Both in life and online, I often see people confusing the two terms. Especially how they relate to opiates or pain medications. It is very difficult for a lot of people to understand how someone who is addicted to an opioid differs from someone who is dependent. They do share one similarity, so I can understand this to an extent, but even with that, they are two very different issues with very different symptoms, causes and treatments.
As someone who has dealt with both, I’ve decided to use my experiences (shocking, I know!) to try to explain these differences as best I can as they relate specifically to medications.
Before getting to the difference, I want to look at why it is so difficult for some people to separate the two. I mean, even if you Google “medication dependency” you’re going to find article after article about drug abuse and addiction.
Addiction and dependency are the same on one particular level: They occur when the body becomes reliant on a substance to the point that taking that substance away initiates withdrawals. And…that’s about where the similarities end.
The main difference between the two is the fact that with one, you will destroy your life and the lives of those around you to get a substance and with the other you just need to have it on a regular basis to assist your body in functioning correctly, but you don’t compulsively seek it.
Let’s look a bit further into each one.
The general definition of addiction is:
Compulsive need for and use of a habit-forming substance (such as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful.
Someone who is addicted to a substance, be it heroin, alcohol, tobacco or whatever, have an uncontrollable need to use the substance. They will do anything from lying to stealing to get the substance because it’s not about regulating a bodily function, it’s about feeling “high”.
Although there are other theories, the general consensus among scientists and researchers is that addiction is a disease. A disease is defined as any condition that harms an organ or bodily function in a human, animal or plant, causing it to not work properly.
Certain substances or actions work on the “pleasure center” of the brain, which produces chemicals like dopamine, which create feelings of happiness and “reward”. Over time and repeated use or action, this pleasure center becomes physically changed and can no longer produce these chemicals in substantial quantities on its own. This means that the substance or action is required more and more to feel happy or rewarded.
This then leads to destructive behaviors in order to have the substance at all times, which is the main, core symptom of addiction.
Defining dependency in this particular meaning is somewhat difficult.
It is possible to become dependent on almost any medication. If you have a health problem and require a medication to assist or fix it, you will more than likely become dependent on that medication.
If your body cannot regulate your blood pressure, thyroid, insulin, etc. on its own, you’ll probably be prescribed a medication that will take over the regulation of said chemical/organ. Because your body cannot do it on its own, you will become dependent on that medication for your body to function properly. That doesn’t mean that you are addicted, though. I’ve never heard of someone abusing their thyroid medication or insulin injections (primarily because these do not create a euphoric effect), but if you take them off of those medications, they will still withdraw from them in some form or fashion. It could be physically or mentally, but there will be a period of adjustment that will not be pleasant.
For an example, let’s talk about my experience with Benadryl. I have a very hard time falling asleep and I always have. A few years ago, someone suggested that I use Benadryl to help. I started taking it on a nightly basis, 25-50mg depending on the day, and it worked well. It didn’t make me high, it just helped me to fall asleep.
About a year after taking it on a regular basis, I skipped it for about three days one weekend because my activities left me tired enough to not need it. Well, that Monday I go into work thinking nothing of it. At around 10am I start going through withdrawals. I’m having cold-sweats and my stomach is churning and I’m just so fatigued.
I was at a total loss. I couldn’t understand what was going on. I wasn’t sick, I had my regular pain medications. Yet, here I was sweating and freezing and going to the bathroom every ten minutes. The only thing I could think of was the Benadryl. I immediately went online and discovered through various forums that suddenly stopping it could cause withdrawal. I went downstairs to the pharmacy and bought a small pack and within 30 minutes my symptoms subsided.
Now, I wasn’t taking Benadryl compulsively. I never took it during the day, only at night before bed. I never thought about it until I was ready to go sleep. I didn’t obsess over whether I had enough. I had no symptoms whatsoever of addiction. Yet, when I stopped it, I went through withdrawals.
That’s because after regular use of it, I became dependent on it. My body needed it to function because it was replacing something that I wasn’t naturally producing.
In the end, the main difference between addiction and dependency is whether or not the person dealing with it compulsively and obsessively seeks out the substance or if they just take it on a regular basis. The biggest indicator of addiction is when the substance creates a euphoric feeling, because the person will chase that feeling.
If you are taking a medication on a regular basis because it is helping you in some way, whether it be pain medications or heart medications, but it doesn’t make you high, you don’t obsess over how many you have and you don’t take more than you’re supposed to, you are dependent.
If, however, you are taking more and more every day because you like how it makes you feel, and you obsess over whether you have enough and you would do literally anything to get more, you are addicted.
This distinction is important, and the lack of understanding surrounding it is hurting people like myself on a regular basis. I am dependent on my pain medications to live a somewhat normal life and to get out of bed without crying every day. Because I have legitimate pain, my medications reach that first, meaning I don’t get high from them. I won’t deny I feel better when I take them, but that’s because the pain subsides. If I stop them cold turkey, I will go through withdrawals. That said, I never run out early and I do not obsess over them. They are a tool for me, nothing else.
A diabetic has their insulin. A cardiac patient has their heart medications. And I, a chronic pain patient have my pain medications. It’s as simple as that.