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:

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 & Opiates: Perceptions vs Reality

3 thoughts on “Addiction, Dependence, and Tolerance

  1. Pingback: Why I Need Hydrocodone – National Pain Report | EDS Info (Ehlers-Danlos Syndrome)

  2. Doc Anonymous

    While there is a real SCIENTIFIC distinction between addiction and dependence, the harsh reality is simple: For the DEA and the Department of Justice THERE IS ABSOLUTELY NO, REPEAT “NO”, distinction between addiction and dependence. As far as the DEA and DOJ (FBI) are concerned, if you are physically dependent on opioids, no matter how much you need and use them legitimately, you are an addict and they consider it illegal to treat you with further “narcotic” medication. Until that legal definition changes, people who have chronic pain and need opioids will continue to be treated as if they are criminals. Remember, any doctor who prescribes opioids to an addict is under the law guilty of a crime. Therein lies the root of the ill-treatment of chronic pain sufferers.


  3. Pingback: Pain Care Advocacy in an Era of Opioid Abuse | EDS Info (Ehlers-Danlos Syndrome)

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