Addiction vs. Tolerance vs. Dependence

Addiction, tolerance, and dependence are often mistakenly used interchangeably among common society however these are distinct behaviors with specific definitions. Addiction is a psychological condition affecting the brain that is characterized by compulsive drug and alcohol-seeking behavior. Chronic drug and alcohol use changes the brain chemistry and communication systems by rewiring the reward and pleasure pathways in the brain creating more intense cravings for these illicit substances rather than natural rewards. Addiction results in compulsive and harmful behaviors that can affect every aspect of an individual’s life including their occupation, relationships, and home life.

Tolerance is defined as the individual’s diminished response to a drug after its repeated use. The more often an individual uses alcohol or an illegal substance to get high, the less of a response their body will have to that stimulus and therefore more of that drug will be needed to reach the same effects. This physical effect of repeated drug use is not associated with addiction, per se, meaning that an individual can develop a tolerance to alcohol or heroin without necessarily being addicted.

Dependence is known as the body’s physical adaptation to the abused substance of choice and once the individual stops taking the abuse substance the body will undergo predictable and painful symptoms known as withdrawals. Withdrawal symptoms must be present for tolerance to occur. Each drug has it’s own withdrawal symptoms. For example nausea, vomiting, diarrhea, irritability, headaches, and extreme muscle aches are characteristics of opioid withdrawal whereas a high heart rate, elevated blood pressure, excessive sweating, tactile, auditory and visual hallucinations, and seizures.

Treatment for Substance Abuse

Depending on the substance of abuse and the severity of the behavior, treatment can range from inpatient hospitalization to drug and alcohol classes such as Alcoholics Anonymous. Usually, the first step in treating an individual with a drug or alcohol addiction is detoxification, which works to eliminate the addictive substance from the body. Medications can help alleviate side effects from certain drugs such as opioids, alcohol, and benzodiazepines. Residential treatment, partial hospitalization, intensive outpatient care, and outpatient counseling are the different levels of treatment for substance abuse.

The number one reason individuals are not seeking treatment for substance abuse is due to costs and access to treatment. Overdose, drug abuse, and alcohol abuse affect men more than women. Alcohol, heroin, marijuana, cocaine, benzodiazepines and other opioids are the top substances of abuse in the United States. Depending on the specific substance, medications can be used to help prevent cravings and ease withdrawal effects. Additionally, psychotherapy is needed in order to teach individuals coping skills and uncover the underlying reason for their addiction. Often times, individuals will have a co-occurring disorder associated with their alcohol or drug abuse. Co-occurring disorders are at least two different mental health disorder that exists at the same time and usually, one disorder such as anxiety can lead to another disorder such as alcohol abuse or vice versa. Anxiety, depression, schizophrenia, self-harm behavior, and bipolar disorder are all common mental health disorders that often co-occur with a substance abuse disorder.