We all think we know what substance abuse looks like. Maybe it’s your aunt who drinks to much at birthday parties and then stumbles through your house starting arguments with your friends and family. Or maybe, it’s your brother who started smoking marijuana while away at school and never quit when he “became an adult”.
Are these people addicts, or do they have a dependency on their desired substance? The answer could be either or even both. Let me try and explain.
Most people these days use both terms interchangeably because the external cues for addiction or dependence are practically identical. But the medical community has added specific definitions for diagnoses in the past.
Addiction, they say, is a disease defined by behavioral issues. In short, the addict continues to use their drug of choice despite harmful consequences. The person can’t stop even if their life around them is crumbling - even when they witness the physical harm to their bodies, they will continue to use.
Dependence on the other hand has been used to describe an individual’s physical connection to addictive behavior. A person’s body adapts to the drug and higher and higher doses are needed to get the same “high”. That alone isn’t always an addiction but if can often accompany addiction.
“The point is, neither is good,” says Rudy Kump, LIDC-CS, Clinical Manager of the outpatient unit for Cleveland Clinic’s Alcohol and Drug Recovery Center. “One's not better than the other, but there is hope for both.”
Most treatment facilities these days (the good ones at least) have evolved to acknowledge that substance abuse arises from an intricate and complex set of complex variables. These include, but are not limited to the individual’s genetic, mental, social, and emotional influences.
The World Health Organization has even gone as far as defining a syndrome for dependence and defines it as
“being a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value.”
The organization created a list of diagnostic signals that include:
After reading that list, it becomes difficult to distinguish the difference between addiction and dependence. Psychology today makes the claim that addiction can be defined as an activity that is once enjoyed by a person but now requires higher amounts to achieve a similar high, threatening the individual’s life responsibility.
Again, it’s easy to see how the two definitions are commonly exchanged.
The point, as Mr. Kump states above, however, is that neither action, no matter how it is defined, is good for the individual.
We often hear people say that certain substances are more addictive than others and even Mr. Kump believes this is partially true. We know, and we see on a daily basis, that opioids are highly addictive substances and that addiction to these drugs can happen quickly. Opioids have a double edge sword in that they give the user the desired dopamine effect, while also creating habitual use to avoid withdrawal symptoms. It’s not uncommon to see someone develop an addiction to opioids in just a couple of weeks.
One of the most popular and the most abused drugs in America is alcohol. This drug choice for many has a much slower path to physical dependence than opioids but can be just as devastating. Yet we’ve heard of people who do not have an addiction to their heroin use, but cannot give up smoking.
This leads to the question; is it the person or is it the drug?
If we take into consideration the evidence that complex factors like genetics, mental health, or social triggers can be influential factors in one’s addiction, then should we not ask if the relationship between the user and the substance may play a greater role than just one or the other?
Doctors often ask patients for their immediate family members’ medical history when determining the likelihood of cancer and heart disease in a new patient. Should we not also strongly consider the role of heredity in addiction? Does your family’s history with addiction contribute to your own relationship with an addictive substance?
It doesn’t matter what term you use to describe a disease that is devastating both to the individual and to their family. What is important, is to understand that treatment for this disease is available and if you are suffering, you can get help.
I like to believe that dying from addiction is unnecessary in today’s day and age because the disease is highly treatable. If we understand that the disease may not be curable for some, it is treatable. Like any chronic disease, treatment will help you maintain a positive lifestyle. You may die with your addiction, but you no longer have to die from your addiction.
The hardest part of the path to recovery is first acknowledging your disease and then reaching out for help. Those two actions alone are so difficult for some that it results in years, if not a lifetime of hiding the disease.
For many, the emotional layers under their addiction, or their dependence can take a lifetime to unravel and a single social can trigger can wipe out months of therapy. From the outside, it may seem virtually impossible for an addicted individual to break the cycle of the compulsive drug user.
The truth is – they probably can’t. Not without qualified and effective assistance.
If you feel that you or someone you love is struggling to make that first step know that it is a hard one, but you have to do it. No one has to die from this anymore.
Treatment is out there. Just ask.