When considering the definition of addiction vs. dependence, past thinking made it fairly simple to differentiate between the two terms. Although addiction and dependence possess similar symptoms, the manifestations and associated behaviors differ significantly.
Let’s Look at Past Definitions, Creating the Distinctions of the Two
Suppose a person begins to use a substance that possesses physical dependence characteristics. This may be defined as a substance that after prolonged use followed by abrupt and complete discontinuation of use, the user experiences withdrawal symptoms, which can vary in intensity and severity (e.g. heroin, benzodiazepine, alcohol, etc.). The symptoms of withdrawal will occur whether addiction, dependence or both are present.
If this same person is not an addict, they likely have a choice of whether or not to use the substance again. The choice to use it or not use it will likely be made based on the consequences the person experienced – positive or negative. In other words, they have the ability to apply reason to the decision process. In many cases, the physiological withdrawal discomfort is enough to choose not repeat the behavior of prolonged use, or any use at all.
But in the case of an addict, while the physiological dependence and withdrawal symptoms remain the same based on the substance, the experience of positive or negative consequences does not come into play regarding resumption of use. In fact the part of the brain that handles choices, the frontal cortex, is no longer in control and an older part of the brain, the mid-brain, is running the show. The mid-brain cannot process consequences, it only knows that it wants the substance, for the substance has become the most important thing, above survival (fight or flight response), sustenance (hydration and nourishment), and reproductive instincts – all of which the mid-brain facilities are responsible for securing.
The Addict No Longer has the Power of Choice.
With the advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the terms addiction and dependence are no longer used, and have been replaced by the term Substance Use Disorder. Essentially, the DSM-5 focuses on the severity of substance use and wraps the physiological withdrawal symptoms in the mix. The determining factors are a set of eleven criterion for diagnosis, and certain combinations of criterion determine the degree of severity: mild, moderate and severe. Within these degrees, addiction (or the loss of choice, in spite of information) is found.
Old school or new logic, the regimen of treatment needed to stabilize a person suffering from addiction or dependence is different. Dependence may require or benefit from a medical procedure to stabilize, while addiction may require both a medical procedure and/or a therapeutic approach to stabilize and achieve recovery.
Valley Recovery Center of California is a Sacramento based addiction treatment center offering several different programs, including day treatment. Please feel free to contact us anytime at (888) 989-9690 with questions.