In the field of behavioral health, it is common to hear the term “dependence” used in association with addiction or substance use disorder (SUD). Dependence and addiction may even be used interchangeably. However, it’s important to understand the differences, as dependence is not the same as addiction.
What is Dependence?
Dependence usually refers to a physical dependence to a substance. Two common symptoms associated with dependence include tolerance and withdrawal:
- Tolerance: Refers to a person’s diminished response to a substance, often leading to an increased dosage to achieve the same effects.
- Withdrawal: Presence of physical or psychological symptoms when a person reduces or stops taking a substance.
A person can have a dependence without being addicted. Often individuals who are prescribed opioids over a long period of time must be weaned off of medications with their doctor’s help. Dependence can also be a physiological response to a drug used to manage a chronic condition, such as high blood pressure.
While dependence can increase a person’s susceptibility or be a precursor to addiction, it does not always lead to addiction. Dependence is also not always associated with illicit drug use.
What is Addiction?
Addiction is a complex brain disease characterized by uncontrollable substance use (or behavior) despite harmful consequences. Over time, addiction can lead to changes in the brain that impact self-control, regulation, learning, decision making and more. These changes can make it difficult for a person to stop using, even if they are aware of their disorder.
How the Definition of Dependence Has Changed
The Diagnostic and Statistical Manual of Mental Disorders is the diagnostic tool published by the American Psychiatric Association. In the fourth edition of the DSM (DSM-4), substance abuse and substance dependence were different diagnoses.
Substance Dependence in the DSM-4
Substance dependence included symptoms such as tolerance, withdrawal, unsuccessful attempts to stop using, and using in larger amounts or for longer than intended. Dependence referred to physical and psychosocial symptoms.
Dependence also had an increased severity compared to substance abuse in the DSM-4. One reason for this distinction was the belief that substance abuse was an early symptom to the onset of dependence.
Dependence as a Symptom of Addiction
For many reasons, the DSM-V changed the diagnostic criteria for substance use. The DSM-V combined substance abuse and substance dependence as a single disorder, substance use disorder. Dependence is not referenced in the DSM-V.
One goal with this change is that it enables anyone to get effective treatment, regardless of the severity of their disorder.
To have a SUD diagnosis, an individual must have 2 or more of the following symptoms. Severity is based on the number of symptoms present.
- Taking the substance in larger amounts or for longer than intended
- Wanting to reduce or stop but being unable to
- Spending a lot of time obtaining, using, or recovering from use of the substance
- Craving or a strong desire to use the substance
- Recurrent substance use leading to problems with work, home or school
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational or recreational activities because of substance use
- Using substances even when it leads to harm or danger
- Continuing to use despite physical or psychological problems that could have been caused or made worse by the substance
- Tolerance, needing more of the substance to achieve the same effect
- Withdrawal, which can be relieved by taking more of the substance
It’s important to note that tolerance or withdrawal symptoms are not required for a SUD diagnosis in the DSM-V. In other words, dependence is not always a component of addiction.
If someone exhibits tolerance and withdrawal from opioids under appropriate medical supervision, they would not receive a SUD diagnosis.
There has been confusion around the terms dependence and addiction, largely due to how these terms have been defined in the Diagnostic and Statistical Manual of Mental Disorders. Importantly, as the medical community’s understanding of addiction has changed, so has the diagnostic criteria. Understanding these differences can help to reduce stigma and ensure people get the treatment they need.
Substance use disorders are treatable. If you or a loved one is experiencing symptoms, contact Pyramid Healthcare to learn about our treatment options. Call our admissions department for more information.
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