The Difference Between Dependency & Addiction: AKA the Addiction Test.
What’s the big difference?
People often confuse dependency and addiction. The distinction is a constant source of confusion and frustration.
I want to take the time in this post to clarify the difference and teach you a test that you can use to distinguish between the two.
By the end of this post, you’ll have a better sense of what addictive behavior looks like and how to recognize it. Recognizing these behaviors is important, because recognition is the first step in getting help and recovery.
Before I begin, I need to remind you that nothing I talk about today should be considered medical advice. If you have a question regarding addiction, speak with a medical professional.
Back to the topic!
Dependence
Dependency describes the physical state wherein a person must take a substance on a regular basis, else they develop unpleasant withdrawal symptoms.
Many people are dependent on substances but not addicted. A common example is caffeine, which is the most used drug in the world. Many people drink coffee on a regular basis and experience headaches and irritability when they abruptly stop, but they are not addicted to caffeine because the use of the drug does not have adverse effects on their life.
Addiction: aka Substance Use Disorder
That is the major factor which separates dependence from addiction. Substance use disorder is the medical term for addiction. Substance use disorder is diagnosed when a person’s use of a substance impacts their life. Patients with substance use disorder have trouble controlling their use of substances, and they use more of the substance than they intended or use it for longer than they intended. They use substances despite knowing that it is harming their health. They use substances even if it causes strife in their family or professional life. Their substance use takes away from time they would otherwise spend on their career, hobbies, or family life.
The DSM-V describes 12 diagnostic criteria describing substance use disorder. To be diagnosed, a patient has to meet at least two and the severity of their addiction can be gauged according to the number of criteria they meet.
The caveat, however, is that you cannot diagnose a patient with substance use disorder if the only criteria they meet are tolerance and withdrawal. A person dependent on a particular substance will exhibit both tolerance to the effects of that substance and withdrawal when that substance is stopped. That means if a patient is taking a so-called habit-forming medication under medical supervision, such as opioid pain medications, they don’t have an opioid use disorder just because they meet the diagnostic criteria of tolerance and withdrawal.
How To Differentiate The Two: aka, the “Addiction Test”
Remember when I told you that I was going to teach you a test to distinguish dependence and addiction? We’re going to talk about that now.
If a person is dependent on a substance and we would like to know if they have a substance use disorder, we can run a thought experiment to test whether they meet any other criteria for substance use disorder.
The experiment is simple: Ask what would happen if the person had to stop using the substance. Certainly, they will experience withdrawal, but if they are able to abstain from further use, then they were simply dependent on the substance, not addicted. For the vast majority of coffee users, this would be the case; they would be cranky for a few days, but life would go on and there would be little disruption to their schedule.
If the person seeks out alternative sources of the substance after their supply is cut off, then this can be evidence of substance use disorder, as it is evidence of their inability to control or moderate their use, which is a DSM-V criteria.
If this exact scenario has played out multiple times, then it’s stronger evidence for the diagnosis.
I say this can be a criteria, as many chronic pain patients would exhibit similar behavior if the source of their pain medication was interrupted. The same goes for methadone and buprenorphine patients. You must take context into account.
Even stronger evidence for substance use disorder would be if the person is willing to participate in risky behaviors such as visiting drug houses, committing robbery, or sharing needles in order to obtain their drug of choice. Such activities are defined as risky use of substances in the DSM-V.
Finally, ask what motivates the desire to use the substance. If the person is simply using the substance for treatment of a medical condition, such as oxycodone for a broken ankle or Ritalin for ADHD, those can be healthy desires. If the person experiences intense mental cravings to use, absent a legitimate medical reason or in addition to a medical indication, that also counts as a DSM-V criteria.
Conclusions
I called this a though experiment, but it is likely that the person you have in mind has already experienced such scenarios and you have probably observed their behaviors. They might say that they can “quit anytime they want” but what happened when they actually attempted to do so or were forced to quit?
If they are dependent on a substance and unable to moderate their use of substances, engage in risky behavior to use substances, or experience intense desires to use the substance, they probably have an addiction to that substance.
Of course, substance use disorder should always be diagnosed by a trained professional. However, the test I described today can help you recognize the signs of addiction and help you identify when a friend or family member needs help.
Too often addiction is unrecognized or ignored, because it’s a difficult topic to speak about. If you need help talking about addiction with a loved one, check out my video “How to Stage an Intervention”’; the link should appear somewhere up there.
If you or someone you love is suffering from problematic drug or alcohol addiction use and is seeking treatment, contact the clinic by calling or clicking the “Get Started” button in order to schedule a discovery call and initial evaluation, both of which are free.
We are here to help.
North Tampa Executive Health Clinic is directed by Dr. Jack McGeachy. He provides confidential and comfortable addiction treatments and therapy for opioid and alcohol use disorder. Rather than a rehab or detox, meaning that each patient is cared for one-on-one by a medical doctor, in contrast to other treatment programs. Heed Help? Book your in office appointment in the Tampa office or via video conferencing today.
Helping patients with addictions in Tampa Florida, Temple Terrace, Brandon, Bloomingdale, Carrollwood, Thonotosassa, Town N Country, Lutz, Wesley Chapel, Land O Lakes, St. Pete, Clearwater, Oldsmar, Westchase, Palm Harbor, Tarpon Springs and surrounding areas.
