Dependence vs. Addiction
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Untangling the Complex Web of Dependence and Addiction
Q: I’ve been trying to learn about substance abuse online, and I keep coming across the terms “dependence” and “addiction,” which sometimes sound like they are the same thing. Are they?
A: They are not the same, though some people use them interchangeably in conversation, which adds to everyone’s confusion. In fact, the difference between the two terms is important.
Dependence is a word used to describe a physical condition. A person’s body gets used to having a substance and the person begins to need more of that substance to get the same effect he or she used to get from less. He or she experiences unpleasant withdrawal symptoms (mental, physical, and more) when trying to stop using the substance. Dependence can occur with many drugs, including prescription medications used for an extended period even when they are used as prescribed.
Addiction, on the other hand, is a complex condition in which a person cannot stop using a particular substance or combination of substances, even when bad things are happening as a result of the substance. This loss of control is reflected in the adverse effects the substance has on major areas of the person’s life as well as his or her ability to function.
A person can be physically dependent without having an addiction. In that case, the person addresses his or her physical dependence on a substance, usually in partnership with a medical professional (the importance of which cannot be overstated, since withdrawal can be dangerous and even life-threatening), and then goes on with his or her life without the compulsion to resume using that substance.
In the case of addiction, however, the person has lost control and will not give up using a particular substance even when he or she wants to. The person with addiction may or may not be physically dependent on the substance. (The person might be a binge drinker, for example, who refrains from drinking for periods of time and therefore does not experience the withdrawal symptoms associated with long-term alcohol use.) It’s important to understand that absence of physical dependence, where the person has multiple serious instances of substance abuse but is not yet physically hooked, does not make an addiction less serious or dangerous. Consider the fact that binge drinkers can die of alcohol poisoning or in drunk-driving accidents without being long-term or physically dependent drinkers. People who abuse drugs can have unintended overdoses before true physical dependence has set in.
If you or someone you care about is struggling with substance abuse and its negative effects yet feels unable to stop despite undesirable consequences, it can be helpful to meet with an addiction specialist. Also, if a person with addiction participates in a detoxification process, it’s important for the person to realize the problem isn’t automatically solved. With regard to addiction, the compulsion and behavior patterns are the central problem, not the body’s craving for a substance or how the person experiences withdrawal. A person with addiction generally needs more help than just physical detoxification to recover.
Susan Lemere, ESME’s Addiction Resource Guide, is a Solo Mom of two, as well as a therapist, a writer, and an artist coach.
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