Over 20.2 million adults in the United States suffer from a substance use disorder. If you talk to most people about drug or alcohol abuse, chances are you will hear them use the words “dependent” and “addicted” interchangeably. For those who do not work in the mental health or recovery fields, these terms mean much the same thing — they both refer to individuals who have a substance use disorder. In fact, however, there is an important distinction between these two terms. In clinical practice, an individual can be diagnosed as an addict but not suffer from dependence — and a person can also be dependent without being an addict. What do these two terms mean?
In most cases, dependence comes before addiction. Dependence is a purely physical phenomenon. A person can develop a dependence on alcohol or any drug. Dependence occurs when the body has adapted to the effects of a psychoactive substance. Once the body has become accustomed to the presence of alcohol or drugs, then intoxication becomes the person’s baseline state. At such a point, they will experience uncomfortable symptoms when the drug is not in their system. These negative physical and emotional symptoms are known as withdrawal symptoms.
It may be helpful to think of dependence as the first stage of addiction. However, it is important to note that not everyone who has a dependence on a substance develops an addiction. In some cases, people are able to successfully withdraw from drugs or alcohol without experiencing obsessive urges. This often occurs with pharmaceutical drugs that people use for non-recreational purposes: they take the drug while it is prescribed, develop a slight dependence, and then withdraw from it when their treatment is over. However, it should be noted that many people do in fact develop addictions to pharmaceutical drugs!
Addiction occurs when regular substance abuse has led to permanent or semi-permanent changes in the brain’s neural pathways. Addiction, unlike dependence, is not a purely physical phenomenon. Instead, it is a serious mental health condition that impacts cognition, emotions, and behavior. When a person suffers from addiction, they will generally experience a wide range of adverse consequences as the result of their substance abuse. Meanwhile, they will find it extremely difficult to control their intake. In many cases, people with addiction have a strong desire to lower their usage or quit drugs and alcohol entirely — but they will find their will power insufficient.
How do people develop addiction from dependence? When people develop a dependence on alcohol or a drug, they experience withdrawal symptoms that begin as soon as they reduce their dosage or stop taking the substance. Over time, however, they also develop a tolerance to the drug’s effects. As their body acclimates to the substance, taking the same dosage as before will cease to produce the euphoric effects that recreational drug users are seeking. As a result, people with dependence are often driven to increase the quantity and frequency of their substance abuse. Over time, this process can make people obsessed with their drug of choice.
When people become addicted to drugs or alcohol, their brain undergoes changes, and this affects their behavior. Most cases of addiction occur after periods of prolonged substance abuse. However, some people find that they experience obsessive compulsions related to drugs and alcohol even before a strong physical dependence has developed. Over the long term, addiction leads to a number of permanent neurological changes that can affect the following:
Ultimately, these changes make it even more difficult to escape the cycle of addiction. Without seeking outside help, individuals with substance use disorders can find themselves in a dangerous loop from which there is no escape.
It is crucial to recognize that substance use disorders are not “cured” after a person has eradicated their dependence. In fact, the failure to understand this crucial distinction is one of the reasons so many people relapse. Whether they are trying to get sober on their own using individual will power or enrolled in a treatment program, many people in early sobriety mistakenly equate recovery with physical abstinence. After withdrawing from drugs and alcohol, a process that is often quite arduous, they may consider themselves “cured.” After all, they are no longer physically dependent! It may come as a shock when they relapse shortly afterwards.
Between 40% and 60% of people relapse after withdrawing from drugs and alcohol. Relapsing after taking the time and effort to withdraw from drugs and alcohol can be very demoralizing. After experiencing this several times, many people come to the conclusion that it is hopeless and that they’ll never escape their addiction. However, what they fail to realize is that they’re only treating their dependence — and that recovery is possible for people who treat their addiction as well.
Dependence goes away after withdrawal, but substance use disorders are chronic mental health conditions. There is no medically recognized “cure” for substance use disorders that makes people into so-called normal drinkers or recreational drug users. Even if a person is not physically dependent, if they take a drink or use a drug the cycle of addiction will always begin again. Whether it’s due to genetic factors or environmental ones, the fact is that their brains are wired that way.
Like other chronic conditions, however, addiction can be treated and managed. People with high blood pressure or diabetes can live their normal without experiencing any symptoms as long as they take prescribed medicine. For individuals with substance use disorders, the same principle applies. By treating underlying issues, learning new coping skills, and making use of a peer support network individuals with substance addictions can free themselves from the compulsions and obsessions that characterize addiction. Moreover, they can build lives for themselves that are joyous and meaningful.
At NuView Treatment Center, located in West Los Angeles, we offer outpatient addiction treatment that is designed to give clients the tools they need to recover from both dependence and addiction. Our highly trained staff develop individualized treatment plans for every client, helping them to address underlying conditions — including mental health disorders and family conflicts — that may be motivating their compulsion to drink or use drugs. Meanwhile, clients develop new coping strategies and plans for dealing with possible triggers. Through compassion evidence-based therapeutic modalities, our outpatient programs help clients not only achieve physical sobriety, but learn how to stay sober over the long term.
If you are ready to escape the vicious cycle of substance addiction and relapse, contact NuView Treatment Center today for a free and confidential evaluation.