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Comparing Drug Dependence to Addiction: Which Is Worse?

Psychoactive drugs work by changing your brain chemistry. Drugs like cocaine and heroin change the way the brain sends and receives its chemical messengers throughout the central nervous system. When you take these drugs regularly, your brain can get used to these changes, and drug dependence can occur.

When drug dependence forms, the brain doesn’t work the same way it did before. Side effects, such as drug cravings and withdrawal symptoms, can set in when the drug isn’t working actively in the bloodstream.

Drug dependence is a physical consequence of chronic drug use. It can occur even when taking prescription drugs for medical reasons exactly as directed.

The American Society of Addiction Medicine (ASAM) publishes that addiction is a brain disease. It does involve changes to brain circuitry and wiring. It generally also includes drug dependence, but addiction is also a behavioral disease.

Someone struggling with addiction is unable to control their drug use, and drugs can impede their overall quality of life. Addiction can take over a person’s entire life and is more comprehensive and dangerous than drug dependence on its own.

Both drug dependence and addiction are treatable through specialized and comprehensive programs.

drug dependence

Drug Dependence Is Physical

The National Institute on Drug Abuse (NIDA) explains that drug dependence is a physical state in which the brain no longer works as it did before the drug’s interaction. It therefore doesn’t function normally without the drug.

When you take a mind-altering drug, neurotransmitters — which are the brain’s chemical messengers that tell the body how to feel, move, and act — are impacted. Dopamine and serotonin are some of the chemical messengers that are commonly impacted.

Drugs often interfere with the way these neurotransmitters are reabsorbed into receptors in the brain, which can cause a flood of them. This in turn creates the euphoric high that many drugs of abuse can create.

In the case of an opiate drug, for instance, the drug engages with opioid receptors in the brain, which then keep dopamine from being reabsorbed. Dopamine helps to regulate emotions, and surges of the neurotransmitter in the brain causes feelings of intense pleasure. When the drug wears off, levels of dopamine dip and a crash can occur. The desire to recreate the high and avoid the crash is part of what makes drugs like heroin and cocaine so addictive.

Drugs of abuse often interfere with the normal way neurotransmitters are transmitted, sent around the central nervous system, and recycled. With repeated use of a psychoactive drug, dependence can form. This means that the brain can no longer keep itself balanced chemically without the drug.

With drugs such as methamphetamine, cocaine, heroin, prescription painkillers, and benzodiazepines, tolerance can form after taking the drug for a period of time. The Drug Enforcement Administration (DEA) warns that for a drug like cocaine, tolerance can build quickly. A person will need to take higher doses more regularly to feel the same effects as before.

With repeated dosages, dependence forms more quickly.  Drug dependence is recognized by intense cravings for the drug in between doses as well as physical and psychological withdrawal symptoms when the drug wears off.

Withdrawal symptoms vary from drug to drug, but some are common across most drugs.

  • Nausea
  • Vomiting
  • Diarrhea
  • Depression
  • Irritability
  • Insomnia
  • Tremors
  • Muscle aches
  • Pain
  • Dizziness
  • Headache
  • Restlessness
  • Drowsiness and fatigue
  • Respiratory distress
  • Cardiovascular issues, including high blood pressure and irregular heart rate
  • Anxiety
  • Hallucinations
  • Delirium
  • Psychosis
  • Difficulty concentrating and memory issues
  • Sweating and chills
  • Seizures

In the case of alcohol, benzodiazepines, and opioids, withdrawal related to drug dependence can be dangerous and even possibly life-threatening, leading to coma or even death. Drugs like these should not be stopped cold turkey. Professional intervention can aid in resetting drug dependence safely.

Addiction as a Behavioral Disease

woman suffering from anxiety

According to the National Survey on Drug Use and Health (NSDUH), more than 20 million adults in the United States battled addiction in 2016. Addiction is a compulsive disease that involves brain circuitry as well as decision-making abilities.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as published by the NIDA, identifies the following as signs of drug addiction:

  • Taking a drug in higher doses at a time or for a longer duration than intended initially
  • Drug tolerance and the need to increase dosage for the desired effects
  • Being unable to stop taking the drug or cut back on use despite wanting to
  • Drug cravings when the drug wears off
  • A lot of time spent thinking about getting the drug, using it, and recovering from its use
  • Giving up social, recreational, or other activities for drug use
  • Drug use interfering with regular fulfillment of obligations
  • Using the drug even when it regularly negatively creates interpersonal and social issues
  • Continuing to use the drug when knowing that it causes emotional and/or physical problems
  • Using the drug in physically dangerous situations
  • Withdrawal symptoms when the drug isn’t active in the body

There are different levels of addiction. The more symptoms that are present, the more significant the disorder is.

Addiction is not only a physical disease but also a behavioral disorder that can interfere with social, familial, and interpersonal relationships. It can cause problems at school, work, and home. It can lead to legal and criminal issues as well as financial struggles and disrupted living situations.

Addiction can have many negative consequences that can permeate a person’s entire life as well as the lives of the people close to them. It is classified as chronic by NIDA, meaning that it has a high rate of relapse and doesn’t just go away. It needs to be managed through specialized treatment.

The Similarities and Differences Between Dependence and Addiction

You can suffer from both drug dependence and addiction at the same time, and typically, someone battling addiction also struggles with drug dependence. The reverse is not necessarily true, however.

You can develop drug dependence and not struggle with addiction. Drug dependence can form when taking a prescription drug under medical direction and for a medicinal purpose.

Addiction nearly always involves drug misuse, whereas drug dependence may not. When someone battles addiction, drugs are likely to be taken in doses that are higher than intended, and drug use is regularly continued beyond medicinal necessity.

Even if drug use begins with a legitimate and necessary prescription, drug addiction involves compulsive use of a drug without an ability to control it. Addiction is when drug use is continued despite all of the negative consequences that occur as a result.

Drug dependence is mostly physical in nature and can be spotted by feeling sick in between doses, drug cravings when not taking the drug, and mood, sleep, and appetite changes.

Addiction is more pervasive. Personality changes, cognitive issues, physical health problems, lack of attention to personal hygiene and appearance, performance-related issues at work and school, legal troubles, and financial difficulties can all be signs of addiction, Mayo Clinic publishes. Addiction can interfere with a person’s ability to perform everyday tasks and therefore negatively interfere with daily life.

people in a drug rehab room

Getting Help for Drug Dependence

Drug dependence can be managed through medical and often pharmacological means. Depending on the severity, it may be controlled through outpatient treatment.

Minor drug dependence on a prescription drug may be handled through changing prescriptions or weaning off the drug slowly. More significant drug dependence is treated through a detox program that allows the drug to process safely out of the brain and body.

The goal of detox is to let the brain find a way to balance itself without the drug. The chemical balance needs to be reset without the drug.

When a drug has been used for a long time and in high doses, a medical detox program is the ideal method for treating drug dependence. Medical detox often uses medications to stabilize the brain and body.

With some drugs, such as benzodiazepines, this can mean tapering the drug dosage down slowly, and weaning it safely out of the body on a controlled and stable schedule. This allows the brain to slowly restore its balance.

When drug addiction is also present, a comprehensive and specialized treatment program should follow detox directly to manage all aspects of the disease.

Steps for Managing Addiction

sign for rehabilitation

The first step in treating addiction is often managing drug dependence and its physical manifestations. Helping a person to become physically stable is a common initial goal of treatment.

After detox, addiction treatment should start immediately. It should include:

  • Behavioral therapies.
  • Individual and group counseling.
  • Management of any co-occurring mental health or medical disorders.
  • Pharmacological interventions and medication management.
  • Relapse prevention programs.
  • Life skills trainings and workshops.
  • Educational programs.
  • Peer and ongoing support, often through 12-step or alternative programs.
  • Recovery support and aftercare services.

Addiction treatment will manage all aspects of the disease. It will help a person to make healthy lifestyle changes, learn coping skills and techniques, and develop tools for managing cravings and minimizing relapse.

NIDA explains that drug abuse treatment should be specialized. Addiction is a complex disease that impacts each person in a unique way, and treatment should be just as individualized.


Definition of Addiction. American Society of Addiction Medicine.

Definition of Dependence. (January 2007). National Institute on Drug Abuse.

Cocaine. Drug Enforcement Administration.

Key Substance Use and Mental Health Indicators in the United States: Results from the National Survey on Drug Use and Health. (September 2017). Substance Abuse and Mental Health Services Administration.

The Science of Drug Use and Addiction: the Basics. (January 2018). National Institute on Drug Abuse.

How Effective Is Drug Addiction Treatment? (January 2018). National Institute on Drug Abuse.

Drug Addiction (Substance Use Disorder). (October 2017). Mayo Clinic.

Principles of Effective Treatment. (January 2018). National Institute on Drug Abuse.

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