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June 02, 2021

Are Addiction and Dependence the Same Thing?

Are Addiction and Dependence the Same Thing?

A recent study found that a staggering two out of three Hoosiers know someone struggling with addiction. That “struggle” is different for everyone. Understanding “addiction” and "dependence" and how we talk about them can help someone move from struggle to recovery.

Addiction and dependence are labels that are often used interchangeably today, but they do mean different things, according to Allyson Dir, PhD, a licensed clinical psychologist with the Addiction Treatment & Recovery Center at IU Health Methodist Hospital.

Two important aspects of dependence deal with how they physically affect the body, said Dir. "First is tolerance, which is when you need significantly more of the same substance over time to get the same effect. Second, is withdrawal, which happens when you stop taking the substance and have physical symptoms."

Allyson Dir, MD
Allyson Dir, MD

Addiction is different due to what it impacts. Addiction occurs when a need to keep using a substance causes uncontrollable changes in behavior, like missing work, failing in school or ruining relationships.

"You can become physically dependent on a drug, but not have uncontrollable, addictive behavior," said Dir.

The power behind these words isn't so much how they're used but that they're used at all, said Dir. Often, they're used as a label—calling someone an addict or drug dependent—that categorizes someone at rock bottom who needs to seek treatment. Using those labels actually has the opposite effect, said Dir.

"Addiction is stigmatizing," said Dir. "It can be a significant factor that influences whether someone seeks treatment or not."

New terminology is more accurate

Clinicians believe one of the most effective ways to begin to turn the tide on the substance abuse crisis raging throughout the U.S. is to start with how we talk about it. It's why Dir and clinicians use the term "substance use disorder," now the medical term for addiction.

They're following the action taken in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the leading source for diagnosing addiction. The DSM dropped the words "addiction" and "dependence" because of the stigma they carry. They also lead to all or none thinking when it comes to diagnosing and treating substance use.

"Substance use disorder is a broader term and includes different levels of severity," explained Dir.

Though the term is broader, it allows clinicians to diagnose more precisely. A weekend binge drinker has different treatment needs than a heroin user who's been cut off by their family and been arrested for theft.

Diagnosis is based on the number of symptoms someone has had over 12 months. There are 11 symptoms related to the disorder:

  1. Using more of a substance or for longer than intended
  2. Wanting to cut down or stop using, but not being able to
  3. Spending a lot of time getting, using or recovering from using
  4. Craving
  5. Unable to manage commitments due to use
  6. Continuing to use, even when it causes problems in relationships
  7. Giving up important activities because of use
  8. Continuing to use, even when it puts you in danger
  9. Continuing to use even when physical or psychological problems may be made worse by use
  10. Increasing tolerance
  11. Withdrawal symptoms

Experiencing two to three symptoms is considered a mild disorder, four to five is moderate and six or more is severe.

Reducing stigma of addiction isn't just talk in Indiana

Clinicians aren't alone in changing the way they talk about addiction. Indiana has taken the effort statewide with its Next Level Recovery initiatives to reduce the stigmas of substance use disorder that keep people from getting treatment. Changing the language around addiction is a powerful start toward recovery.

If you or someone you love is battling substance use disorder, there's hope, and there's help:

  • Call 211 for help 24 hours a day, 7 days a week, or click here to connect with help.
  • Call the Indiana Addiction Hotline: 1.800.662.HELP (4357) or visit here to live chat with a representative.
  • Locate addiction treatment resources, tools and support at Next Level Recovery.
  • Learn more about Addiction Treatment services available at IU Health.

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