In a substance abuse disorder, a lot is going on psychologically and physically. So much so, there’s a clear distinction between substance addiction and dependence.

Understandably, most think the two are one and the same. For this reason, we’ll explore both in detail and explain how they’re different.

Definition of Addiction

Addiction is the behavior of using a substance to the extent that it interrupts normal daily functions. ¹ For example, you might fail to meet key obligations with family, friends, and other responsibilities (such as school or work).

Addiction makes it difficult to stop the use of a substance even when consequences arise (i.e. legal, homelessness, etc.). You may even risk your own well-being or that of others for the sake of using a substance.

Addiction is very psychological. You DO NOT need a physical dependence to struggle with it. This is why many non-physical activities, such as gambling, can become addictions.

Definition of Dependence

Dependence refers to the physical (and sometimes mental) need for a substance. ² More specifically, it’s categorized as:

• Physical Dependence – When the body craves and causes you to physically seek out a substance. When the body doesn’t receive the substance, you’ll experience withdrawal symptoms, which can sometimes be life-threatening. ³

• Mental Dependence – When a substance is used in response to an event or feeling. These events or feelings are called triggers and will cause a mental response.

In many regards, if you’re dependent on a substance, you need the drug for your body to function.

The Distinction Between Addiction and Dependence

If you feel like we’re splitting hairs, we understand. Dependence and addiction are so closely related that it can be difficult to make a well-informed distinction. To simplify the matter: ⁴

• Addiction refers to the behavioral impact and effects that a substance may cause.

• Dependence refers to the biological responses within the body, leading to cravings.

It’s a difficult distinction to make if you struggle with one or the other. It’s best to break dependence versus addiction down to a biology versus behavior perspective. When the body craves a drug, it’s dependent. If you continue to take that substance with or without cravings, it’s addiction.

How They Feed Into One Another

Even though addiction and dependence are separate processes, they’re also a match made in heaven. In other words, people with addictive personalities may develop a dependence. Vice versa, you can become dependent on a substance and it leads to addictive behaviors.

However, both cannot happen at the same time. Addiction and dependence may occur around the same time, but one always comes first. In most cases, dependence begins the stages of addiction.

This has been clear through the opioid epidemic. Many Americans receive a painkiller for medical reasons. Their body develops a dependence on opioids and, from there, they turn to street drugs to carry out addictive behaviors. ⁵

How to Identify Addiction

Signs of drug addiction include: ⁶

• Building a tolerance
• Cravings
• Experiencing withdrawal
• Failure to meet responsibilities (i.e. work, school, etc.)
• Inability to cut down or stop taking a substance
• Knowing a substance’s danger and continuing use
• Lack of interest in previous enjoyments (i.e. hobbies, social engagements, etc.)
• Taking larger amounts of a substance than intended
• Trouble keeping up with friendships and relationships

Addiction is often a byproduct of another mental illness. In other words, someone who struggles with anxiety or depression may use a substance to relieve symptoms. ⁷ As such, if you seek addiction treatment, it’s key to address these underlying concerns as well.

Final Word

A substance abuse disorder is a serious illness. Beyond the biological and physical issues, you may find problems in other areas of life, such as work and relationships.

Understanding the difference between addiction and dependence is important. However, knowing when you need help is key to overcoming this disease.

References

¹ Zou Z, Wang H, d’Oleire Uquillas F, Wang X, Ding J, Chen H. Definition of Substance and Non-substance Addiction. Adv Exp Med Biol. 2017;1010:21-41. doi: 10.1007/978-981-10-5562-1_2. PMID: 29098666.

² Szalavitz M, Rigg KK, Wakeman SE. Drug dependence is not addiction-and it matters. Ann Med. 2021 Dec;53(1):1989-1992. doi: 10.1080/07853890.2021.1995623. PMID: 34751058; PMCID: PMC8583742.

³ Gupta M, Gokarakonda SB, Attia FN. Withdrawal Syndromes. [Updated 2023 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459239/

⁴ O’Brien C. Addiction and dependence in DSM-V. Addiction. 2011 May;106(5):866-7. doi: 10.1111/j.1360-0443.2010.03144.x. Epub 2010 Oct 6. PMID: 21477226; PMCID: PMC3812919.

⁵ Lyden J, Binswanger IA. The United States opioid epidemic. Semin Perinatol. 2019 Apr;43(3):123-131. doi: 10.1053/j.semperi.2019.01.001. Epub 2019 Jan 14. PMID: 30711195; PMCID: PMC6578581.

⁶ Fluyau D, Hashmi MF, Charlton TE. Drug Addiction. 2024 Jan 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31747190.

⁷ Smith LL, Yan F, Charles M, Mohiuddin K, Tyus D, Adekeye O, Holden KB. Exploring the Link Between Substance Use and Mental Health Status: What Can We Learn from the Self-medication Theory? J Health Care Poor Underserved. 2017;28(2S):113-131. doi: 10.1353/hpu.2017.0056. PMID: 28458268.