Addiction vs. Physical Dependence

[LotusRising]

What is the difference between addiction and physical dependence?

 

There’s a lot of confusion about “addiction” and “dependence” among doctors and the general public. Addiction and physical dependence are not the same thing. Addiction has a behavioral component to it, while physical dependence is associated with physical effects, like tolerance or withdrawal symptoms.

 

In the FDA’s 2019 Draft Guidance Document addiction is defined as “a cluster of behavioural, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use, continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations, and possible tolerance or physical dependence.” On the other hand, physical dependence “is a state that develops as a result of physiological adaptation in response to repeated drug use, manifested by withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug.” Therefore, “physical dependence is not synonymous with addiction; a patient may be physically dependent on a drug without having an addiction to the drug” (FDA, 2019).

 

Why does it matter?

 

This distinction is important, since inaccurate labeling may result in inappropriate or harmful treatment, as well as stigma and potential feelings of shame, guilt and fear. When we change our language, we increase awareness, break down stereotypes and reduce stigma and negative biases associated with use of, and discontinuation from, psychiatric medications.

 

If you have been taking any psychiatric drug, including benzodiazepines and sleep drugs, for more than a few months, your body has likely adapted to it and become physically dependent upon its consistent presence in your body (this process also leads to tolerance or loss of drug effect, which may not have any symptoms). The cardinal sign of physical dependence is the emergence of withdrawal symptoms when you reduce or stop the drug (O’Brien, 2018).

 

FDA. (2019). Drug Abuse and Dependence Section of Labeling for Human Prescription Drug and Biological Products—Content and Format Guidance for Industry. https://www.fda.gov/media/128443/download

 

O’Brien, C. P. (2018). Chapter 24: Drug Use Disorders and Addiction. In Brunton, Hilal-Dandan, & Knollmann (Eds.), Goodman & Gilman’s The pharmacological basis of therapeutics. (13th ed.). https://accessmedicine.mhmedical.com/content.aspx?bookid=2189&sectionid=170270255

 

[Emonda]

A helpful post , @LotusRising

 

Thanks for making the distinction between the two terms clear for me.