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  • Q&A with Australian Health Practitioners

    What is the difference between drug addiction and drug abuse/dependence?

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    Dr Nikolas Dietis

    HealthShare Member

    This question seems to be coming up very often to forums and discussion groups, mostly asked by drug (ab)users as they are seeeking to understand whether they are addicted or dependent on a specific substance.
    However, one of the reasons for this frequent presence of addiction/dependence questions, is the fact that there are many ‘anonymous analysts’ and ‘unsigned articles’ on the web which seem to promote misconceptions about addiction and dependence; contradictory information that is driven  by the naturally intrinsic complexity of these two aspects of neurofunction.

    Below, I copy-paste a previous answer that I have provided to a similar question posted earlier on HealthShare and which I believe clears many of the gray areas by putting aspects of addiction and dependence side by side for easier comparison:

    Addiction is defined as the compulsive use of a substance or activity, despite its potential negative or dangerous long-term effects, usually because of short-term contentment. Addiction can be seen not only in substances of abuse (drug addiction, smoking) but also in activities (i.e. gambling, watching TV, playing video games, etc). 

    The most common misunderstanding, even among scientists, is the differences between “addiction” and “dependence”; its true that they don't have a very clear and solid boundary. However, these two definitions are used for slightly different things:

    Dependence is identified as when the person stops a repetitive use of a substance, stops periodically, but the presence of unwanted “withdrawal effects” (often called rebound effects) compel a reuse. Withdrawal effects are very strong side-effects arisen from the abrupt discontinuation of a substance usage, i.e. when a person abruptly discontinuates anti-depressants then they may face withdrawal symptoms like panic, confusion, hallucinations, mania, and symptoms that they didn't necessarily had prior to anti-depressant use. 

    - Addiction is often reflected as the person not being able to stop due to short-term contentment. 
    - Dependence is often reflected as the person not wanting to stop due to negative withdrawal effects.

    - Addiction is a state of mind, a neurobiological disease, triggered by genetic/psychosocial/environmental factors, characterised by an impaired control of use and it has more psychological element involved rather than physical.
    - Dependence is a state of being (not a disease), triggered by the drug reward system and characterised by the manifestation of withdrawal symptoms, having more physical element involved rather than psychological. 

    What we do know is that in both addiction and dependence there are chemical changes happening in onse brain, that underline this behaviour. In both states, the role of specific neurotransmitters in our brain (chemicals that govern the brain activity, like dopamine which produces the “feeling good”) is implicated. For example, in addiction we know that the organism is over-active with dopamine in a way that the mind is “hijact” and these increased levels are “expected as usual”. The person cannot stop the use/activity because it will produce a drop in dopamine levels (loss of “feeling good”). 

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