Are you dependent on alcohol or do you just like a drink? Have you been taking more painkillers than you need because it’s a habit or are you addicted? Is taking cocaine every weekend just a bit of fun or a compulsive disorder? Dependence and addiction take many forms and it’s not always glaringly obvious if you have a problem.
Of course, sometimes sadly it is, and by that point hopefully you, or someone who cares, have managed to access the help you need. It’s important to understand the difference between physical dependence and psychological addiction to support your recovery and others who may be struggling.
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People often talk about dependence and addiction interchangeably. In reality, they are not the same, but share some commonalities and are often linked. Both are types of chronic disorders. When someone drinks alcohol or takes drugs, there are various physical and psychological reactions at play that affect their brains, bodies and behaviour.
Long-term use of any substance, especially in high quantities, can lead to a tolerance – we all have that friend who seems to drink far more than anyone else and not get drunk. This is the first sign of a dependence. Traditionally, the term ‘dependence’ is used to describe the evidence of physical dependence (i.e. withdrawal symptoms) when people stop taking certain drugs, such as alcohol, heroin, antidepressants or betablockers.
Clinicians describe dependence as the normal biological reactions that occur when someone takes a substance for a long time. Whereas addiction is defined as the continued use of alcohol or drugs despite negative consequences. Dependence and addiction both tend to result in withdrawal symptoms, but the side effects are different in relation to the substance. People don’t experience the same physical side effects when coming off cocaine as they do alcohol, for instance.
“Nearly everyone who takes opioids for months or more will develop dependence, but only around eight percent or fewer of patients on chronic opioid therapy for pain will develop addiction” (1)
As the waters have been muddied, there’s been a call for greater clarification over the difference between physical dependence and addiction. Studies suggest failing to distinguish between the two can be detrimental to patients. For instance, in the case of opioids, clinicians may see evidence of withdrawal symptoms as addiction, instead of physical dependence, and fail to precribe the pain medication required. (2)
Following years of dispute, the Diagnostic and Statistical Manual of Mental Disorders (DSM), recatagorised drug and alcohol addiction, dependence and abuse under the same umbrella. ‘Substance Use Disorders’ is now the preferred medical term by the scientific community. However, it’s still useful to understand the difference between physical dependence and psychological addiction, as they’re the terms that are still in everyday use.
When a person has a chemical need for drugs or alcohol they are classed as having a physical dependence. This is because the brain has adapted to the substance in order to function. Once you take that substance away, the body goes into shock and will produce a variety of physical symptoms. These are different depending on the individual, the amount and duration of abuse and the type of substance.
There’s a big difference between physical dependence and addiction. Someone can develop a physical dependence over a period of time without even realising it. If you never have any alcohol-free days and drink heavily, it’s likely you’ll have some sort of physical reaction when you stop. The same is true of prescription drugs. It can take only a couple of weeks to become addicted to painkillers. That’s why your doctor will often recommend you taper the dose when you decide to come off them.
Signs of physical dependence include:
Physical dependence is different to psychological addiction because it involves the body’s reaction to substances rather than the mind’s perceived need for them. If you’ve developed a physical dependence on alcohol or drugs, you will experience withdrawal symptoms which may include tremors, headaches, nausea and insomnia.
While dependence centres around the way your body and mind physically react to substances, psychological addiction is classed as a brain disorder. It happens due to adaptations in the brain’s complex networks. Substances interact with our pleasure and reward response which causes the brain to want to repeat the same behaviour and fuels the cycle of addiction.
The difference between physical dependence and psychological addiction is the way our body reacts to a substance. You can be dependent, addicted, or both. If you’re physically dependent on alcohol because you’re used to having a few glasses every night after work, but can’t drink because you’re in hospital, for example, you might notice you can’t get to sleep or feel a bit grumpy. If you’re psychologically addicted to alcohol you might start to feel anxious and fearful that alcohol is not available.
Signs of psychological addiction include:
Both physical dependence and psychological addiction can result in withdrawal symptoms if you suddenly quit. If you recognise any of these signs in yourself or others, it’s important you seek professional help.
If your body has become physically dependent on a substance it will be almost impossible to try to quit alone. There are various medications that can help you to withdraw safely while your central nervous system tries to rebalance. A clinical detox is typically carried out on a residential rehab programme where you’ll also receive appropriate nutritional support and round the clock supervision.
The detox phase of rehabilitation to address physical dependence usually takes one to two weeks. Your withdrawal symptoms will vary in intensity depending on the type and quantity of substances taken. The psychological effects of addiction can take much longer to resolve. People usually have a variety of emotional and environmental triggers that cause cravings. This is where therapeutic support comes in.
Adverse Childhood Experiences (ACEs), past trauma and mental health problems are often an underlying cause of psychological addiction. Talking therapies, such as Motivational Interviewing and Cognitive Behavioural Therapy (CBT) are proven to help people overcome negative thought patterns and maintain their motivation to remain abstinent.
We help people overcome both physical dependence and psychological addiction at our wellness retreat in Cheshire. Set in six acres of tranquil forest surroundings, our state-of-the-art facilities have been purposely designed to support your recovery emotionally, physically and mentally.
We offer a range of residential rehab programmes that can support you through this difficult time. Our clinical detox lessens the physical side effects of giving up substances ensuring you are in a safe and comfortable space to begin the healing process. We then begin intensive therapy with one-to-one counselling and group therapy work to help you understand the reasons behind your dependence and/or addiction.
Cognitive Behavioural Therapy (CBT) is especially useful for helping to rewire your thought processes. Our holistic therapists will work with you to develop coping mechanisms for life when you leave our care. You will also immerse yourself in a range of somatic healing practices such as breathwork, mindfulness, grounding, music and art therapy.
Our goal is to help you stop the physical cravings for alcohol or drugs, start to heal the trauma that led you to this point and ensure self-growth. All our guests leave with 12 months’ aftercare and a future-proof plan to overcome dependence and addiction for good.
If you are concerned about drug or alcohol addiction, call us confidentially to speak to a member of the team today.
1. Volkow ND, McLellan AT.. Opioid abuse in chronic pain–misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–1263. .
2. O’Brien CP, Volkow N, Li T-K.. What’s in a word? Addiction versus dependence in DSM-V. AJP. 2006;163(5):764–765.
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