We’ve touched on this topic before in other articles but given the misunderstandings and misconceptions surrounding this critical principle, we felt the topic of addiction vs. dependence was a good one to discuss today.
The difference between these two principles may seem subtle to some or maybe it’s been unclear up until this point what’s the difference, if any, between them. People use the terms dependence and addiction interchangeably and the misunderstanding of these important recovery terms lead to misleading and untrue statements like “medicine assisted treatment is replacing one addiction with another” and “heroin is very addictive”. The second one in particular may have you scratching your head or even ready to dismiss this article as fabrication, but I urge you, don’t do that. Technicalities may be just that and definitions of words may not seem overly important, but distinguishing the difference between addiction and dependence is crucial to helping anyone else conquer their drug abuse. Let’s start by defining each and then we’ll provide examples of addiction and dependence.
What is Dependence?
Dependence is the body’s physical reliance (or dependence) on a particular drug or substance that leads to withdrawal symptoms if you stop taking it. There’s no doubt that those who stop taking heroin after ongoing use will experience severe withdrawal symptoms – so severe in fact that most heroin dependents or addicts (more on the difference shortly) will continue using heroin simply to avoid experiencing them. Furthermore, dependence and addiction are triggered from different areas of the brain. See the image to the right. Sure they can and often do work together making heroin and other dangerous drugs more difficult to stop using. However, they are both unique and distinct and should be defined that way.
What is Addiction?
Addiction is a disease that alters the brain’s chemistry and structure upon its onset. Addiction creates a ubiquitous connection to a drug, substance, activity (referred to as the “object of addiction”) and a powerful compulsion / urge to continue using the object of addiction without stopping. See “Proof that Addiction is a Disease: How Addiction Alters the Mind” for more specific information on how addiction alters the brain.
Clear Differences Between Addiction and Dependence
The difference between addiction and dependence may seem subtle based on definition alone, but let me assure you the difference is huge. For starters, addiction affects the mind while dependence has to do with the body. Yes, they are connected beyond the shadow of a doubt, but addiction relates to an actual cognitive and ubiquitous connection and compulsion while dependence relates to the body’s reaction.
Example of Dependence Vs. Addiction
Instead of heroin, let’s take a look at a completely unrelated drug or medication. Zoloft is a medication that helps alleviate the effects of depression on the mind and body. Thus, Zoloft is very popular for those who are experiencing depression and want to feel better. I don’t think I’ve ever heard someone call someone who uses Zoloft for depression a Zoloft addict nor have I heard of anyone becoming addicted to Zoloft. That’s because Zoloft doesn’t create any kind of euphoria of the mind that reacts without our genetically predisposed (to addiction) brains.
While people may not develop an addiction to Zoloft, they do become dependent on it. In other words, those who stop using Zoloft cold turkey may experience flu like symptoms. This is called withdrawal. However, to further differentiate addiction and dependence, we provide this real life example.
Someone we know happens to be on Zoloft and often forgets to take her medication. She explains how she’d lie in bed at night and it would dawn on her that she hadn’t yet taken her Zoloft for the day. But because she didn’t feel like getting out of bed (because there was no ubiquitous connection or compulsion to Zoloft), she would just wait until the next day to take it. However, when she was addicted to heroin, she was both dependent and addicted to it. Lying in bed and being tired would not stop her from getting out of bed to use heroin because of the addiction, that compulsion to use was present. Note that the fear of withdrawal may have been part of it, but the addiction was the stronger force which kept her using.
So Am I a Heroin Dependent or a Heroin Addict?
Addiction and dependence are two distinct entities however, when both are present, it becomes more difficult to conquer. Heroin, is particularly dangerous because people can become addicted and dependent on it. I’ve seen other articles state that with ongoing use of heroin, addiction sets in. This is incorrect. Addiction typically sets in at first use. Dependence on the other hand takes ongoing use before the body becomes physically dependent on it.
Between the two forces, addiction is more powerful. There is no physical dependence to gambling but breaking free from a gambling addiction is hard work. Addiction is addiction but there are varying degrees of dependence. Dependence has more to do with the actual substance which is why when you hear phrases like “heroin is highly addictive”, they’re really saying that people who use heroin can become highly dependent on it. Other substances may produce lesser withdrawal symptoms upon ceasing its use while others may produce greater withdrawal symptoms
Why Do People Become Addicted to Heroin? What About Gambling? What about Work?
Those who experience the onset of addiction possess a genetic predisposition to it. No one gene has been isolated at this time, but scientists have provided evidence based on comparing a number of genetic based diseases to addiction and watching the brain react in similar ways. But if addiction is strictly genetic why don’t people become addicted to everything?
There’s something about specific substance and activities that stimulate the mind in unique ways that interacts with the brain’s genetic predisposition in a way to create “addiction”. That’s why we don’t become addicted to everything we try. For example, the drug heroin creates a euphoric feeling that the brain and body enjoy. Those with a genetic predisposition to addiction possess a brain that latches onto that feeling and as a result, the brain’s chemistry and structure changes creating that ubiquitous connection and strong compulsion to use in an ongoing manner. Well that’s great, but what about activities such as gambling?
Gambling provides a feeling of anxiety and excitement, that coupled with the risk factor does something to the brain, stimulating it into “addiction”. Workaholism exists because it provides a sense of worth and accomplishment to the genetically predisposed mind creating “addiction”. See where we are going with this?
Now it should be pointed out that the last two addictions (workaholism and gambling) do not possess any dependence properties. Sure we may say that we depend on our jobs, but we are not using the term “dependence” in the same way here. A physical dependence results in an unpleasant physical change in the body referred to as “withdrawal” whereas using the phrase “we depend on our jobs” means that without our jobs, we would have no money and thus, our lifestyle would change. Thus, no matter how you use the word dependence, it always results in some kind of change without whatever we are dependent on.
Why Aren’t Those Genetically Predisposed to Addiction “Addicted” to Everything?
Why the brain becomes specifically addicted to some substances and experiences and not others is unknown. But I’m guessing it has to do with preference and personality. Some people love chocolate so much that they can’t live without it. Others can’t stand the taste of it. Long story short a particular “like” or “dislike” has to do with our brain’s perception of it. While one may ingest chocolate and the brain’s interpretation may be positive resulting in pleasure while eating it, someone else may experience the exact opposite. I suspect most people who try heroin experience some sensations of pleasure but perhaps the sensation isn’t great enough for some people’s genetically predisposed brains to grasp on and cause the disease of addiction. However, that same person may drink alcohol and the pleasure sensation is so great in the brain that it interacts with the brain’s genetic predisposition, causing addiction. Thus, based on “preference” and our brain’s interpretation of a particular substance or activity, we don’t become addicted to everything.
Why Do People Become Dependent?
As previously stated dependence occurs as a result of perpetually using substances that contain properties of dependence. Thus, if you research a drug, medication or substance and withdrawal symptoms are listed, unless you are immune for some physiological reason, there is a good chance that your body will become dependent on it.
More specifically, the ingredients in the substance (heroin for example) interact with your mind’s and body’s physiology, affecting homeostatsis (the process of maintaining “normal” balance). The brain therefore adapts and makes changes by creating a new balanced set-point. This process is referred to as allostasis. This results in a change to an individual’s homeostatic balance. Thus, as long as one continues to use heroin or the object of dependence, homeostatic balance remains unchanged. However, if one decides to quit using heroin or the object of dependence, the body experiences discomfort (withdrawal) as allostatis works to create a new (or returned) homeostatic balance. Tapering off of a medication slowly causes allostasis to work more slowly reducing discomfort (or withdrawal) as a new homeostatic balance is created.
Can You Become Addicted to Suboxone and/or Methadone?
Simply put….yes and no. Allow us to explain. People can become dependent on medicine assisted treatment (Methadone and Suboxone in particular) due to the body’s physical reliance after ongoing use. But rarely does anyone using Methadone and Suboxone as legitimate heroin treatment options become addicted to it. That’s because people who’ve been using the stronger heroin acquire no physical feeling of euphoria when using them. That said, those who’ve never used opiates before and use Suboxone or Methadone for the first time for recreational use will likely experience a pleasurable feeling that may transform into an immediate addiction. So people who use Methadone and/or Suboxone for recreational use can become both addicted and dependent on it, making them just as dangerous as heroin. For more on medicine assisted treatment, view the article “Suboxone and Methadone: The Brutal Truth About Medicine Assisted Treatment“.
There are a number of fine lines as addiction and dependence work together and create a real problem for those using a particular substance like heroin to quit. The good news however, is that recovery is possible and help is available. Whether you are addicted or dependent (or both) on heroin, opiates and/or other drugs, help is available. View our list of recommended addiction treatment centers / drug rehabs or ask your questions on our heroin addiction & recovery discussion forum. Feel free also to contact us.
Written and Published By,
William – Publisher and Founder of Kill the Heroin Epidemic Nationwide™
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