Although the terms addiction and dependence are oftentimes used interchangeably, their meanings are not the same. Addiction indicates a marked behavioral change consequent to neurochemical changes in the brain resulting from continued substance use.1,2,3,4,5 Dependence refers to a physical dependence upon something that results in tolerance and withdrawal.1,2,3,4,5
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), both of these terms fall under the general diagnosis of substance use disorder.
What Is Addiction?
Addiction constitutes a pervasive repetition of behavior that continues despite the consequences.4 Consequences may range from minimal to severe but oftentimes impact important familial, social, occupational, financial, and spiritual/religious obligations. This is when behavioral change is noticed by others. One may demonstrate emotional lability, change of friends, loss of interest in past activities, become withdrawn, and so on.
An individual may be completely oblivious to one’s addiction, in denial, not concerned about it, or actively desiring to stop. An issue for those desiring to stop are uncontrollable urges or cravings to engage in substance use or other problematic behaviors (e.g., gambling, stealing, spending, sex, etc.).3 Thoughts become obsessive, ultimately leading toward a compulsion to satisfy them.
An important distinction of addiction is that it is classified as a disease.3,6 Common diagnosable addictions include those of substance-related (i.e., drugs, alcohol) and other addictive disorders. These are also included in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).7 Addiction is a condition that is considered treatable but not curable. Treatment in this case is ongoing and adaptable to where one is at in the recovery process.
What Is Dependence?
Dependence is a state of physical dependence upon a substance.1,2,3,4,5 This is a natural physiological response to continued use of a substance. It may occur whether one uses a substance as recommended, prescribed, or in abusive fashion. At this point there are neurophysiological changes that occur in the brain. These are marked by tolerance and withdrawal.3,6
Tolerance is characterized by increased amounts of a substance to attain the desired effect while withdrawal is a cluster of symptoms associated with not using. With increased tolerance, the body struggles to maintain equilibrium and begins relying on the external source.3
Dependence is not unique to drugs and alcohol. People oftentimes become physically dependent upon everyday substances such as sugar and caffeine. Consider that if the daily caffeine consumer were to discontinue consumption that the withdrawal effects may begin within 12-24 hours and last anywhere from 2-9 days.8 Dependent upon the substance’s strength, method of consumption, frequency of use, one’s overall health, and other factors; physical dependence may prove more substantial.
Because physical dependence is a naturally occurring phenomenon, it is predictable and manageable.3 Accordingly, it may be medically managed as appropriate.3 In some cases a 72-hour detox or equivalent may work. In others, it may require prescribed replacement medications that taper off over time and with marked progress. Being physically dependent upon something does not mean that one is addicted.3,6 Physical dependence without an addiction meeting diagnosable criteria is curable.
Signs of Addiction
Although every person and situation are different, there are some common signs of addiction. These impact individuals among the domains of biological (physical), psychological (mental and emotional), and social. As the addiction intensifies, the number and severity of signs do as well. As a first step toward getting help for yourself or someone else is recognizing the signs.
Common signs that one may have an addiction include:
- Continuing to take a drug when it is no longer medically necessary
- Requiring increased amounts of a substance to achieve the desired effect
- Experiencing emotional instability, lethargy, or physical discomfort when the effect wears off
- Regardless of a desire to stop one continues using despite the consequences
- Much time is spent thinking about and acquiring the substance of choice
- Boundaries consistently become blurred and broken, which includes using increased amounts of a substance over longer periods of time than intended
- Engaging in physically hazardous activities to self or others while under the influence
- Stealing or borrowing money to pay for the substance
- Becoming distant from and struggling to get along with loved ones and friends
- Getting too much or too little sleep
- Eating too much or too little
- Beginning to physically change in appearance
- Surrounding oneself by only those who engage in the same problematic behavior
- Doctor shopping for prescription drugs or stealing them from others
- Combining prescription drugs with alcohol and recreational drugs9
If you or a loved one is presenting with the aforementioned signs, it is recommended to consult with a therapist immediately. You or your loved one and the therapist may work together to determine whether a problem exists and to what severity.
Signs of Dependence
Because the terms addiction and dependence are commonly exchanged erroneously, it is easy to confuse the signs of dependence with addiction.6 Again, dependence does not necessitate addiction.3,6 The signs are different. In this case, each sign is specifically associated with a physiological aspect of one’s being.
Common signs of dependence include the following:
- Physical cravings
- Development of tolerance
- Compromised immune system
- Weight changes
- Memory issues10
If any of these signs are present, it is recommended to consult with a physician immediately. Part of the treatment process may include therapy, especially if there are signs of addiction as well.
Symptoms of Addiction
The symptoms of addiction have been clearly defined in the DSM-5 and are used as diagnostic criteria. The more symptoms one presents with, the more severe the condition. Two or three symptoms indicate a mild condition, four or five is moderate, and six or more is severe.
For the sake of deciphering addiction from dependence, the final two criteria regarding tolerance and withdrawal must be removed. Accordingly, diagnostic symptoms of addiction include the following:
- Consuming a substance in larger amounts over a longer period than intended
- Persistent desire or unsuccessful attempts toward cutting down or controlling consumption
- A great deal of time is spent obtaining and consuming the substance
- Craving or strong urge to use the substance
- Recurrent use resulting in a failure to fulfil major role obligations
- Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by its effects
- Important social, occupational, or recreational activities are given up or reduced
- Recurrent use in situations in which it is physically hazardous
- Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use7
Symptoms of Dependence
Symptoms of dependence, like the signs, are specifically tied to physiological changes resulting from continued use. Using the DSM-5 as a reference, these include the final two criteria for diagnosing a substance use disorder.
The symptoms of dependence are the same as addiction, but also include:
- Tolerance, as defined by either a need for increased amounts of the substance to achieve the desired effect or diminished effect with continued use of the same amount.
- Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance or it is taken to relieve or avoid withdrawal symptoms.7
Note that meeting only these two criteria may technically diagnose a substance use disorder, but caution should be taken if there are no signs of addiction. Treatment in each case should be different.
How to Get Help for Addiction & Dependence
The first step toward getting help for addiction and dependence is identifying the problem. If the signs and symptoms discussed in this article are present, it is important to seek professional help. Addiction and dependence both escalate quickly becoming increasingly difficult to manage. The earlier one engages in treatment, the greater likelihood of positive outcomes.
Although there are numerous resources available for addiction and dependence nationally, it does vary by location. You may begin by researching addiction and dependence providers and agencies within your area. From there it is recommended to review the websites of top providers in your area. After reviewing the websites follow up with a phone call or email with questions. Finding a right fit is important for the longevity of recovery.
Cost of Addiction & Dependence Rehab
The cost of addiction and dependence rehab does vary widely depending on the level of treatment received. Support groups may be offered gratis, while outpatient therapy is traditionally more affordable than intensive outpatient (IOP) or residential treatment. Medical detox and prescription medication factor into the cost. Some managed care plans offer more coverage than others, but all have limits.
Cost of Addiction Rehab
Addiction rehab is oftentimes more extensive than dependence rehab, which yields a higher cost for treatment. Unfortunately, the cost can be quite expensive. Depending on managed care coverage, alternative funding, or whether one must pay completely out of pocket, an inpatient residential treatment program may cost anywhere from $0 to thousands a day.11
A traditional 30-day program may cost anywhere from $10,000 to $100,000 for one of the more luxurious ones you see on TV. Outpatient detox is usually around $1,000-$1,500.11 Medication may also cost upwards of thousands of dollars annually as well.
Cost of Dependence Rehab
The cost of dependence rehab will depend on the level of treatment needed. Without the signs and symptoms of addiction present, it may prove manageable with outpatient detox or medical titration and outpatient therapy. In other cases, IOP or residential may prove necessary. This can only be determined by a professional. All things considered, in cases where addiction is not present, the overall cost may be significantly lower.
Length of Treatment
The length of treatment for either addiction or dependence depends on progress made during recovery. Rather than entering treatment with the mentality of, “How long is this going to take?” it is important to recognize that everyone’s road to recovery is different.
While some individuals may find success in a relatively short period of time, for others, it will be a life-long progress. Either case is okay so long as one is living a healthy, satisfying life. In either case of addiction or dependence, one’s motivation to recover is a prominent factor.
Length of Treatment for Addiction
With addiction there is a general thought that recovery takes about at least as long as the addiction was present. For instance, an individual with a heroin addiction of 5 years might anticipate active recovery taking at least 5 years with aftercare occurring thereafter. At the same point, it is important to consider relapses.
Considering that relapse is more common than not for more severe substance use disorders, there may be some setbacks. Although discouraging, 30-day residential stays are typically not a one-and-done type situation. A continuation of outpatient therapy, support groups, and perhaps even medication is warranted for creating a successful relapse prevention plan.
Length of Treatment for Dependence
The length of treatment for dependence will vary by individual as well. If no signs and symptoms of addiction are present, then recovery may progress relatively quickly. Outpatient detox followed by outpatient therapy may last several sessions to a year or longer.
How Do I Know What’s Right for My Situation?
To determine what is best for your situation, it is important to first consult with a professional—preferably one who specializes in addiction and dependence. Upon assessment and receiving a formal diagnosis, treatment planning may begin. Note that there are many cases in which a professional may recommend something different than originally thought. It is important to be open-minded to such suggestions, as professionals are trained and experienced in these matters. If you would like to receive a second opinion, that is okay as well. One thing to not do, however, is decline necessary treatment all-together.
Do consider that the more severe the condition, the more invasive the treatment. In more severe cases an ideal scenario may include completing detox and engaging in residential treatment followed by outpatient therapy and support groups. Even in the event of less severe situations, some treatment is appropriate for additional support. Positive social support is a leading factor toward recovery, and this is available through any form of treatment as well as support groups.
When choosing which treatment might work for you, consider the following:
- Is your current living situation conducive to the changes you want to make?
- Do you have a strong support system around you?
- Are you serious about wanting to make a healthy change in your life?
- Have the things you tried in the past worked for you?
- Does your managed care plan cover the cost of treatment?
- Do you have the finances available to cover necessary out-of-pocket expenses?
- If finances are a problem, are you willing to engage in free or low-cost sliding scale options?
- What are the available treatment options in your community?
- If treatment options are limited, is it practical to utilize online resources such as virtual support groups and/or therapy?
These questions, among others, may help guide you toward making the best decision. Although the road to recovery may differ from what you envisioned, know that there are always options.
For Further Reading
If you or a loved one is struggling with an addiction, check out the following resources: