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Addiction vs. Dependence

Addicted or dependent? Are they the same thing, or are they two different animals? Well, that depends on who you are talking to. To the lay person, the words seem like they can be used interchangeably, but to a mental health professional, there are a variety of subtle differences. Some of the differences can even be confusing to those in the mental health field.


Let’s start with dependence. Initially, dependence referred primarily to physical dependence, a term initially defined by two primary criteria:

  • A tolerance for the substance being used, meaning it takes more to achieve the same effect.

  • The presence of withdrawal symptoms when not taking the substance for a period of time.

In the 1980’s, the Diagnostic and Statistical Manual of Mental Disorders III (DSM III), a medical text widely used by mental health professionals, expanded the definition of dependence to include other factors. These factors sounded a lot like the accepted definition of addiction. The expanded definition of dependence now included:

  • Uncontrolled use

  • Negative psychological and social consequences of ongoing substance use

Interestingly, a person was thought to be able to be able to suffer from a dependency without being addicted, although addiction frequently follows dependency. This occurs in part, because dependence impacts the human brain in the thalamus and brain stem, while addiction causes changes in the pleasure/reward part of the brain. As the individual continues to use a drug, the brain begins to adapt to the chemical changes occurring in the brain, until the altered state becomes the new normal. When that new state is disrupted, such as when no drugs are taken, symptoms of withdrawal become present. While dependence can be a red flag for addiction, it may also simply be an indicator of the biological response to certain medications.


Addiction is often defined as compulsive abuse despite negative consequences. Why doesn’t everyone who is dependent become addicted? The answer can be quite complicated, with a mix of both genetic and environmental factors playing a part. When the reward and motivation centers of the brain are stimulated through drug use, some individuals come to find that the pleasure or sensations received are more important than any possible negative consequences. This is the point where addiction occurs. The place where even if you want to stop using drugs, you can’t, because it’s now both a physical and psychological addiction.


In 2013, the DSM IV overrode much of the previous information about addiction and dependence, effectively categorizing the two together under the name “Substance Use Disorders” (SUD). While many still use the terms interchangeably, they are both being replaced by SUD as the appropriate phrase for any individual struggling with the use of any substance, including alcohol.

How can a person tell if they are addicted or dependent?

No matter that you want to call it, there is helpful information out there about how to determine if you are suffering due to the use of drugs or alcohol. Consider the following statement from the National Institute on Drug Abuse, “Dependency is a state in which an organism functions normally only in the presence of a drug.” More simply, if an individual is taking a drug and then stops, a period of withdrawal ensues, lasting for a relatively short period of time. While this period may be uncomfortable, the individual can continue to maintain the decision to not take the drug. This individual is dealing with a dependency. Should the individual continue to compulsively look for ways to acquire their drug of choice, irrespective of the damage that using it causes in their personal or professional life, they are likely addicted. Either will need help to stop.

Should you find yourself in the position of being unable to control your desire for opioids or any other drug, it is critical that you ask for help. Reach out to a friend or a loved one and tell them that you believe that you have a problem with addiction. Everyone needs a helping hand at times, if you're struggling with your addiction, please contact us now - we are here to help!


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