If a friend or family member is struggling with substance abuse, you may be inclined to ask: why can’t they simply stop using? The trouble is, the reasons behind why an individual continues to abuse drugs, alcohol, or medications are not always clear. Some people continue to use due to being physically dependent on the drug. Others are psychologically dependent. Often however, for those with full-blown addictions, there is a mix of both.
Understanding the difference between psychological and physical dependence, as well as how they both relate to addiction, can be helpful if you’re concerned with a loved one’s drug or alcohol use. Recognizing that many factors are involved in addictive behavior may help breed compassion as you assist a friend or family member on their road to recovery. Remember that addiction is treatable, and the more you understand the disease, the more you may be able to support a loved one as they go through treatment.
What is Psychological Dependence?
Common symptoms of psychological dependence include:
- Cravings or a strong urge to use drugs or alcohol
- Anxiety when faced with the prospect of not being able to use alcohol or drug of choice
- Irritability or mood swings when questioned about substance abuse or while trying to quit
- Depression while attempting to stop drug or alcohol use
- Feelings of “needing” drugs or alcohol to cope with daily stressors, go to sleep, be social, etc.
- Recurring or constant thoughts about obtaining drugs or alcohol
Psychological Dependence Versus Physical Dependence Versus Addiction
When discussing substance abuse and addiction there is a lot of lingo that gets thrown around. Many terms are used interchangeably but they are not always used in the correct context. If you’re concerned that a friend or family member has a problem with drugs or alcohol, it’s important to know the difference between physical and psychological dependence and how both of these factors can play into addiction.
Physical dependence is synonymous with the body’s tolerance to alcohol or a specific drug. This means, over time, the body will require more of said drug in order to achieve the same desired effects. Being physically dependent on a drug also means a person will typically experience physical withdrawal symptoms if they reduce dosage significantly or stop taking the drug all together. These physical withdrawal symptoms vary depending on the drug. Some physical withdrawal symptoms are more mild, such as nausea and vomiting, while others, like seizures or irregular heartbeat, can be life-threatening.
As mentioned previously, psychological dependence is associated with a person’s thoughts and emotions about alcohol or a specific drug. Any of the symptoms listed above, including strong cravings or feelings of “needing” the drug, may all be signs of psychological dependence. It’s important to note that while not all drugs are thought to lead to physical dependence, developing a psychological dependence may be possible with any drug.
Addiction is defined by the National Institute on Drug Abuse as “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” Addiction actually causes changes in the brain’s reward circuit, making it challenging for an individual to permanently stop using. This is one of the reasons that addiction is classified as a chronic disease. Although it can be managed and treated, like other chronic health conditions, at this time there is no “cure” for addiction.
Some examples of addictive behaviors include:
- Not being able to stop drug or alcohol use
- Putting themselves or others at risk while using
- Failing to meet obligations at home, work, or with friends in order to drink or use drugs
- Engaging in illegal activities in order to obtain drugs or alcohol>
Dependence Without Addiction
While psychological and physical dependence can overlap with addiction (and often do), they can also occur on their own. An example is an individual taking prescription opioids exactly as directed by their physician. Over time, this person may develop a tolerance to the drug and if they were to stop using the drug abruptly, they would experience physical withdrawal symptoms. This is an example of physical dependence. However, if the person is not engaging in compulsive and reckless drug-seeking behaviors, such as taking more medication than directed or partaking in illegal activities to obtain more opioids, they would not be classified as having an addiction.
It’s possible to have a psychological dependence to a drug without having an addiction, as well. For instance, an individual may have a glass of wine every night when they come home from work. Over time, they may associate this glass of wine as something that helps them relax after a long day. They may even begin to feel that they “need” this glass of wine in order to relax. If they’re not able to have their nightly glass of wine, they may feel anxious or worried they won’t be able to wind down. This is an example of psychological dependence. However, like the opioid example, if this individual is not engaging in addictive behaviors, such as losing control around alcohol or risking the safety of themselves or others in order to drink, they would not be seen as having an addiction.
Drugs Associated with Physical and Psychological Dependence
As mentioned earlier, not all drugs have been linked to physical dependence, but that doesn’t mean psychological dependence can’t develop. Some drugs that are typically associated with psychological dependence include:
- Psilocybin “magic” mushrooms
Drugs that have a high component of physical dependence but may also be linked to psychological dependence include:
- Benzodiazepines (such as Valium, Ativan, or Xanax)
- Opiates (such as heroin and morphine)
Treating Psychological dDpendence
When a person enters treatment for drug or alcohol addiction, the first step is typically to detox from drugs and/or alcohol. During detox, the goal is to completely remove drugs and alcohol from the person’s system. When a person goes “cold turkey” like this, they usually experience physical withdrawal symptoms, which is a sign of physical dependence. Although uncomfortable, this is actually the easy part of treatment. Physical withdrawal symptoms tend to follow a timeline, and although they can vary in severity, health care professionals and addiction specialists generally know what to expect when an individual is undergoing detox.
Detox is specifically focused on treating physical withdrawal symptoms. Once detox is over, however, many individuals need to continue treatment to address their psychological dependence to drugs or alcohol. Unlike physical dependence, the timeline for treating psychological dependence tends to vary greatly amongst individuals. Treatment for psychological dependence is also typically most effective when conducted by mental health professionals and addiction specialists. Reputable drug and alcohol treatment centers should have services that address psychological dependence, such as:
- Therapy: Through individual and family therapy, someone struggling with addiction can address the underlying issues that may have triggered their initial substance abuse, as well as any anticipated roadblocks in the recovery process. This is also a space where psychological dependence may be addressed and managed by helping the individual find alternate ways to handle stress, challenging emotions, social situations, or any other “triggering” events without the use of drugs or alcohol. Having an individual recognize their psychological dependence to drugs or alcohol allows them to be aware of and begin to change negative thoughts, feelings, and behaviors associated with their addiction.
- Support Groups: 12-Step groups, anger management classes, process groups, and psychoeducation groups all provide outlets for individuals to address their psychological dependence to drugs or alcohol, gain accountability from others, and learn tools to deal with symptoms of psychological dependence such as cravings, recurring thoughts about using, and feelings of “needing” drugs or alcohol to cope with daily stressors. Due to the fact that psychological dependence differs for everyone, some individuals choose to take part in support groups for months or years after leaving treatment.
- Medication: Psychological dependence to a substance may manifest in anxiety, depression, or other mood related disorders. Many treatment centers will have a psychiatrist on staff who may prescribe medication to help treat and/or manage these symptoms.
When to Seek Treatment for Psychological Dependence
While some people can safely treat symptoms of physical dependence at home (although you should always consult with your doctor before detoxing), many individuals find that treating psychological dependence to drugs or alcohol is most effective while done under the care of mental health professionals and addiction specialists. As the symptoms of psychological dependence vary amongst individuals, choosing a recovery facility that focuses on personalized care may be crucial to maintaining long-term sobriety.
Nexus prides itself on providing customized treatment plans for all of our clients. The plans focus on treating all aspects of addiction—including psychological dependence. If you or a loved one is struggling with substance abuse or addiction, contact us today for a free consultation with a trusted recovery advisor. We’re here to help you take the next steps on the road to recovery.