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Understanding Drug Addiction and Substance Use Disorder

When we speak of drug addiction, we are talking about something that is a chronic health issue, not just a bad habit. 

Addiction is not a moral failing or a lack of willpower. It is a recognized medical condition.[1] The DSM-5 gives us the framework to see when someone’s use has crossed over into a clinical problem.[2] Understanding that shift is the only way to move from feeling ashamed to actually getting better. 

Prolonged drug use actually rewires the brain, affecting how a person thinks and how they act every day. Once those decision-making pathways in the brain get hijacked, a person keeps craving and using the substance, even if it is ruining their relationships, their job, or their health.

How Addiction Affects the Brain

When an addictive substance is used, it causes a surge of dopamine in the brain’s reward system. This artificial dopamine release is much greater than what the brain would receive after natural rewards, like food or social connection.

The brain also adapts very quickly. Over time, it adapts to dopamine floods by producing less of it naturally and desensitizing its dopamine receptors.[3] The end result is that someone using substances will gradually need more and more of it to feel the same effect and will start feeling less pleasure from everyday activities.

These changes to the brain’s reward system are why behavioral therapy is so important.[4] Once the brain has been rewired by substances, it makes cravings more intense and stopping extremely difficult, even if the user genuinely wants to.

Physical Dependence vs. Addiction

People often use physical dependence and addiction interchangeably, but it is important to understand that they are not the same thing.[5]

Physical dependence is when the brain and the body adapt to the presence of a substance. If the person stops using or reduces the use of that substance, it produces uncomfortable withdrawal symptoms. This can happen with any type of substance: illegal drugs, prescription drugs, or painkillers, even when used as directed by a doctor.

Addiction, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), goes further than physical dependence. Someone addicted to a substance will use it compulsively, lose control, and continue to use it despite any negative consequences. They may feel that they will not be able to cope with their daily routine without that substance. 

Someone can be physically dependent on a substance without being addicted to it, but most people with addiction also have a physical dependence on the substance they are using. Both dependence and addiction should be addressed to achieve effective treatment results.

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If you or someone you love may have a substance use disorder, Meridian Recovery is ready to help.

Our admissions counselors are available to answer questions, verify insurance, and determine the best level of care. Reach out today and let’s see what treatment can look like for you.

What is drug dependence?

Drug dependence is a state in which the body and brain have adapted to the presence of a substance, producing withdrawal symptoms when use is reduced or stopped. Dependence can be physical, meaning the body requires the substance to function normally, or psychological, meaning a person relies on the substance to manage emotions, stress, or daily life. Both forms of dependence are clinically significant and need to be addressed in treatment.

What comes first, addiction or dependence?

This can vary depending on both the substance and the individual using that substance. In certain individuals, particularly when using opiates or benzodiazepines, physical addiction may develop before they even fit the criteria for psychological dependence. In other instances, psychological addiction may occur at the same time or prior to developing significant physical addiction. Clinical evaluation will be needed in order to receive proper treatment.

Which drugs cause dependence?

There are several, including alcohol, opiates, benzodiazepines, methamphetamine, cocaine, marijuana, and prescription amphetamines. The substances with the highest potential for dependence include opiates, alcohol, and benzodiazepines. When someone attempts to stop using an opiate, alcohol, or benzodiazepine, they will experience withdrawal symptoms that may require medical intervention. The degree of addiction experienced is dependent not only upon the substance, but also on the amount and frequency of use, and the user’s body, genetics, biology, and mental health.

What are the signs of drug addiction?

Common signs of addiction include using more than planned, trying to stop without success, spending time obtaining, using, or recovering from a substance, cravings, using despite consequences, withdrawing from activities, and experiencing withdrawal symptoms when not using. If you see these behaviors in yourself or in someone you know, the next best and most important step is to receive a professional evaluation, as not everyone will show the same signs as others.

Do people with addiction ever fully recover?

Yes. Recovery is always possible. Most people who complete addiction treatment have a chance to lead a full, healthy, and productive lifestyle. Substance use disorder is a chronic, but treatable illness. When clients receive ongoing support and participate in a combination of evidence-based therapies and receive individualized therapy, long-term sobriety can be a realistic and reachable goal.

Sources

[1] [3] [4] National Institute on Drug Abuse. (2020, July 13). Drugs, brains, and behavior: The science of addiction. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

[2] American Psychiatric Association. (2013). Substance use disorder. https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

[5] Volkow, N. D., & Blanco, C. (2021). Drug dependence is not addiction—and it matters. American Journal of Psychiatry, 178(10), 891–893. https://pmc.ncbi.nlm.nih.gov/articles/PMC8583742/

[6] National Institute on Drug Abuse. (2019, June). Treatment approaches for drug addiction. https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction