Dependence vs. Addiction: What’s the Difference?
Key takeaways:
Although addiction and dependence may seem the same, they are actually different issues connected to substance use.
A person can have only addiction or only dependence, but the two often present together.
Addiction is a psychological state marked by obsessive thoughts and compulsive behaviors aimed at getting and consuming more of a drug.
Dependence is a physical response involving brain changes that requires the presence of the substance for you to feel well and function normally.
Terms often linked to substance use like addiction and dependence may seem the same. But they actually have very different meanings and effects on your life and well-being. Separating the two and learning their characteristics can help you understand and explain your situation more effectively for yourself and others.
What is addiction, and how do I know if there’s a problem?
Addiction is a psychological response caused by the use of alcohol and certain other drugs over time. As a psychological response, addictions impact your thoughts and behaviors.
Addiction is a long-term condition with periods of recovery and relapse. When addicted, you may continue using alcohol and other drugs, despite the high chances of something bad happening. Rather than spending time with people you love and doing things you enjoy, you might be committing more time, effort, and money toward getting, using, and recovering from substance use.
What are some of the most common signs of addiction?
Becoming addicted to a substance is a gradual process, so many people do not see the risks developing. Some of the most common signs of addiction include:
Behavioral changes: Sleep, diet, and physical activity levels often shift during addiction. Engaging in dangerous, odd, or unhealthy behaviors could also be a warning sign.
Social changes: People experiencing addiction could change their friend group or begin to isolate from friends and family. You could have increased fights and disagreements.
Emotional changes: Addiction can create an emotional rollercoaster, so you could feel incredibly happy one moment and terribly depressed the next. You could be very angry, anxious, paranoid, or restless.
How do you know if you’re addicted?
When addictions begin to form, you will become intensely focused on the substance and driven to get and use more. At this point, the drug becomes your top priority. All people, things, and experiences cannot compete.
Because addiction can hurt the ability to accurately see yourself, other people may see the addiction before you can. Check in with a trusted friend, family member, or mental health professional for clarity regarding addiction.
What is physical dependence, and how is it different from addiction?
Dependence is a biological change that occurs in the brain when you use certain drugs consistently over time. Even if you take a prescription drug, like an opioid painkiller, as prescribed, dependence is still a possibility.
Dependence can start when you use illegal drugs like:
Cocaine
Heroin
Methamphetamine (crystal meth)
Physical dependence can stem from use of legal drugs like:
Alcohol
Prescription pain medications
Prescription stimulant medications, including the ones recommended for attention-deficit/ hyperactivity disorder (ADHD)
Prescription sedatives, including benzodiazepines
Not all substances result in dependence, though.
When substances enter the brain, they trigger the release of certain chemicals. With time, the brain becomes more used to the substances, and it adapts to drugs being in the system. At this point, it needs the drugs to stay in balance.
Though they tend to overlap often, dependence is separate from addiction. A person could be using a prescription opioid as directed by their doctor and become physically dependent over time. However, they are not engaging in any changed thoughts or behaviors, so there is no addiction. On the other hand, a person could be abusing hallucinogens, like LSD or MDMA, and not become dependent.
What are the signs and symptoms of physical dependence?
The brain trying to balance chemical levels creates two of the most telling signs of physical dependence: tolerance and withdrawal.
Tolerance
Tolerance is the need to use a substance in greater amounts or in higher potency over time to achieve the desired effect. Maybe you could feel drunk from a few beers years ago, but now it takes a 12-pack to feel the same way. Maybe any marijuana could get you high in the past, but now you need a more powerful strain.
Withdrawal
Withdrawal includes a set of uncomfortable, distressing, and potentially dangerous symptoms that emerge when use reduces or ends. A drug’s withdrawal symptoms are the opposite from its intoxication symptoms, so opioid withdrawal results in anxiety and insomnia, while intoxication results in a calm and sleepy feeling.
The signs of tolerance are obvious while you are still consuming drugs. But withdrawal may only be clear in the hours or days after last use. Withdrawal usually creates a strong craving for the substance, which tends to restart use and delay withdrawal.
Are addiction and dependence the same as substance use disorders?
Even though many people continue using the terms addiction and dependence, substance use disorder (SUD) is a more modern way of describing a problematic relationship with alcohol or other drugs. A substance use disorder combines the psychological aspects of addiction and the physical aspects of dependence into one condition.
SUDs are recognized mental health and addictive disorders that professionals can diagnose and treat as needed. Someone using alcohol could have an alcohol use disorder, and someone using heroin would have an opioid use disorder.
How can I avoid addiction, dependence, and substance use disorders?
Aside from abstinence, you can avoid addiction and dependence by educating yourself about the drugs and how they harm your body and mind. By knowing what addiction and dependence are, what they look like, and how they develop, you can limit your risk.
You should always understand the medications your doctor prescribes and note their potential for addiction and dependence. Most prescription and over-the-counter drugs do not create risk. But opioids, sedatives, and stimulants carry a notable potential for addiction and/or dependence.
Some people will be at greater risk of ill-effects from substances based on their individual differences and life experiences. Several factors are linked to an increased chance for addiction:
Family history: Having family members who struggle with substances increases your risk.
Friends and support: Being around friends who use substances can encourage your use.
Early substance use: The earlier you use substances, the more likely you are to become addicted to them.
Method of use: Injecting or smoking a drug produces more danger of addiction because the substance reaches the brain faster and creates a more intense reaction.
As always, be honest with yourself and others about your substance use. If you are noticing unwanted effects of the drug, or if more of your life is focused on the substance, it could indicate a problem.
Substance use disorder treatment
Getting professional substance use treatment early is a great way to manage problems with a SUD and stop its development. Rather than feeling like you need all the answers, go for an intake assessment with a mental health or addiction professional so they can evaluate your status and relationship with drugs.
From intense inpatient programs to monthly outpatient sessions, drug addiction treatment offers tremendous flexibility based on your needs and your lifestyle. Treatment providers can help you understand your substance use disorder and provide a combination of therapy and medication to minimize symptoms and promote well-being.
The bottom line
Addiction, dependence, and substance use disorders are common conditions that directly affect the mental and physical health of millions of people each year. Understanding the conditions, their risks, and seeing the warning signs of addiction and dependence can help stop problems before they grow too strong.
Why trust our experts?
References
Centers for Disease Control and Prevention. (2022). Recovery is for everyone: Understanding treatment of substance use disorders.
Indian Health Service. (n.d.). Warning signs of substance and alcohol use disorder.
National Institute on Drug Abuse. (n.d.). Adolescent brain.
National Institute on Drug Abuse. (2020). Drugs, brains, and behavior: The science of addiction.
Szalavitz, M., et al. (2021). Drug dependence is not addiction — and it matters. Annals of Medicine.
World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
