Dr Craig Swainey, who specializes in Addiction Medicine and is also in long-term recovery himself, responds to a question that we are often asked here at the Coleman Institute: What is the difference between drug addiction and dependence?
The Difference Between Addiction & Dependence
We get this question a lot: Is dependence the same as addiction? Does someone have to have dependence in order to have an addiction? It can be confusing, so I'm going to try to make it pretty simple here.
When you hear people in the press or on the internet talk about addiction, a lot of folks use it in the context of dependence. Let me use some examples to illustrate.
Patients Concerned About Addiction
I was a practicing medical oncologist for a while, and when I would start folks on pain medicine for whatever cancer they had, they would say, "Wait, wait. I don't want to take this, because I don't want to become addicted."
I got that question all the time when people would start an opiate prescription, and I had to do a little bit of education there: "No, I think what you're saying is you don't want to become dependent, meaning that you don't want to take them so much that you have to have them, where you go through a withdrawal period." They would respond, "Yeah, that's exactly what I'm talking about."
So there's a misunderstanding between what is addiction and what's dependence.
UNDERSTANDING ACCELERATED OPIOID DETOX
Addiction, Dependency, and Substance Use Disorder
You don't have to have dependence to have an addiction. You don't have to have dependence to have a Substance Use Disorder (SUD). From here on, I’m going to say “Substance Use Disorder" instead of addiction. Most people who have substance use disorder, the majority, do have dependence as part of their substance use disorder. We do see people who don't have dependence who still have raging substance use disorders.
An example of that would be the person who is a binge drinker. Once they start drinking, they drink, black out, and they do it every weekend, or something like that. Another example would be a person who only uses crystal meth a couple of times a month, but when they do, they just blast it--go to the wall. So that would be people who don't have a dependence but who do have substance use disorders.
Addiction Vs. Dependence: A Real Life Analogy
People can be dependent without having a substance use disorder, so I'm going to make an analogy using caffeine as an example. A lot of us drink caffeine. A lot of us drink a lot of caffeine. A lot of us drink caffeine so much that if we don't drink caffeine, we go through a little bit of a withdrawal. We get a little bit of a headache and kind of cranky, if we don't get our caffeine in the morning. That is dependence, so there are a lot of us out there who are dependent on caffeine. If we don't get it, we go through that withdrawal period.
Let's think about Diet Coke. All right, so I drink three Diet Cokes a day, and if I don't drink them, I get a headache. That's dependence. "Well, when do you drink your Diet Coke?" "Well, I drink one for breakfast, one for lunch, and then I have one in the afternoon." "Okay--every day?" "Yep." "Why do you drink it?" "Well, I like the taste of it, and when I'm thirsty and need a drink, I drink it." "Okay, that's fine." And the person still has dependence. There's nothing wrong, so to speak, with why they're drinking Diet Coke or how often they're drinking Diet Coke.
Now, you have another person who comes in and says, "Yeah, I love Diet Coke. I drink a case of it a day. Every hour, I'll knock it down." "Okay, that's a lot of Diet Coke. Why are you drinking so much of it?" "Well, it just relaxes me, and if I don't have one in my hand, I just don't feel right. It helps me with my anxiety, helps with this, that, and the other." "Okay, well, drinking that much Diet Coke, is that bothering you, sir?" "Actually, my wife doesn't like it because I'm spending a lot of money, but I like this specific type of Diet Coke, and I have to get this from the store. I'm stocking up on it, and money's been an issue, but we get through it."
Clearly, those are two different examples. The first example is person who's drinking Diet Coke three times a day, has a dependence, but it's not causing any problems. They are drinking it for normal reasons, so to speak. They're thirsty; they like the taste of it. Then you have this other person who's knocking down a case of it every day--and that's an extreme example--don't get me wrong. I used it to illustrate that it's not about dependence. It's about: How are you taking it? Why are you taking it? Is it causing problems? All that mixes in to make up a substance use disorder.
Dependence Can Lead to Substance Use Disorder
Dependence is just dependence. Dependence doesn't mean anything other than if you don't take whatever it is, you go through a withdrawal period. That's all it means. It doesn't mean there's a problem. It means that there could be a problem, that's for sure, but it's not required to have a substance use disorder.
So I know that's confusing. I hope that example helped a little. If it didn't, write us back. Let us know. I'll do everything I can to answer your questions.
Craig Swainey, MD
Medical Director
Coleman Institute for Addiction Medicine
