Difference Between Drug Addiction and Dependence

Is There Really a Difference Between Drug Addiction and Drug Dependence? – Scientific American Blog NetworkBy Jonathan N. Stea -November 2019 (repost)

As a follow-up to a previous post, Addiction vs dependence | National Institute on Drug Abuse, here’s an article from the Scientific American pointing out the messy confusion between the two created by the DSM-5.

It is no secret that misinformation about addiction is rampant in popular media. One particular area of misinformation concerns what language gets used when describing topics related to addiction.

all sorts of individuals—medical professionals, journalists, parents, people who use substances, people in recovery—incessantly argue over terminology such as “addiction,” “dependence,” “abuse,” “misuse,” “habit-forming,” “recreational use” or “medicinal use.”  

the most important and commonly confused distinction is between “addiction” and “dependence.” And it is no wonder.

The scientific construct of addiction has a rich and evolving history. Even the people who dedicate their lives to researching addiction and who are responsible for the very medical texts that we use to diagnose addiction haven’t arrived at a clear consensus about which terms to use when.

If they can’t make this distinction, they are frighteningly incompetent because there are such great differences between the two.

A Contentious History

One of the main medical texts used by mental health professionals to diagnose addiction is called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is currently in its fifth edition.

In the 1980s a committee of experts met to revise what was, at the time, the DSM-III. And after much debate over whether to use the term “addiction” or “dependence,” the word “dependence” was chosen by a margin of a single vote, mainly because some of the committee members believed the word “addiction” was pejorative.

God forbid we use any “pejorative” words to describe people who get stuck in the horrible state of addiction. While they’re at it, perhaps they should avoid describing people as criminals or murderers or child molesters too.

To throw people who need opioids for their pain into the same category as people who use opioids to disengage from real life is outrageously sloppy science. It’s morally, ethically, and scientifically just plain wrong to conflate the two.

I’m sure many people who are addicted hate being in that accursed state, where their whole lives are dominated by the need to find their illicit drug of choice, no matter how or at what cost, no matter how great the risk it may be poisoned by added illicit fentanyl.

The Biggest Source of Confusion

If that history lesson sounds confusing, that’s because it is and there’s no way to simplify what happened.

the medical world was left with two very different definitions of dependence:

  • one that signified physical dependence and
  • one that signified a more complicated kind of biopsychosocial dependence, which, in reality, was used as a proxy to diagnose “addiction.”

The term “addiction” is much more complicated, and there still remains considerable debate in the medical community about exactly how to define it—for example, whether it’s best conceptualized within a disease model, a learning model or somewhere in between.

Unhelpfully, however, the DSM-5 does not explicitly and transparently mention this. In fact, the American Psychiatric Association, which developed the DSM, nonchalantly uses the terms “substance use disorder” and “addiction” interchangeably on its Web site.

Can Someone Be Dependent without Being Addicted?

Absolutely. Physiological dependence is common and can occur with many different kinds of substances

Can Someone Be Addicted without Being Dependent?

This is a much tougher debate, but the short is answer is yes.

Why Does it Matter?

My hope for this piece is to clarify rather than further confuse the distinction between “addiction” and “dependence,” something that is not only confusing among nonexperts but among medical professionals as well.

This is a sad state of affairs when even experienced and highly trained medical professionals are confused about the absolutely critical difference between people who need opioids for their intractable pain versus those who need them to feed an addiction.

This is the result of all the misused, misdefined, and mistaken mumbo-jumbo of what should be well-defined medical terms spread by anti-opioid zealots and their lackeys, the unquestioning media.

Whatever happened to verification before publication? When did the media stop vetting their sources and start publishing whatever nonscientific nonsense comes out of some self-proclaimed expert’s mouth?

Even the Centers for Disease Control and Prevention (CDC) is confused, as evidenced by the terminology page on its Web site, which states that for  “drug addiction,” the “preferred term is substance abuse disorder.” This is false. To reiterate, the DSM-5 dropped the categories of “substance dependence” and “substance abuse.”

So the CDC didn’t know what it was talking about when it wrote the opioid guidelines. 

The CDC is about “Communicable Disease Prevention”; it was established to manage outbreaks of contagious diseases, like smallpox or measles, which were killing hundreds of thousands of people at that time (not tens of thousands like drug overdoses).

Neither pain nor addiction is a “communicable disease” and opioids aren’t medication used to combat any “communicable diseases”, so this agency has zero expertise in pain and addiction.

Instead, we have the government agency of NIDA, the National Institute of Drug Addiction, which was established for this very purpose.

This is exactly why this agency had no business writing any guidelines for opioids, or pain, or addiction.  They clearly overstepped their boundaries, but this doesn’t seem to matter to anyone; I’ve never heard one peep of protest.

the distinction between these two concepts—addiction and dependence—is not trivial.

Medical professionals are ethically required to get the diagnosis right so that they can get the treatment right.

Exactly: doctors are ethically required to understand the difference between these two entirely different medical concepts.

3 thoughts on “Difference Between Drug Addiction and Dependence

  1. Kathy C

    This deliberate confusion has been profitable, especially for marketers. The deliberate confusion has led to a lot of deaths too. A lot of people who die from opioid overdoses, are not pain patients with prescriptions or craven drug addicts, they are first timers, or occasional drug users. The US has lied about drugs and created draconian laws that made the problem worse. Most young people know they are being lied to, they don’t trust or believe anything, especially when told by the media, a corporation, or cops in the classroom.
    The DSMV was written with industry pressure to provide more ample prescribing opportunities, and no accountability. Over the years the number of Americans, who live in despair and hopelessness has increased, which leads to more drug use. The DSMV was written to deny environmental pressures, and systemic problems. The DSMV was written to protect the medical and insurance industries too, they knew there was a large population of older people with pain disorders, and chronic pain, which they re-framed as a psychological problem. The problem of psychological distress from dealing with a corrupt healthcare system, or no healthcare access was deliberately left out of the DSMV, paving the way for blaming sick people for the problem.

    Things have gotten worse for people with serious mental illness too, the DSMV ensured that there would be no attempt at a safe standardized treatment. They made sure that the random pharmaceutical products they are marketing, will never be analyzed for effectiveness. The DSMV was designed to create grey areas, so that treatments could be based on beliefs, prejudices or whatever a drug company was peddling this week. When the people effected by this die, end up in jail of and ER, the drug prescriber is off the hook because none of it is tracked, by design.

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    1. Zyp Czyk Post author

      This whole situation is getting me so depressed and anxious that I really wish I weren’t alive – not kill myself, just not be alive. We are all victims of the drug-war and unrestrained capitalism, which is becoming more and more like social Darwinism. Those of us with chronic health issues have become the “untouchables” and we know we’re not wanted. I think that’s why no one is taking suicides seriously – the attitude seems to be “good riddance”.

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  2. Kathy C

    I feel that way at times too, it is as if they are committing slow genocide on us. Not one of these self described experts, has even considered the impact of their statements. The constant barrage of deceptive information is ruining lives, and isolating us all.
    It is snowing out, so I don’t feel guilty about not doing anything today. No doubt that I will pass 3 or 4 wrecks on my way into town.
    I found this piece of garbage on Harvard health News, https://www.health.harvard.edu/blog/mind-body-therapies-can-reduce-pain-and-opioid-use-2020021118772 Knitting can provide a temporary distraction too, but they are not studying that. We have to view it all as marketing or deliberate misinformation. There is a deliberate attack on the very nature of reality, as long as they can mislead a few of the persuadables, they can continue repeating nonsense across the internet.

    As long as they can continue the denial over suicides, caused by our broken and corrupt system, they can continue what they are doing. Youth suicides are going up, and they are not even taking that seriously, they use it for marketing. When children are committing suicide, it should have made someone take notice, but that did not happen. it is as if people are under some kind of thrall, where pain and distress do not exist. It is end stage capitalism, the only thing keeping it going is denial, lies and misinformation.

    I filled up the bird feeders so at least I have some entertainment. We have to keep slogging on, something interesting could happen. Scince Fiction did not prepare me for any of this.

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