Addiction vs. Substance Dependence: What's the Difference?

Even though the terms "addiction" and "substance dependence" are related, there are slight differences between the two. 

Double board-certified in both addiction psychiatry and general psychiatry, Dr. Hadi Estakhri at Allied Psychiatry & Mental Health in Newport Beach, California, knows firsthand the importance of distinguishing the nuances between addiction and substance dependence. 

Continue reading and learn more about the differences between these two terms.

Facts about addiction and substance dependence

Addiction involves a compulsive drive to engage in a behavior or consume a substance despite negative consequences, while substance dependence centers on your body's physiological reliance on a substance and the potential withdrawal symptoms upon cessation. 

Addiction

Addiction is a complex psychological and behavioral phenomenon characterized by a compulsive desire to engage in a certain activity or consume a substance, despite negative consequences. It involves a loss of control over your actions and an intense focus on obtaining the subject of your addiction. 

Addiction can encompass a wide range of behaviors, including substance use disorder, gambling, sex, gaming, and even certain food-related behaviors.

Substance dependence

Substance dependence, on the other hand, specifically relates to the physical reliance on a substance. It’s often referred to as chemical dependence and involves your body's adaptation to the consistent presence of a substance. 

However, it’s important to note that substance dependence isn’t necessarily bad. According to a paper published in the Annals of Medicine, people who require daily medication to keep a chronic condition in remission 一 for example, people with diabetes need insulin to manage their condition 一 may be considered dependent on their medication. 

In other words, you depend on medication to keep chronic conditions under control. When your body becomes physically dependent, your risk of addiction increases. Dependence can become a problem if:

• You start using a substance despite it causing harm 
• The risks start to outweigh the benefits
• Severe withdrawal symptoms make cessation of a non-beneficial medication difficult

You can reduce your risk of sliding into the danger zone by always taking prescription medication exactly as directed, and that includes steroids, pain medication, and medication to manage mental health conditions. 

If you have substance dependence and experience withdrawal symptoms when trying to reduce or stop using the substance, you may find yourself stuck in a cycle of continued use to avoid these unpleasant symptoms. 

If that applies to you, don’t hesitate to speak with your prescribing physician. For example, you can avoid withdrawal symptoms from headache medication by tapering your medication as directed to avoid rebound headaches. 

Key differences between addiction and substance dependence

You can also compare these two terms in other ways: 

Psychological versus physiological

The primary distinction between addiction and substance dependence lies in their underlying mechanisms. Addiction is driven by psychological factors, such as craving, compulsion, and a sense of reward. Substance dependence, however, is rooted in physiological changes that occur in response to chronic substance use (e.g., your headache dissipates after taking migraine medication). 

Control and compulsion

Addiction is characterized by a loss of control and an inability to stop engaging in addictive behavior or substance use, even when faced with negative consequences. Substance dependence involves a compulsive need to use the substance to avoid withdrawal symptoms.

Types of withdrawal symptoms

Substance dependence is closely associated with the experience of physical withdrawal symptoms when the substance is reduced or discontinued. 

Addiction may involve cravings and emotional distress but not necessarily the same physical symptoms associated with withdrawal. For example, you may not feel any physical withdrawal symptoms if you stop gaming, but you may feel sad or irritable. 

Implications for treatment 

Recognizing the distinction between addiction and substance dependence has important implications for treatment and support. Effective interventions for addiction may involve psychotherapy, counseling, support groups, and behavioral therapies aimed at addressing the underlying psychological factors driving your addictive behavior. Treatment for comorbid conditions, such as depression or anxiety, is also very important.

Treatment for substance dependence often requires a medically supervised detoxification process, followed by ongoing therapy and support to manage cravings and prevent relapse.

If you require a detox, Dr. Estakhri may suggest an outpatient detox from alcohol and opioids, or in the case of a severe condition, your treatment can be optimized by medication-assisted treatment (MAT). Here at Allied Psychiatry and Mental Health, this may include Suboxone® and Vivitrol® treatment. 

Are you dealing with addiction or substance dependence?

Addiction and substance dependence are related but distinct concepts, and at first glance, you may not be able to tell whether you’re dealing with an addiction or substance dependence, but you don’t need to figure it out on your own.

If you’re struggling with any kind of substance-related issues, don’t hesitate to reach out to our team here at Allied Psychiatry & Mental Health. Book an appointment with Dr. Estakhri today by calling us at 949-945-0927 or scheduling online to get started.