Psychological Dependence: Definition, Examples, & Treatment

What Is Psychological Dependence?

Addiction involves a pattern of compulsive substance use or other destructive behaviors that are continued even after someone knows they’ve become problematic.¹ The continuation of problematic behaviors in addiction is usually driven by dependence, which can be psychological, physical, or both. Psychological dependence, or psychological addiction, is a mental and/or emotional dependence that can form an addictive substance or behavior.²

Relying on an addiction to cope with stress, numb painful emotions, quiet negative self-talk, or racing thoughts are examples of psychological dependencies that can form a substance. Sometimes, people can develop a psychological addiction without ever becoming physically addicted. Psychological dependence can cause strong cravings and withdrawals that are just as hard to overcome as the ones people experience when they’re physically addicted to something.^2,3

Causes of Psychological Dependence

Psychological dependence is caused by a complex set of environmental, genetic, and psychological factors. Childhood trauma, a family history of addiction, mental illness, and early drug experimentation all increase the risk of developing psychological dependence. Even without these risk factors, it’s possible for someone to develop a psychological dependence on a drug or behavior if used/performed too much or too often.⁴

Symptoms of Psychological Dependence

All addictive disorders are diagnosed using the same set of symptoms from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Addiction and dependence often overlap considerably, and the DSM-5 criteria for diagnosing substance use disorders can also help identify the signs of psychological dependence.⁵

Symptoms of a substance use disorder include:⁵

• Taking the substance in higher doses or more frequently than intended
• Wanting or trying to cut down or stop using a substance but not being successful
• Spending a lot of time getting, using, or recovering from the effects of a substance
• Having strong urges or cravings to use a substance
• Not managing responsibilities at school, home, or work because of substance use
• Continuing to use a substance even after it causes problems in a relationship
• Giving up important social or leisure activities because of substance use
• Using a substance in situations where it’s risky or physically unsafe to do so
• Continuing to use a substance that’s negatively affecting your physical or mental health
• Needing to use more of a substance to get the desired effects (developing a tolerance)
• Experiencing physical or psychological discomfort when you stop or cut back that could be relieved by the substance (experiencing withdrawal symptoms)

Signs of psychological dependence include:^2,3

• Feeling unable to give up a drug or other addictive habit
• Relying on a drug or addictive habit to cope with stress or difficult thoughts & feelings
• Having strong emotional cravings or urges for a drug or other addictive habit
• Being preoccupied with intrusive thoughts and about the drug or habit
• Depending on a drug or addictive habit to function, feel normal, or complete tasks
• Experiencing anxiety at the thought of giving up a drug or addictive habit
• Denial and defensiveness when confronted about the addiction
• Becoming irritable or moody without the drug or addictive habit
• Feeling the need to enhance your feelings with drugs or an addictive habit
• Using a drug or addiction as a ‘reward’  or motivator for doing or achieving something
• Personality or behavior changes when craving, using, or withdrawing from a drug or addictive habit.

Psychological Vs. Physical Dependence

While physical and psychological dependence often goes together in addiction, it’s possible for them to occur separately. The main difference between them is that physical addictions involve a dependence your body and brain has formed on a drug or habit, while psychological dependencies are mental and emotional in nature.^1,2

Some of the similarities and differences between physical and psychological dependence include:^2,3

Similarities Between Physical & Psychological Dependence	Differences Between Physical & Psychological Dependence
Both are linked to addiction and often develop simultaneously	Not all drugs are physically addictive, but most can be psychologically addictive
Both can cause strong urges, cravings, and withdrawal symptoms to occur	Psychological withdrawals affect mood & thought, physical withdrawals affect the body
Both are fueled by dopamine, which can cause an addiction pathway to form	Psychological dependence can form to drugs or behavior, physical only to drugs
Prolonged abstinence is the key to overcoming both forms of dependence	Physical dependence ends after detox, psychological withdrawals can persist
Both can be easier to overcome with addiction treatments like meds & therapy	The timeline & symptoms of physical withdrawals are more predictable

Physical Dependence Alone

When someone only has a physical dependence on a drug, it means they can expect their withdrawal symptoms to begin when or shortly after the last dose. The physical withdrawal process will follow a fairly standard timeline, which depends on the type of drug, typical dose, and frequency of use.^2,3,6

For most substances, physical withdrawals will begin within hours after the drug leaves their system, peak within the first 72 hours, and normally resolve within a week or less as they go through the detox process. The specific withdrawal symptoms vary, depending on what drug someone is detoxing from.

Some of the common symptoms of physical withdrawal include:^2,3,4,5,6

• Nausea, cramps, and stomach pain
• Physical discomfort, body aches, or headaches
• Feeling sweaty or itchy
• Increased or decreased appetite
• Trouble sitting still, restlessness
• Intense physical cravings
• Diarrhea or constipation
• Fever, chills, or flu like symptoms
• Tics or shaking
• Racing heart or high blood pressure

Psychological Dependence Alone

When someone only has a psychological dependence, the withdrawal process tends to be less predictable. The specific symptoms vary more with psychological dependence, as well as when those symptoms start and end. In some cases, psychological withdrawal symptoms happen shortly after the last dose and in other cases, there is more of a delayed onset. While physical dependence causes withdrawal symptoms only during the detox phase, psychological withdrawals can persist for weeks, months, or longer.^2,5,6

Some of the common symptoms of psychological withdrawal include:^2,3,5,6

• Mood swings
• Increased irritability
• Increased anxiety or panic attacks
• Trouble concentrating/thinking
• Symptoms of depression
• Insomnia or hypersomnia
• Brain fog or trouble thinking clearly
• Obsessive or intrusive thoughts
• Strong cravings, especially when stressed
• Lowered self-esteem or confidence

Psychological & Physical Dependence

It’s common for people to experience symptoms of both psychological dependence and physical dependence together. This can include any combination of the symptoms listed above, which can occur simultaneously or separately. The detox period after stopping a substance is when a person can expect to experience combined physical and psychological withdrawal symptoms.^1,3,6

The physical withdrawal symptoms usually taper off and stop within a week or less, but the psychological dependence symptoms can persist for longer. Less commonly, some people withdrawing from opioids or stimulant drugs may experience prolonged withdrawals, which is also referred to as post-acute withdrawal syndrome (PAWS). The symptoms of PAWS are mostly psychological and can mimic the symptoms of depression, anxiety, or ADHD, and may last for months or even years after a person stops using.^5,6,7

Psychological Dependence Vs. Addiction

Dependence, either physical or psychological, and addiction are often used interchangeably, but they have different meanings. Dependence is a physical or psychological reliance on something, whereas addiction is a disease that involves a variety of characteristic patterns and symptoms, including dependence. While they often co-occur, dependence and addiction can present separately.^1,3

Here are some examples of dependence and addiction occurring separately:

• Psychological dependence without addiction: A person develops a psychological dependence on a prescribed anxiety medication and feels unable to cope without it but displays no other symptoms of a substance use disorder.
• Physical dependence without addiction: A person takes a steroid long-term to combat inflammation, resulting in physical dependence on the medication.  They experience  withdrawals when they stop, but the steroid doesn’t cause a ‘high.’
• Addiction without dependence: Someone has a problem with binge drinking on the weekends and continues to drink after an accident while driving drunk, resulting in a DUI and a head injury, but reports no cravings or withdrawals when they stop drinking.

Substances Associated With Dependence

A person can develop a dependence on several different types of drugs. Some drugs like nicotine, heroin, and cocaine are known to cause physical dependencies, while other drugs like marijuana are less likely to. Any of these substances can cause psychological dependence since this involves a mental and emotional attachment.

Drugs that are closely associated with physical and psychological dependence include:^3,5,6

• Amphetamines, including cocaine, crystal meth, and some ADHD medications
• Cannabis and synthetic cannabis products, including Delta 8, Delta 9, THC-A
• Benzodiazepine medications for anxiety, including Xanax and Klonopin
• Sedative drugs, barbiturates, and depressants, including alcohol
• Opioid drugs like prescription painkillers, fentanyl, morphine, and heroin
• Tobacco and nicotine products, including vape juices, lozenges, and chewing tobacco

Treating Psychological Addiction

Treatments for psychological addiction and dependence can include group, individual, or family therapy provided in an inpatient or outpatient treatment setting. Sometimes, treatment at a rehab facility is necessary to support the person during the initial detox, especially if they’re experiencing both physical and psychological withdrawals. In some cases, treatment also includes medications to help reduce cravings and lessen withdrawals.^4,6

The specific types of therapy and medication recommended for psychological addiction depend on the type of drug the person uses, their pattern of use, and what withdrawal symptoms they experience. Often, it’s also recommended for people in recovery from an addiction to engage in addiction support groups like SMART Recovery or 12-step programs. The aim of addiction treatment is usually to help the person establish their sobriety and develop skills and supports to maintain it long term.⁶

Effective addiction treatments for people with drug dependence include:^4,6

• Cognitive behavioral therapy (CBT): CBT is a structured treatment that helps people recognize, change, and cope with difficult thoughts and feelings and make positive behavior changes that align with their long-term goals.
• Contingency management: Contingency management programs that are often offered in inpatient and residential addiction treatment programs that reward people with money or privileges for remaining drug-free and attending treatment.
• Motivational interviewing (MI): MI is a type of therapeutic coaching that involves supporting people in the process of making a major behavior change, including helping them identify motivators, overcome barriers, set goals, and make concrete plans to achieve them.
• Family therapy: Family therapy sessions in inpatient, outpatient, or residential treatment centers involve helping people with addictions improve communication, trust, and closeness with loved ones.
• Medication-assisted treatment: Medication-assisted treatment provides prescribed medications to relieve withdrawals and cravings and promote long-term recovery, including suboxone or methadone for opioid addiction treatment or naltrexone for alcoholism.

In My Experience

The psychological aspects of drug dependence and addiction can cause cravings, obsessive thoughts, and mood changes. While the physical addiction and withdrawal usually last about a week after quitting, the psychological withdrawals can linger for weeks or longer. The good news is that it’s possible to overcome psychological addictions with healthy coping skills and a strong support system.

While it’s possible to overcome a psychological dependence on your own, many find that seeking treatment from a licensed addiction counselor helps overcome an addiction. In some cases, medications are also helpful in relieving withdrawals, managing cravings, and promoting long-term recovery.