Addiction vs. Dependence: Understanding the Difference

Addiction vs. Dependence: Understanding the Difference—and Why Both Deserve Compassion and Care

Abuse. Addiction. Dependence. These are three words we often hear said when it comes to substance use. Addiction and dependence are often used interchangeably, but they are distinct concepts, and understanding the difference between the two can help a person better understand their own circumstances and the type of treatment they may need. 

What is Abuse, Dependence, and Addiction?

Of these three terms, abuse is probably the easiest to differentiate. It is the pattern of excessive use of a substance beyond the recommended amount, including the use of substances that are not prescribed to a person. For example, according to the National Institute of Health (NIH), heavy drinking is considered: for women - four or more drinks daily, eight or more drinks a week; for men - five or more drinks daily, fifteen or more drinks a week. This can include binge drinking - too much, too fast - and too much, too often. Substance abuse can have adverse consequences to a person’s physical and mental well-being, relationships, education and job productivity, criminal behaviors, and driving under the influence.  

Dependency is a natural response as the body and brain adapt to having this substance in their system. As withdrawal is often experienced when taking something every day, a person will continue to take the prescribed medication, alcohol, or drug, to avoid these side effects. This is what we consider physical dependence which can cause physical (shaking, headaches, digestive problems, etc) and emotional (anxiety, depression, irritability, etc) symptoms. Another type of dependency is psychological. This is when a person has a response (substance use) when facing a trigger or stressful situation. We often use the term “people, places, and things” when thinking about triggers. The thought, craving, and urge to use is automatic and can add more stress to an already stressful event. 

Note: Never stop taking a prescribed medication suddenly. Always consult with your prescribing physician on how to taper off medications.

Addiction is the compulsive behavior around substance use with no consideration to the harm it is causing oneself or others. The person has typically lost control over their use and behaviors and will only regain control through abstinence. The brain’s capacity to function without the substance is lost due to the rewiring of the circuits and neural pathways that govern reward, stress, and control. 

While addiction and dependency share similar symptoms, a person can be dependent without becoming addicted. Common examples of substances that people often depend on, without becoming addicted are: prescribed medications like SSRIs, non-narcotic anti-anxiety medications, and mood stabilizers; nicotine; and caffeine. 

Prior to the 2013 update of the Diagnostic and Statistical Manual of Mental Disorder (DSM), a person could be diagnosed with “substance abuse” or “substance dependence”. Through research and a growing understanding of substance use, these diagnoses have been replaced with one classification, “substance use disorder” or “SUD.”

The Continuum of Substance Use

A person doesn’t wake up one day and decide they are going to start using or misusing substances. It starts with experimenting and socializing, and for many, abuse of one or more substances. Over time with consistent and excessive use, a person starts developing a dependence on the substance. Many people may go their entire lives being dependent on alcohol and/or other drugs, they face no real consequences that they can see, and feel that because they are functioning they don’t have a problem. But if you ask them to slow down their use, or stop completely, you are often going to get a defensive response and unwillingness to do so. If you can explore with them enough the reason behind the use, you’ll find their substance(s) of choice is giving them a feeling they are otherwise missing or helping escape from unwanted feelings. In essence, they are self-medicating and thereby not learning how to deal with stress and life without the aid of a substance. Unfortunately, what they are not seeing is the effects the substance is having on them mentally and physically, possibly even in other ways, and that in time they may face irreparable consequences.

For some, dependency does turn into addiction. This is when the person’s life becomes unmanageable and the sole focus is on getting their substance of choice, using it, and recovering from its effect. Nothing else matters but the substance. Everything else is irrelevant and falls into the background. Very real consequences are happening around them, and while they can see it, they cannot acknowledge it. 

Addiction and Dependence Both Benefit from Treatment

Treatment can work. It’s not easy. The early stages of recovery are difficult. With persistence and commitment, recovery is possible. 

Whether a person is addicted or dependent, even if they are “just” abusing, getting some form of treatment can go a long way. Treatment should be individualized to the person’s level of abuse and dependency.  Depending on what is being used, an inpatient detoxification or rehabilitation program may be necessary. For other people, starting in an outpatient setting, such as PHP or IOP, may be sufficient. Still others may be able to stabilize with weekly individual sessions alone. 

It’s important to recognize stopping the substance use is just a part of the process. Understanding how it goes from experimenting to abuse to dependence to addiction is a critical part of the healing process. As the brain recovers from the substance use, as the physical withdrawal stabilizes, the mental and emotional reasons for use become prevalent, and leaving them unaddressed, often leads to relapse. 

Therapy can help a person become more aware of their relapse triggers and warning signs, understanding what about them makes it a trigger, and identifying healthy alternative ways to cope.

Summary

More simply put: according to the American Society of Addiction Medicine, dependence is the body adapting to a substance and addiction is the compulsive use of a substance despite consequences. Understanding this distinction can help understand how a person’s use is progressing and identify the more appropriate level of care for treatment to begin with. 

The stigma that comes along with labeling a person an “addict” often drives shame and guilt onto a person, making it difficult for them to disclose they are having a problem. Reframing to “they have an addiction”, makes it less personal and does not make it their entire identity. Similarly, assuming a person can “just stop” and “it’s a choice” when dealing with dependency or addiction overlooks the fact that addiction is a disease, and stopping and learning to make the right choice takes time as the brain recovers from the effects that substance has had. 

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REFERENCES

American Society of Addiction Medicine

Substance Use Disorders vs. Substance Abuse and Dependence: DSM-5 Changes

The Basics: Defining How Much Alcohol is Too Much

Understanding Substance Misuse, Abuse, Dependency and Addiction

Use, Abuse, and Dependency: Understanding the Addiction Process

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