Is substance dependence the same as addiction to substances?

[usregimechange]

If someone has been using IV drugs for 35 years and are still alive, are they addicted to the substance or dependent on it, or are they the same thing?

DSM-IV Criteria for the Substance Dependence
Page 192

A maladaptive pattern of substance (alcohol) use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12 month period:

(1) tolerance, as defined by either of the following:


(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) withdrawal, as manifested by either of the following:


(a) the characteristic withdrawal syndrome for the substance

Criterion A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

Criterion B. Two or more of the following, developing within several hours to a few days after Criterion A:

(1) autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)

(2) increased hand tremor

(3) insomnia

(4) nausea or vomiting

(5) transient visual, tactile, or auditory hallucinations or illusions

(6) psychomotor agitation

(7) anxiety

(8) grand mal seizures

(b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances), use the substance, or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

APA, DSM-IV-TR

[GeorgeGist]

1. Are you dependent or addicted ...

to inhaling air?

[usregimechange]

2. I am guessing the clinical word dependence has a different meaning

to many.

[rwheeler31]

3. Hmmmm medication every day for the rest of your life.

[nebenaube]

7. funny...

that's basically what it says on the bottle I get every month.

[porphyrian]

4. Let's use a dictionary!

de·pend·ence –noun
1. the state of relying on or needing someone or something for aid, support, or the like.
2. reliance; confidence; trust: Her complete reliability earned her our dependence.
3. an object of reliance or trust.
4. the state of being conditional or contingent on something, as through a natural or logical sequence: the dependence of an effect upon a cause.
5. the state of being psychologically or physiologically dependent on a drug after a prolonged period of use.
6. subordination or subjection: the dependence of Martinique upon France.

ad·dic·tion –noun
the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.

It seems a fairly big difference to me.

[stillcool]

5. same, same...

in my case. Chemical/Alcohol/Drug dependence requires use, and an 'addict' is a 'user'.

[valerief]

6. Is a fetus dependent on or addicted to a womb? nt

edited to add the word "on"

[usregimechange]

8. dependent, in the nonclinical meaning of the word, which I was

not talking about.

[Buzz Clik]

9. I believe I am negatively addicted to polls. Sort of a mental v-chip.

[skids]

10. not the same.

http://www.scinfo.org/PAINN2002/tsld051.htm
http://headaches.about.com/od/advocacyissues/a/addict_depend.htm
http://panicdisorder.about.com/cs/benzosbasics/a/addiction.htm
http://www.theangrypharmacist.com/archives/2007/07/addiction_vs_de.html

...ah I'm getting sick of just cutting and pasting links so: http://www.google.com/search?hl=en&lr=&safe=off&as_qdr=all&q=dependence+versus+addiction&btnG=Search

...but very importantly: http://ajp.psychiatryonline.org/cgi/content/full/163/11/2014-a

And even more important, get thine ass down to the clinic and talk to some real addicts, instead of pot-smoker X.

[Fiendish Thingy]

11. per the DSM IV: dependence=addiction, what you left out was substance "abuse"

I do therapy groups with teens with drug and alcohol problems, and I teach them the stages of addiction:

1) Experimentation

2) Recreational

3) Habituation

4) Abuse (a separate DSM IV diagnosis from dependence)

5) Dependence

[Quantess]

12. Dependence and addiction are not quite the same.

Gotta have it to feel normal is dependence
Gotta have it for whatever other reason, is addiction.

[timtom]

13. So, then

methadone clients are "dependent"?

[Quantess]

15. Yes. Correct me if I'm wrong.

I'm not a professional, but it does sound right to me.

[Warren DeMontague]

14. Does it make a difference what you call it?

Some addictions work for people. They do. I'm fairly well addicted to caffeine, I'd say- but that's the only drug I use, and it's an addiction I can manage and live with.

Other addictions definitely progress, get worse with time, etc. I don't think "being addicted" is inherently an evil thing- if I get a painful, terminal illness, am I gonna want a doctor who says "sorry, I'm not giving you morphine for your last 6 months- after all, you might get addicted." Fuck that, Jack- gimme the drugs. I'm not worried about passing some afterlife piss test.

I also think addiction/dependence progresses and works in different ways depending on the drug and the person. If the person in question has been using something, whatever it is, for 35 years and hasn't had their life fall apart, that tells me something right there.

I have to wonder what the motivation is for calling it one-- versus the other.

What's the story?