Drug Addiction vs. Drug Dependence: What’s the Difference?

Drug Addiction or Drug Dependence? The Most Obvious Difference

If you’re wondering how you can make an educated guess about determining the difference between addiction and dependence, consider the following two scenarios by way of illustration:

1. Betty

For the last year, your roommate Betty has been taking the doctor-prescribed benzodiazepine Klonopin every night in order to sleep. Lately, she has grown anxious about the fact that she can’t go to sleep without her Klonopin, and she expresses a sense of helplessness about not being able to get off the drug on her own. She consults her doctor, who gradually helps her taper off the drug, replacing Klonopin with a less habit-forming sleep aid.

2. Orvis

Ever since a bad shoulder injury required surgery, your college-aged son, Orvis, a talented baseball player, has been taking the prescription pain medication Oxycontin, and at increasingly higher doses. He says he can’t play baseball without it. Meanwhile, his grades have dropped dramatically, he’s missing classes, and avoiding you and other friends and family members. Even Orvis’ coach called the other day to say Orvis had missed five consecutive practices. All the while, Orvis seems not to care that his drug use is leading to negative consequences.

In which of these scenarios is addiction more likely the problem? If you guessed #2, you’re right. The most obvious difference between addiction and dependence is compulsive drug use that continues despite the negative consequences.

Other Differences Between Dependence and Addiction

Here are some other differences to be mindful of when considering whether someone’s drug use is addiction or dependence:

• Drug dependence is not a substance use disorder or disease, whereas addiction is both of these things. Dependence is a pretty predictable and normal process by which the body physically adjusts to the presence of a drug and learns to rely on that drug or addictive substances over time. Dependence can thus be characterized by increasing physical tolerance for a drug and by physical withdrawal symptoms in the absence of that drug. With addiction, these same features of physical dependence may be present, but they also accompany other psychological and behavioral elements.

• Drug dependence is not characterized by strong, uncontrollable cravings, whereas addiction is. Such cravings, or compulsive behaviors and intense feelings to use a drug, are what feed substance abuse in cases of addiction. These cravings also result from actual changes to the brain. In both of these ways, cravings are unique to the disease of addiction.

• Drug dependence and addiction occur in different parts of the brain. If you could look at a scan of Orvis’ brain, chances are you’d see the reward pathways in his brain light up — the ventral tegmental area (VTA), the nucleus accumbens, and the prefrontal cortex all going crazy. Not so with Betty’s brain. Her physical dependence shows up in a different region of the brain, the thalamus and brain stem area.

• Drug dependence and drug addiction require different treatment interventions. Drug dependence essentially disappears with a long slow taper off one or more drugs or medicationscausing physical dependency. The disease of addiction requires a far more extensive plan of treatment involving multiple clinical and behavioral interventions, often in the context of medically supervised detox, such as medication-assisted treatment and inpatient treatment at a recovery center.

For Benzo Betty, it took a doctor’s supervision to help her safely and gradually taper off of Klonopin, but this purely medical, outpatient intervention was sufficient to help her move beyond her tolerance and dependence.

That’s not the case for Oxycontin Orvis. He will need a far more individualized and extensive plan of substance abuse care, a plan that doesn’t just address his physical dependency but also treats the emotional, psychological, behavioral and spiritual dimensions of his addiction.

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