Learn / Addiction vs. Dependence: Understanding the Difference

Addiction vs. Dependence: Understanding the Difference

Hannah Friedman
 July 17th, 2023|   Clinically Reviewed by 
Rajnandini Rathod

Key Points

  • Addiction is a psychological reliance on a behavior despite negative consequences.
  • Dependence is a physical reliance on a substance that can lead to withdrawals.
  • Treatment should address both physical and psychological aspects of addiction.

The terms “addiction” and “dependence” may sound interchangeable, but they mean different things. Dependence is the physical reliance on a drug. Addiction, on the other hand, has primarily psychological symptoms. You can be dependent on a substance without having an addiction. Most types of addiction include physical dependence—but that’s not always true. When you understand the difference between these issues, you can find the type of treatment that best suits your needs.

Defining Addiction

Addiction means continuing to use a substance1 in spite of its negative consequences. This is a complex psychological condition. Addiction affects the way you think and how you behave. You might feel like your actions are out of your control. While everyone’s experience is different, there are some common signs of addiction:

  • Obsessively thinking about the substance or behavior
  • Feeling like you can’t stop acting on your cravings, no matter how hard you try
  • Developing withdrawal symptoms when you try to quit
  • Isolating yourself or hiding your behavior

People can be addicted to multiple substances at a time. This includes prescription drugs, alcohol, and illicit drugs. You can also develop addictions to behaviors like sex, watching porn, using the internet, and gambling

Understanding Dependence

With dependence, your body relies on a substance2 to feel normal. If you go into withdrawal when you stop drinking or taking drugs, you probably have a physical dependence on that substance. Withdrawal symptoms3 vary depending on your exact health history, but a few are especially common:

  • Sweating
  • Tremors
  • Insomnia
  • Nausea
  • Increased heart rate
  • Elevated blood pressure
  • Headaches
  • Seizures
  • Hallucinations 

Both illicit and prescription substances can cause physical dependence on drugs. But there’s a difference between dependence vs. addiction. For example, many people with diabetes depend on insulin but aren’t psychologically addicted to it. You can also come to depend on substances like alcohol, cocaine, marijuana, and nicotine. And some prescription drugs, like opioids, have high rates of both dependence and addiction.4

Even if you only take drugs as prescribed, it’s important to monitor your substance use. Notice when and why you start to physically depend on a drug. If that substance dependence has a negative impact on your life, you could be at risk of addiction.

Psychological vs. Physiological Aspects

It’s possible to have addiction without dependence,5 and vice versa. But if you have both, your physical and psychological symptoms might feed off each other. For example, you might start taking opioids to relieve pain after an injury. Then, as your body heals, lowering your dosage could make you feel anxious. What starts as a physical need can become an emotional one.

Without proper support, this can quickly lead to addiction. When you’re ready to recover, it may help to differentiate between the physiological and psychological aspects of what you’re going through. Doing this empowers you and your care team to choose the most effective types of treatment.

Psychological Aspects of Addiction

There’s a good reason addiction feels so out of your control. Addictive substances change the way your brain works.6 They flood your brain with dopamine, a feel-good chemical that activates your reward system. Over time, substances change the way your brain produces dopamine.7 Drug use might become the only thing that gives you a sense of reward. The National Institute on Drug Abuse explains:

“The difference between normal rewards and drug rewards can be likened to the difference between someone whispering into your ear and someone shouting into a microphone. Just as we turn down the volume on a radio that is too loud, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. As a result, the person’s ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.”

Physiological Aspects of Dependence

Like your brain, your body can quickly get used to any drugs8 you take. If you use a drug often, you’ll need higher doses to feel the same effects. This is called tolerance. You can develop a tolerance to some drugs very quickly. For example, it takes just 2-3 doses of opioids9 for some people to develop a tolerance.

Once you have a tolerance, you might start taking higher doses to get the same effect. You might also become physically dependent on the drug, and feel withdrawal symptoms if you try to quit. Many people keep using drugs to avoid those withdrawal symptoms. If this pattern continues, it might lead to addiction. 

If your body depends on a substance, withdrawal can range from being uncomfortable to dangerous. Detoxing from certain substances—like alcohol, opioids, and benzodiazepines—can even be fatal. Formal addiction treatment can keep you safe during this phase of recovery.

Implications and Consequences

Addiction can impact every aspect of your life, starting with your mental health.10 Substances change your brain, and might contribute to co-occurring disorders like anxiety and depression. These symptoms, along with other aspects of addiction, can interfere with your relationships. If you prioritize drug use over your colleagues or loved ones, you might face serious consequences. 

Dependence also affects your physical health, whether or not you have an addiction. For example, alcohol dependence can lead to liver problems,11 heart disease, and even cancer. Opioids increase your risk for cardiac and respiratory problems.12 And illicit drug use has a high risk of overdose13 and death.

While addiction and dependence aren’t the same, they often overlap. So when you start recovery, both your body and mind will need time to heal.

Connect with a rehab program for alcohol and drug addiction to determine which treatments can best meet your unique needs.

Frequently Asked Questions About Addiction vs Dependence

What’s the difference between addiction and dependence?

Dependence is a physical reliance on a substance, while addiction is a psychological condition wherein people continue using substances despite negative consequences. While both are often present at the same time, they’re not always the same.

Can someone be dependent on a substance without having addiction? 

Yes, you can be dependent on a substance without having an addiction. Dependence refers to the physical reliance on a substance to feel normal, while addiction involves psychological symptoms and compulsive behavior. While most types of addiction include physical dependence, not all cases of dependence indicate addiction.

What are the common signs of addiction?

Common signs of addiction include obsessively thinking about the substance or behavior, being unable to stop acting on cravings, having withdrawals when you attempt to quit, and isolating yourself or hiding the behavior in question. Addiction affects the way you think and behave, and it may involve substances or behaviors such as drugs, alcohol, sex, internet use, and gambling.

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