The Difference Between Addiction And Physical Dependence

“When you’re an addict, you can go without feeling anything except drunk or stoned or hungry. Still, when you compare this to other feelings, to sadness, anger, fear, worry, despair, and depression, well, an addiction no longer looks so bad. It looks like a very viable option.” —Chuck Palahniuk, Choke

In A Nutshell

Many people conflate addiction and physical dependence, but they are actually quite distinct from each other. After taking a drug for a long time, someone might increase their tolerance to it and have unpleasant withdrawal symptoms if they quit using. This is physical dependence. If you are using drugs for the wrong reasons, and you allow them mess up your life but continue using them in spite of that knowledge, you are addicted.

The Whole Bushel

One of the most common and damaging mistakes is to mix up addiction with physical dependence. Addiction is more a problem with a person’s specific pattern of behavior. Conflating the two can be damaging and counterproductive. After all, you don’t want to accuse someone who is merely physically dependent on a medication of being a full-blown addict.

You see, when someone is prescribed a medication of any sort that they require over a long period of time, they may slowly build up a tolerance to it. This is similar to drinking. If you are a heavy drinker, you will likely need more and more to get to the level you want. Now imagine if you are on pills for chronic pain. Instead of tolerance meaning you don’t get as drunk as you want, it now means you aren’t handling the pain as well. If you start taking more to deal with it the cycle will only repeat itself and get worse. And with many drugs you will experience painful withdrawal symptoms upon quitting use. Likely you will need to slowly wean yourself off to avoid the worst of the withdrawal. The above is an example of physical dependence.

Addiction, on the other hand, is quite different. You might think that all addicts are physically dependent, but this is not necessarily the case either. Addiction has more to do with behavior than biological needs (though they’re obviously closely related), and addicts are characterized by their inability to keep their life together well while using their drug of choice. An addict may have poor impulse control, problems with relationships due to the drug, may steal or beg to get their fix, and will often continue using the drug no matter what the consequences may be. Of course, there are varying degrees of addiction. Not all people who are addicted will steal your electronics. It all depends on the person, the drug, and the level of addiction.

Show Me The Proof

ABC News: Is Physical Dependence The Same As Addiction?
University of Wisconsin: Regulatory Issues & Addiction

  • Fora Nakit

    You didn’t mention all sorts of non-drug addictions like addiction to gambling, plastic surgery, shopping and many more that are present in our society, and sadly, some of them are even encouraged ( like shopping) by media and marketing.

  • Hadeskabir

    I still think they are the same, the reasons aren’t many to differentiate the two.

    • Lisa

      They are very similar which is why you really have to know the person very well to know which issue they have, or wait for a professional diagnosis

    • bowo

      Addiction is like when you keep doing a bad habit, physical dependence is like using narcotics.. No matter how strong your willpower, it’s almost impossible to stop, because it mess up with your nerve system.

      • farfelli

        No it is not impossible to quit Narcotics. Many Many people quit everyday either detox or cold turkey. Just wanted to put it out there in case an addict sees it and gets no hope from your pointless comment.

        • Debbie Thomas

          False hope isn’t helpful.

    • BeeJ

      As a person who requires pain meds, they are NOT the same. A physical dependence can become an addiction, but they’re not interchangeable phrases. I don’t take them because they give me a high, I take them because they allow me to have a somewhat normal life. Your comment is the same as someone sticking their fingers in their ears and saying “I’m not listening”.

      • Andrew Coll

        true if it helps you survive a bad situation it can be better than just forgetting about it “id rather die, than not sleep ” i think a few people said before they bit the bullet and had sleeping problems which few could understand but others self medicated and survived.

        • BeeJ

          I don’t think people understand just how much pain can affect a persons life because it’s not something that can be seen. Without proper treatment it can turn you into an unwilling recluse. And, if my choices are medication or being the crazy, old (I’m not old, but I will be one day) hermit, I’ll take the medication.

          • Andrew Coll

            true man preaching to the choir !

    • Mom424

      They’re often the same, but not always. I know people who are physically addicted to painkillers—in order to function. When the pain is severe you don’t get high; it’s like it gets all used up on pain relief and none left for getting stoned…that’s the big difference. Addicts take it to get wasted…at least at first.

    • Robo

      Not really. For instance dextromethorphan abuse can be (and generally chronic users are) considered addicts whereas it’s available OTC because you can’t become physically dependent on it (supposedly). There’s a difference between being dope sick/going through withdrawl and *needing* something to avoid becoming seriously ill/in a deathly situation/etc and then wanting to get high for whatever reason. And then there’s both.
      The truth is it’s a very grey area, still. I went to a drug rehab program a couple years back and what really surprised me was that the leaders of the group, and at places like NA, AA, said that whatever the user saw as an addiction, a problem, (so anything from weed to PCP and every other drug in between) was a problem.

    • KGraham

      Is a diabetic an addict to his insulin, or dependent? And before anyone gets crazy and says, “apples and oranges”, ask your favorite diabetic about the “withdrawal symptoms” he/she experience when they don’t take their drug.

      The differences with pain meds are very similar, with them you function reasonably well despite the fact that you are still in pain … the drug brings the pain down to a “tolerable level. If you’re an addict, you will need ever increasing amounts to get “high” and the pains you experience are those typical of withdrawal. I have what is considered one of the most extreme forms of pain humans can experience and yet have been on the same dose for more than 9 years. The reason for this is that I have used my reduced pain status to push myself to ever increasing amounts of activity and an ever increasing capacity to “tolerate” the pain … this is a very dangerous and “touchy” process, because with CRPS, the pain tends to spread and get worse, permanently … often with no, or seemingly inconsequential, injuries. What I experience neurologically everyday would be enough to put most people in a straight jacket, if it were to hit them “out of the blue”.

      Without the pain meds., my improvements in functionality would have been impossible … I’d be in a wheelchair by now, or more likely, dead … a suicide due to intolerable pain. I may be dependent on the drugs for a somewhat normal life, but I have become ever MORE functional because of them; and I HAVE a life … not so different from the diabetic.

      If I were an addict, I would more than likely have become ever LESS functional and would most likely BE dead by now (15 yrs) from an overdose, due to ever increasing need! Even if I lived, I likely wouldn’t have much of a “life”. Maybe this will help clarify the differences.

  • The Ou7law

    I am not an addict…………. i just love drugs

    • Carlos Fantastico

      There goes your brain.

      • The Ou7law

        What brain?

    • BeeJ

      I don’t do coke… I just like the way it smells.

      I’ve never done coke, but that’s a joke that’s always amused me.

  • Patrick Marsh

    I am addicted to video games, but not so much that I let it take over my life and go insane and shoot someone(like many people believe >_>)

  • Scott

    That’s why I stick to non-habit forming drugs like weed and shrooms. Oh, and I suppose the occasional acid trip.

  • Passin’ Through

    There is definitely a difference but I don’t think it’s described well here. One aspect is the behavioral component to addiction. Addicts who have quit and are clean and sober are still considered addicts by most. They aren’t continuing to use but they may still be addicted. How and why addiction affects the brain the way it does is still not fully understood. Describing addiction merely as behavioral isn’t fully accurate.

  • Jum1801

    The addiction/dependence dichotomy is particularly troublesome in chronic pain cases. There are tens of thousands of people who because of injury or illness are in constant, terrible, debilitating pain which is unresponsive to surgery, physical therapy, steroids or NSAIDS or technological intervention such as TENS units, etc.. Many can get significant relief only through opioids, sometimes the most powerful narcotics available. Tolerance is a significant problem in chronic pain treatment with opioids, and often long-term patients must be given relatively high doses of opioids to achieve moderate relief of their pain. But tolerance also means that these patients are not incapacitated by these large doses. Even long term use of opioids can leave the patient with a very high quality of life, and permit him or her to resume many regular activities which would otherwise have been impossible without their pain having been greatly reduced. Indeed, in many chronic pain patients, the pain is so intense and soul-destroying that suicide is often seen as the only option.

    So, suicide of a loving spouse, parent or, grandparent because they simply cannot face another day of crushing pain, versus 5, 10 or even 20 years or more of being as physically dependent on a powerful narcotic as any street junkie, but also able to perform most daily tasks? I’ll vote for opioid treatment almost every time. And damn the DEA for trying to put medical pain specialists in prison because they “write too many prescriptions” for narcotics.

    • Debbie Thomas

      Thank you, it’s good to read when some one understands the life I live as a person with chronic pain. I’m treated so badly by nurses and pharmacists. What is so frustrating to me is that I’m a working woman in my forties with no criminal record or moving violations and I’m treated by a specialist. Any decent exam will show a medical professional why I’m in so much pain but I am discriminated against and treated like a criminal nearly every day! I stick up for myself when it’s appropriate, but I can’t change the world. So it’s meaningful to me when I read anything sympathetic like you wrote. Keep writing, maybe you’ll open someone’s mind.

    • KGraham

      Like Debbie, I am also a chronic pain patient. I have a condition called
      Complex Regional Pain Syndrome (CRPS) -Type I. Mine was the result of
      cumulative brain damage secondary to concussions; the pain affected both
      of my feet and hands and the left side of my head/face. The pain which
      patients with CRPS experience is ranked on the various pain indices as
      more extreme than child birth without anesthesia and even amputation
      without anesthesia. Before I was put on methadone and morphine (for
      “break-through” pain), I was heading rapidly toward an extended stay in a
      wheelchair. I couldn’t walk across a parking lot without sitting down
      to reduce the pain in my feet, I wore gloves constantly, even in the
      hottest weather because even a slight breeze felt like a blow-torch, and
      I had to wear a ski mask any time the temperature dropped below 50F.
      Because of the medications I take, I can walk my dog two miles (twice
      daily), I work with my hands doing chores around the house and I have
      managed to reverse some of the bone loss I was experiencing due to
      decreased circulation (another symptom of the disease) and disuse. My
      life isn’t nearly what it was before the concussion that started this
      nightmare, but thanks to the medications (which I really hate having to
      take) at least I have a life … and yes, i was one of those who
      seriously considered suicide … I lost nearly everything that makes us
      feel worthwhile. It is frustrating, even after all of these years, to
      still hear the whispered word “addict” when I go in to pick up my
      medications and someone overhears the name of the med., or sees the
      prescription. And, I still have to explain the difference between
      addiction and dependence to friends and family who “worry” that my
      problem may be that the doctors “got me addicted”. I try to be gentle
      about it and tell them that addicts tend toward ever greater doses to
      achieve a “high”, while i have been at a fairly constant dose for
      several years and that I am in pain constantly, but at levels that allow
      me a version of a “normal” life that I can at least live with; and I’ve never
      had anything even remotely like a “high” from the drugs I take.
      Thank you to “Jum1801”, Debbie Thomas, and the author of this article, Gregory
      Myers … for clarifying the two very different “conditions” and for
      the kind and informative discourse on what is, for some, a very touchy
      subject.

    • The brain sees no difference between emotional and physical pain.

  • Errkism

    There is physical addiction and mental addiction. Physical addiction is when your body develops a need for the substance/behavior at hand; usually alcohol or prescription drugs fall under this category. Mental addiction is when you formed a habit or think you need the substance/behavior, examples of this are food or sex addictions.