Drug Dependence

Drug dependence is a condition where your body becomes so used to a substance that you need it to function normally, and stopping it makes you feel unwell. While often confused with addiction, dependence can occur even with prescribed medications, and understanding the difference is crucial for recognizing when help is needed.

Table of contents

• What is Drug Dependence?
• The Difference Between Dependence and Addiction
• Types of Dependence
• How Drug Dependence Develops
• Signs and Symptoms
• Diagnosis
• Treatment Options
• Recovery and Outlook

What is Drug Dependence?

Drug dependence occurs when your body has become so used to having a particular substance regularly that you need that drug to function normally. If the substance were stopped, you would feel unwell^[4]. This is also known as substance dependence, which is a biopsychological situation where an individual’s functionality depends on the continued use of a psychoactive substance^[3].

The condition has been reclassified in recent medical practice. The American Psychiatric Association used to distinguish between dependence and abuse, viewing dependence as a more severe problem. However, in 2013, these terms were replaced with substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders^[2]. This change occurred because tolerance and withdrawal that previously defined dependence are actually normal responses to prescribed medications that affect the central nervous system and do not necessarily indicate the presence of an addiction^[3].

substance use disorder, drug addiction, substance abuse

The Difference Between Dependence and Addiction

People sometimes use the terms “addiction” and “dependence” interchangeably, but dependence is not the same as addiction^[2]. Understanding this distinction is important for recognizing and addressing these conditions properly.

Addiction can occur without being dependent on drugs. Addiction may involve using drugs despite the consequences, being unable to stop using drugs, and neglecting social and work obligations because of drug use^[2]. Drug addiction is a disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine^[1]. It is a chronic brain disease that causes a person to take drugs repeatedly, despite the harm they cause^[5].

On the other hand, it’s possible to be dependent on drugs without being addicted. Dependence can be a bodily response to a substance. This often occurs if you rely on medications to control a chronic medical condition, such as high blood pressure, diabetes, or glaucoma^[2]. People who are addicted still get cravings for drugs such as opioids even after they have reduced them slowly so that they are no longer dependent^[4].

Types of Dependence

People who have drug dependence may experience psychological dependence, physical dependence, or both^[4].

Physical dependence means a person’s body becomes dependent on a particular substance. Being physically addicted means building tolerance to that substance, so that a person needs a larger dose than before to get the same effects^[16]. Someone who is physically addicted and stops using a substance like drugs, alcohol, or nicotine may have withdrawal symptoms. Common symptoms of withdrawal are diarrhea, shaking, and generally feeling unwell^[16]. These symptoms are unpleasant and could include nausea and vomiting, sweating, difficulty sleeping, muscle cramping, and mood changes^[7].

Psychological dependence happens when the cravings for a drug are psychological or emotional. People who are psychologically addicted feel overcome by the desire to have a drug^[16]. This type of dependence affects cognitive functioning and involves emotional-motivational withdrawal symptoms such as anhedonia (inability to feel pleasure) and anxiety^[3].

Dependence-forming medicines include antidepressants (which improve low mood), benzodiazepines (tranquillizers mainly prescribed for anxiety), z-drugs such as zolpidem and zopiclone for insomnia, opioid pain medicines used to relieve severe and chronic pain, and gabapentinoids used to treat epilepsy, nerve pain, and to prevent migraines^[4].

How Drug Dependence Develops

Drug dependence can develop through various pathways. Drug addiction can start with experimental use of a recreational drug in social situations, and for some people, the drug use becomes more frequent. For others, particularly with opioids, drug dependence begins when they take prescribed medicines or receive them from others who have prescriptions^[1].

Substances change how your brain functions over time. They release dopamine, a chemical in your brain that makes you feel good until the substance wears off. Your brain and body want to continue this good feeling, even if it’s unhealthy^[7]. The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others^[1].

Several factors can make you more likely to develop drug dependence. These include having a family history of addiction, living in an environment where illegal drugs are often used and easy to access, having a history of anxiety, depression, or other mental health conditions^[2]. Mental health problems such as depression, anxiety, or attention deficit/hyperactivity disorder make people more likely to become addicted, partly because drug use and mental health problems affect the same parts of the brain. Also, people with these problems may use drugs to try to feel better^[5].

Starting drug use when you’re young significantly increases the risk. When kids use drugs, it affects how their bodies and brains finish growing, which increases the chances of becoming addicted when they’re adults^[5].

Signs and Symptoms

Drug addiction symptoms or behaviors include feeling that you have to use the drug regularly, daily or even several times a day, and having intense urges for the drug that block out any other thoughts^[1]. As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good^[1].

The symptoms and effects of substance use disorder vary based on the type of substance you use. There are two groups of symptoms based on when or if the substance is in your body. Intoxication is the immediate and short-term effect of a substance in your body, with symptoms including feeling sleepy, calm, excited, or experiencing intense emotions. The substance can also affect your judgment and decision-making or physical and mental functioning^[7].

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the signs of substance use disorder include taking the substance in larger amounts and for a longer amount of time than intended if it’s a prescription, having a strong desire or urge to use the substance, having unsuccessful efforts to cut down on or manage substance use, and spending a lot of time obtaining or using the substance or recovering from its effects^[7].

Additional signs include having issues fulfilling responsibilities at work, school, or home due to substance use, continuing to use the substance even when it causes problems in relationships, giving up social, occupational, or recreational activities because of substance use, using substances again and again even when it puts you in danger, and continuing substance use despite an ongoing physical or psychological problem that’s likely caused or worsened by the substance^[7].

If you notice that a family member or friend is acting differently than before or is having problems in various aspects of their life, they may be struggling with substance use. Signs include changed personality, isolating themselves from friends and family, extreme changes in their behavior and mood, trouble remembering things or staying alert, and loss of interest in activities they once enjoyed^[15].

Diagnosis

Diagnosing drug dependence, now classified as substance use disorder, requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine, or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery^[6].

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association^[6]. The diagnosis focuses on the disorder involving the use of the substance and can be applied to various types of drugs including alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other substances^[9].

Treatment Options

Although there’s no cure for drug addiction, treatment options can help you overcome an addiction and stay drug-free. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse^[6].

Treatment programs for substance use disorder usually offer individual, group, or family therapy sessions, a focus on understanding the nature of addiction, becoming drug-free and preventing relapse, and levels of care and settings that vary depending on your needs, such as outpatient, residential, and inpatient programs^[6].

Withdrawal therapy, also called “detox,” aims to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center^[6].

Recovery options include outpatient counseling, which helps people understand addiction, their triggers, and their reasons for using drugs. This form of treatment is valuable for addressing the psychological aspects of dependence^[9]. Evidence-based guidelines can assist doctors with choosing the right treatment options by evaluating a patient’s clinical needs and situation to match them with the right level of care in the most appropriate available setting^[9].

Research has shown that drug abuse treatment is both effective and cost-effective in reducing not only drug consumption but also the associated health and social consequences^[10]. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy^[9].

Recovery and Outlook

Like many other chronic conditions, treatment is available for substance use disorders. While no single treatment method is right for everyone, recovery is possible, and help is available for patients with substance use disorders^[9]. Substance use disorder is a treatable mental health condition, and help is available when you’re ready^[7].

Drug addiction is considered a “relapsing” disease, which means that people in recovery are at risk for taking drugs again, even after years of not taking them. The brain changes from addiction can be lasting, which is why substance use disorder is classified as a chronically relapsing disorder^[5].

Not everyone who uses drugs becomes addicted. Everyone’s bodies and brains are different, so their reactions to drugs can also be different. Some people may become addicted quickly, or it may happen over time. Other people never become addicted. Whether or not someone becomes addicted depends on many factors, including genetic, environmental, and developmental factors^[5].

Help from your health care provider, family, friends, support groups, or an organized treatment program can help you overcome your drug addiction and stay drug-free^[1]. Family and friends are an important support system for someone who is looking for help^[15].