comes to comparing addiction versus dependence, the latter refers to the physical aspects of becoming physically dependent and reliant on a substance and is characterized by tolerance and physical withdrawal symptoms.

Individuals using prescription medicines may become physically dependent on the drugs they take, meaning that they could experience withdrawal symptoms if they stopped taking the medicine suddenly. Physical reliance can also occur with recreational drugs and many other substances.

In addition to physical reliance, substance use disorder may also include the psychological elements, such as anxiety and obsessive thinking related to using the substance in a milder form when compared to addiction. Addiction is when physical and mental reliance escalates.

Addiction refers to a chronic disease that’s characterized by addictive behavior that is caused by fundamental changes in brain circuitry as a result of physical dependence over time.

These may include distorted thoughts, uncontrollable behavior, and impulsive choices stemming from the person’s chemical drive to keep the substance added to their system. Addiction and substance use disorder are the preferred terms, abuse is no longer used in the scientific community.

A person can develop dependence on a substance without being addicted. However, consistent dependence on a substance over time is likely to turn into a drug addiction if not curbed.

A person who is addicted to a substance is also dependent on it. Both terms fall under the broader umbrella of “substance use disorders,” which the American Psychological Association or APA classifies substance use disorder as “varying degrees of excessive use of a substance.” Substance use disorder was previously known as substance abuse. Even if your dependence or addiction is not at the level of a disorder, you may still wish to seek help.

Physical dependence

Physical dependence generally happens gradually over time and may include physical adaptation to a substance, requiring more of a substance to achieve the same result, which is part of why dependence so dangerous: Physical dependence can happen almost without a person realizing it.

According to research published in Scientific American and many other academic medical journals, substance dependencies stem from biochemical changes in the body caused by drug use. Eventually, an individual may reach a point where their body can only function normally when a specific substance is present. 

In some cases, long-term dependence on a substance is deemed medically necessary or beneficial by a doctor. Examples might include medication for managing seizures or an illness like diabetes. In situations like these, the benefits of long-term use of the drug outweigh any drawbacks. Drug dependence is not necessarily harmful, but it could mean that you would experience adverse effects if you stopped taking the drug. These cases generally do not escalate into addiction and are not categorized as substance use disorders.

Other times, a doctor’s office may be where a harmful dependence on a legal drug begins, as with prescription opioids. The National Institute on Drug Abuse details how the opioid epidemic is a prime example of this legal debilitating addiction began for many people in the US. The opioid crisis showed that you can become dependent on a drug even without the intention of “taking drugs”.

The addiction or dependence resulting from the opioid epidemic refers to the widespread addiction of people to a class of drugs that often starts with a legal prescription from health care providers—such as to manage pain after a surgery, for example. Even regular use of these drugs as prescribed can lead to dependence, and addiction can follow this dependence. 

Remember that since dependence usually refers to the physical effects of substance use, dependence is characterized by symptoms of withdrawal once an individual no longer consumes the substance. Withdrawal symptoms can be different depending on the substance.

For many drugs, they may include physical symptoms like vomiting, tremors, chills, low blood pressure, and psychological symptoms like moodiness and irritability.

It’s also important to note that some make a distinction between physical and psychological dependence, which may coexist. Psychological dependence has to do with the thoughts and emotions related to a physical dependence on a substance. These could include anxiety, obsessive thoughts, or irritability.

Addiction

Substance dependencies frequently lead to addiction (formerly known as substance abuse). Whatever a person’s motivation for consuming a substance initially, it typically becomes conditioned response: the avoidance of withdrawal symptoms and the biological and physiological drive for it once the level of addiction is reached.

True addiction in a severe form is often characterized by a person resorting to more extreme measures to continue using a substance, because their body and brain now depend or rely on it.

This is why addiction often has such an impact on a person’s family, social, and work life. Addiction may negatively affect their ability to fulfill their responsibilities and obligations since they’re now under the strong influence of both dependence and addiction, which may lead them to act irrationally. 

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What are the causes?

An individual can become dependent on or addicted to a substance for a variety of different reasons. They may start using it due to curiosity, social pressure, a desire for gratification, or a desire for pain relief or escape. It’s also important to note that genetics can play a significant role to identify people who may be at risk for developing dependence or addiction.

For opioid use disorder, for example, one study estimates the heritable component to be anywhere from 23% to 54%. Environmental factors can also have a strong effect. Peer substance use, attitudes toward substances in the home or broader culture, socioeconomic factors, and lack of educational or work opportunities can all contribute. Those who have experienced trauma or abuse may be more likely to misuse drugs.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Negative effects

Substance use that escalates is dangerous and can have many negative consequences (including addiction and dependence).

These may vary depending on the individual, their life circumstances, and the substance(s) they are dependent on or addicted to. Some of these consequences may include:

  • Inability to function without the substance
  • Obsessive and/or impulsive behaviors related to obtaining or using the substance
  • Neglect of responsibilities (work, family/children, self-care)
  • Strained relationships with loved ones
  • Mental health effects such as depression, anxiety, paranoia, and/or psychosis, and other mental disorders depending on the substance
  • Risk of cancer from some substances
  • Hormone imbalances
  • Potential legal consequences associated with illicit substances
  • Risk of overdosing on some substances
  • The strain on organs and body systems; potential long-term health consequences
Substance use disorders may also have significant negative impacts on others in the life of someone experiencing substance use problems. About one in eight children in the US had at least one parent experience substance use disorder within the last year. 

Studies have found these children to be of lower socioeconomic status and to have more difficulties in social, family, and academic functioning than children with parents who did not experience substance use disorder.

The risk of misuse and/or neglect is higher for children with parents who have substance use problems, and even those who do not experience these are at greater risk for maltreatment and child welfare involvement. In addition, children in these situations are often at greater risk for developing compulsive behaviors and substance use disorder themselves. 

Treatment for dependence or addiction is available

Given the negative connotations around drug use and the way people talk about it, it can be challenging to seek help. Any kind of substance use problem can be an incredibly difficult thing to face for both the individual and their loved ones or family members. However, recovery is possible. The main priority to treat substance use disorder is to seek help in the first place. 

Treatment for dependence or addiction can vary widely depending on the individual and their state of health, the substance in question, and the degree of dependence. The first step in seeking proper treatment is often to get an evaluation by a medical professional.

They can identify whether a substance use disorder is present and may be able to refer the individual to another professional for the additional steps.

Professional treatment for substance use disorders often involves several components, since the disorder can affect so many parts of a person’s health and life. Physical detoxification in a hospital may be a preliminary step for some individuals.

Enrollment in an intensive outpatient or residential inpatient rehabilitation program or treatment center may be recommended. Mutual aid groups like AA are helpful for some. Connecting with a psychiatrist or therapist may also be useful for achieving recovery.

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Are you dependent on or addicted to a substance?
The role of therapy in recovery
Again, treatment for substance use disorders varies widely depending on the situation and often includes multiple components.

According to the National Center on Drug Abuse (NIDA), for many people, therapy, and substance use counseling can be one of these helpful components. If a mental health condition like depression, for example, contributed to an individual starting to misuse a substance, a trained therapist can help identify the condition and propose strategies for managing symptoms.

If past trauma is a contributing factor to why someone developed a dependence on or addiction to a particular substance, a mental health professional can help the individual address and work through those experiences.

Research suggests that virtual therapy and support groups are effective and practical treatment methods for those who are experiencing depression, anxiety, and other challenges related to mental or emotional health. Those with loved ones who are experiencing substance use problems may also benefit from therapy as a way to sort through and validate their potentially complicated emotions related to the situation. 

Online therapy

Online therapy allows individuals to seek this type of support from the comfort of their own home. It can often be a more cost-effective option for those who are looking to connect with a mental health professional.
Through a platform like BetterHelp, you can get matched with a therapist who you can meet with via phone call, video call, and/or chat to address the challenges you may be facing.

Takeaway

Understanding addiction and the difference between dependence and addiction can help people see when they or their loved ones may have a problem with substance use and when seeking treatment may be necessary. Substance use disorders are complex but treatable conditions. There is no shame in asking for help in overcoming addiction or dependence on substances of any kind. Reach out to an empathetic and knowledgeable online therapist at BetterHelp for support in your recovery journey.

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