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Aurochs

Addiction vs. Dependence

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There seems to be a lot of confusion on this point, especially in regards to benzodiazepine withdrawal, and I'd like to clear that up for the record.

Addiction is not the same thing as dependence. Addiction is psychological. Addiction is compulsive. Addiction is craving. When you're addicted to a drug, the drug starts to take over your mind. A former methamphetamine addict once said that when he wasn't actually on meth, his thoughts basically consisted of "meth-meth-meth-meth-meth". While that's an extreme example, many lower-grade addicts still find a lot of their thoughts taken up by their addiction - when can I get more, when's my next chance to get high, etc. Addicts have trouble quitting because they can't control their cravings - some part of them really, really wants that high.

Dependence is physical. Dependence is feeling like shit when you don't take the drug, because your brain has adapted to the drug's presence. Dependence goes away after a while, because your brain adapts to the drug's absence. Basically, dependence is the state that necessitates withdrawal periods should you need or want to stop taking some kinds of drugs. The headache you get when you don't drink your coffee? That's dependence. You depend on the coffee to avoid the headache.

Addiction and dependence often occur together, but they don't have to. Anything that causes a drug to be in your system for an extended period of time can cause dependence on that drug. An addiction, or abuse leading to an addiction, is one of those things. Medical treatment is another. Luckily, dependence is, in most cases, little more than a pain in the ass. Sometimes it's a giant pain in the ass, mostly in cases of abuse or poor treatment management. But no matter how horrible the withdrawal symptoms are, they do not constitute an addiction.

crtclms posted this link somewhere, which summarizes the medical community's definitions of addiction and dependence:

Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Physical dependence is a state of adaptation that is manifested by a drug-class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Edited by Aurochs
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If I understand correctly, the main difference is that they now refer to Substance Use Disorder as a continuum.  They have a list of 11 criteria and clinicians are advised to evaluate the severity of a patient's condition according to the number of criteria s/he reports (with the minimum being two).

 

1. Impaired control: (1) taking more or for longer than intended, (2) unsuccessful efforts to stop or cut down use, (3) spending a great deal of time obtaining, using, or recovering from use, (4) craving for substance.
2. Social impairment: (5) failure to fulfill major obligations due to use, (6) continued use despite problems caused or exacerbated by use, (7) important activities given up or reduced because of substance use.
3. Risky use: (8) recurrent use in hazardous situations, (9) continued use despite physical or psychological problems that are caused or exacerbated by substance use.
4. Pharmacologic dependence: (10) tolerance to effects of the substance, (11) withdrawal symptoms when not using or using less.

 

Source: http://www.bu.edu/aodhealth/issues/issue_sept13/rastegar_dsm5.html

 

Other useful link: .http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf

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Breen, the issue isn't what is addiction, it's what isn't.

 

Dependence is physical. Period. It is not the same as addiction. You are not addicted to a med just because you can't stop it cold turkey. If you take meds to get high, there is a much better chance for addiction than following your pdoc's instructions.

 

I've been on the same dose of xanax for 8 years, without a rise. But I wouldn't dream of risking seizures, rebound anxiety, and general ickiness by quitting it cold turkey. At 2mg, it would take me several months. But I don't crave it, take too much of it, or seek it out. I'm dependent, not addicted.

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I have been on Klonopin since 1997.  I had to have a procedure that required me to go off Klonopin cold turkey for 3 days prior to the procedure a few years ago.  By the 3rd day I was experiencing hallucinations, the D-T's (bugs crawling all over me), my heart was erratic, major panic attacks, could not think straight, terrified, unable to sleep. I called my physician to cancel the procedure by the 4th day and he said to immediately go back on the drug.  Within 3 hours my symptoms started to subside and by 24 hours I was able to function.

So, my question, is this dependence or addiction?

I remember watching a TV show on addiction where benzos were equivalent to Heroin in the brain, making benzos an organic issue?

One doctor told me it was too late to stop this drug as the withdrawals could kill me being on it this long.  My non-HMO prescribing doctor suggested we try to taper it below 1 milligram.  I got to 0.5 mg and was okay but anything below 0.5mg the same freaky symptoms appeared, as I described above. So, for now I am staying at 0.5 mg. 

Another issue is that a HMO psych doc refused to prescribe Klonopin to me, citing that HMO was given a warning from Medicare not to prescribe Klonopin to any patient over the age of 65.  Apparently, according to the doctor, a study was done on senior patients and Klonopin was a drug that made seniors a significant fall risk and Medicare felt they were shelling out too much money on hip surgery.  I called my local congressman about this and he tried going all the way up to Medicare but Medicare refused to provide the study conducted.  Long story short, I have to stick with my psych doctor who has been prescribing me Klonopin all these years and he's getting ready to retire and I'm scared I won't be able to find another psych doc to keep me on this drug.

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I'm pretty sure that 'cravings are psychological' is way-wrong. I mean, I get cravings for Vitamin C and I'm pretty sure that's not a psychological dependance on oranges. Pregnant people get cravings, etc.. Cravings! They can have lots of physical basis. Addictive drugs are not an exception. Also addiction-in-general, like, even to something completely non-physical, still causes neurochemical brain changes. Also, yeah, when drugs on top of that are /literally changing the physical makeup of your brain/ then Mind/Body Dualism kinda falls flat. 

Cravings for addictive drugs are not just a problem with your thinking.

Whisper

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When I think of dependence, I think of when I was on Paxil and would physically feel withdraws when I didn't take my dose or forgot to for a couple days. I never desired to gain any high feeling from Paxil, nor did it consume my thought process or prevent my from doing other things in my life. Not once did I have the urge to take double or triple the dose I was prescribed of Paxil. However, I knew that taking my dose regularly was essential if I wanted to avoid the negative effects that came with me missing a couple days of Paxil. 

When I think of addiction, I think back to the 2 summers ago when my Xanax use was absolutely out of control. I constantly thought about the drug, the pills inside my prescription bottle, and had a constant urge to consume more than the prescribed dose of the medication despite my self-destructive actions and subsequent consequences. I lost a lot of friends because of how I acted when I was high on Xanax, a result of taking 4 to 6 times my prescribed daily dose. Despite social impairments, in addition to academic and financial impairments, I didn't stop my use of the drug because not only was I physically dependent, but I was also psychologically addicted to Xanax. I also grew tolerance to the desired effects and had to increase the dosage I was consuming, to the point where a single day's dose would knock a normal person out and put them in bed for a few days. I would run out of the drug before my refill and suffer intense withdrawal symptoms, and eventually had my first seizure because of this. Only through intensive in-patient, and currently out-patient, treatment was I able to break free of this addiction and I am currently in recovery and remission. 

Right now, I am on Valium to prevent benzo withdrawal seizures, and while I am dependent on it, I definitely do not have urges or cravings to use this medication, nor is my time consumed with thinking about, taking, or obtaining the drug. I sure would have withdrawal symptoms if I stopped taking it, but I am not loosing myself, my life, or my personality to the drug as a result of abusing it or experiencing problems or consequences from taking this medication.

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Honest question: is "sex addiction" different from "sex dependence", then? 

What about social media? When I went off facebook I felt like I had the flu for about a week. Not the craving of going back, but just something missing from my life, something that hit an excitement button as many times a day as I needed to. 

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