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Dependency Versus Addiction

Why are some people prone to alcohol or drug addiction, but not other people? Substance abuse is a medical illness that can affect anyone: The rich or poor, the old or young, and those who work and those who don’t. It reaches out across all racial and ethnic borders. There’s no telling who will end up in a drug rehab program.

Scientists are still looking for the causes of addiction. While they still cannot pinpoint a way to arrest addictive behaviors, they definitely know that genetics and environmental influences play a major role. Some people are psychologically predisposed to addiction. For some of them, drug or alcohol use can trigger mental health problems. For others, the mental health problems lead the patient to begin abusing substances as a way to self-medicate for the symptoms he has from his emotional problems.  A person’s ability to tolerate stress also comes into play.

Too many people walk into a rehab center in handcuffs, seeking help only because they’ve been backed into a legal corner. Typically they insist that they don’t need treatment because they know other people who have much worse addiction problems than they do. The thing is, if someone is told that his continued use of alcohol or drugs will result in incarceration or mandated participation in a drug rehab program, and he still cannot stop using, then he is demonstrating addictive behavior.

Even the person who begins using because of social or peer pressure rather than some environmental or familial trait may become addicted. Addiction happens very quickly in some people, and scientists are not certain why, but if you can’t stop using even when you know you’re facing dire consequences, then you have to face the fact that you have a substance use disorder.  

A Change in Diagnosis

Previously, the American Psychiatric Association (APA), which issues a manual of all behavioral and mental health disorders—including addiction—differentiated between addiction versus dependency.

  • Dependency occurs, the APA has said, when someone uses a medication regularly and may experience withdrawal symptoms if he stops. The person wants to take the substance again in order to stop the symptoms but he is not obsessed with cravings. This happens when repeated use of a substance causes the brain’s neurons to become accustomed to the substance. The brain will tell the body when it is not getting the substance.
  • Addiction has more to do with the reward response center of the brain. It occurs when someone is overwhelmingly compelled by his cravings to seek a substance. The reward pathway of the brain, the part that lights up like a Christmas tree when we do pleasurable things, begs for more of that wonderful substance. Addiction involves an inability to control the compulsion to use and continued use in spite of the knowledge that the substance is harmful.

In 2013 the APA eliminated the distinction between dependency and addiction. It has changed its primary diagnosis or disease category, as it is called, to substance abuse disorder. This category will identify use by substance relative to the patient’s compulsion to use.  Dependency, the psychiatrists say, can be managed and overcome; a person’s dependence on a substance can end. A person’s substance use disorder will never end and must be managed clinically.

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