What’s the Difference Between Addiction and Dependence?

Image of Martini Glass Full of Colorful Pills

It seems like you can’t browse the web or flip through a paper or magazine these days without coming across another dire warning about the epidemic scourge of addiction to prescription pain pills.

One question nobody seems to be asking is this: Is it really that bad?

Nobody can really argue with a straight face that addiction to prescription pain medication doesn’t exist, or that it isn’t an increasingly occurring problem. But in the great debate playing out in the national media, I suspect that fear-mongering and sensationalism are being fed by a radical misunderstanding.

Put simply, I think a lot of media outlets, journalists, and anti-pain medication advocates are confusing addiction with dependence.

(NB: Yes, I’ve written about this before, but the issue is of such importance and complexity that it bears further discussion.)

Comparing Addiction and Dependence

The first thing to understand is this:

If a person is addicted, she is suffering from an abnormal physical & psychological disorder. If a person is merely dependent on medication, she is experiencing a normal physical response to the medication.

Another key difference between addiction and dependence is that an addict takes medication to achieve a “high,” whereas someone dependent on medication simply takes the medication to function.

Complicating the matter, however, is a set of behaviors that has been termed pseudo-addiction by some experts. It mimics addiction in some ways – a frantic, clock-watching anticipation of the next dose, for instance – but it is caused by the person’s experience of pain, possibly breakthrough pain or possibly pain that is not being adequately controlled by the prescribed medication.

Hallmarks of Addiction to Prescription Pain Medication

The following behaviors can indicate a potential addiction:

  • Taking pills more often than prescribed dose;
  • Taking medicine via an unorthodox method (i.e., crushing, snorting, injecting, etc.);
  • Going to a number of different pharmacies within the same time period;
  • Repeatedly refilling prescriptions before the medicine should have run out according to the label information (i.e., number of pills and frequency of dosage);
  • Doctor shopping;
  • Difficulties in socializing with others, where socialization came more easily before the medication usage began;
  • Increasing isolation from family, friends, and life activities previously enjoyed; and
  • Overall, a sense that the person’s life is in a downward projection, increasingly spinning out of control.

Comparing Drug Dependence to Addiction

It might sound bad – after all, who wants to be dependent on anything, let alone prescription pain medication? But dependence as a biological state is not inherently morally blameworthy as addiction is often viewed as being.

Dependence is simply the body’s natural acclimation to the drug.  It is probably more accurate to say that the body is dependent on the medication, rather than the person.

Some of the characteristic hallmarks of drug dependence, as contrasted with the hallmarks of addiction set forth above, are:

  • Medication taken as prescribed, both in amount and frequency;
  • Medication taken via prescribed method – i.e., no alteration of the physical form of the medication;
  • Patient may need an eventual increase in dosage, but compared to the addict’s self-administered increase, this increase is done under supervision of doctor and according to prescribed instructions;
  • Patient may exhibit anxiety in anticipation of next dose, but once pain is relieved, that anxiety goes away;
  • If pain is being managed, patient is able to function in her life activities and continue to socialize as before; and
  • Overall, a sense that the patient’s life is progressing in a positive direction, given the patient’s diagnosis and prognosis.

The Real Risk of Addiction

I can’t fault the growing numbers of chronic pain patients who express fear and repulsion at the thought of taking prescription pain medication. I was one of them, not that long ago. I completely bought into the hype that everyone got addicted, or could get addicted, to a long-term use of any prescription pain medication.

But that’s simply not true. The studies that have been done on addiction in chronic pain patients do not bear out the fear-mongering we see in our headlines every day. One study looked at over 24,000 chronic pain patients who were administered opioid medication. The number of addicts that resulted? Seven.

Not seven percent. Seven addicts. Out of 24,000.

Yes, I believe the crisis of prescription pain abuse has been somewhat overstated. And I believe that this unfortunate slant has resulted in a climate of fear that in turn results in fewer and fewer chronic pain patients being treated assertively for their pain.

Look, I am all for exploring conservative, non-prescription pain relief methods first. I am also completely in favor of looking at alternative treatments for chronic pain symptoms.

But when you’re in so much pain that you cannot function in your life, I believe you have the right to access any treatment that can restore that function, and that includes prescription pain medication.

It’s true that prescription pain medication, especially in chronic pain conditions that are poorly understood and for which there are currently no cures, will not address the root cause of the illness. Again, I’m all for getting to the root of the problem.

And I agree that most chronic pain conditions are rooted in a complex machinery that combines lifestyle, anatomical, biological, chemical, environmental, and, yes, emotional factors, and thus one pill isn’t going to solve the problem.

My point is that none of us is required to suffer needlessly with pain while we explore that machinery and get to the root of the problem, especially not on the basis of some exaggerated claims about addiction risk.

Bottom line: Know the facts, educate yourself, and make the best choice for you.

 

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