Addiction, Dependence, and Tolerance

There is much confusion about these terms:

Dependence and tolerance are the results of our body’s natural process of adaptation to its environment.

Addiction is a bio-psycho-social behavioral disorder – a disease independent of the substance.

From the American Pain Society:

http://www.painmed.org/files/definitions-related-to-opioid-treatment-for-pain.pdf

I. Addiction

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

II. Physical Dependence

Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

III. Tolerance

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

Here is an explanation from the head of NIDA (National Institute for Drug Abuse), Dr. Nora Volkow:

Addiction Not a Predictable Result of Opioid Prescribing

Here are several more blog posts that discuss the differences:

Pain, Opioids and Addiction Myths and Facts

Dependence on Rx Opioids Confused with Addiction

Ask the Expert: Dependence versus Addiction

Opioids, Endorphins, and Getting High

Tolerance, dependence and addiction: Definitions and Misconceptions

Ask the Expert: Dependence versus Addiction

7 Myths about Prescription Painkiller Addiction

Excellent and balanced WebMD article about long-term opiate use

Opioid Dependence Confused with Addiction – long detailed article by pain-topics.org

Pain & Opiates: Perceptions vs Reality