By Surya Solanki
The continual use of a drug in order to avoid its uncomfortable withdrawal symptoms creates physical dependence. But is this what keeps drug addicts using drugs? We explore the difference between physical and psychological dependence here…then, we invite your questions about dependence at the end.
What is Physical Dependence on Drugs?
Psychoactive substances are chemicals that act primarily on the central nervous system and can include alcohol, LSD, caffeine, and heroin. The National Cancer Institute (NCI) define physical dependence as a “condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses”.
Dependence is sometimes considered the same as ‘addiction’, as dependence arouses the ‘need’ for a substance that causes “enjoyable mental effects” and can have adverse impact on the social, personal and economical welfare of the user. But to what extent is dependence physical? And how much of dependence is actually psychological?
What is Psychological Dependence on Drugs?
The Health Department of Australia states that psychological dependence occurs when a drug becomes “central to the person’s thoughts, activities and emotions”.
In other words, a psychologically dependent user demonstrates a strong desire to use the drug for a psychological aspect (need for stimulation or pleasure). For example, if someone tries to stop doing cocaine but is unable to do so and he misses the ‘high’ he got from crack, then he is psychologically dependent on the drug.
Is Psychological Dependence Physical?
Before we go further, it will help to explore some of the principle and agreed upon definitions used in the diagnosis of substance use disorders.
- Once the body starts adapting to a drug, it requires more and more of the psychoactive chemical to achieve a certain high (tolerance).
- Further, when a user experiences painful physical withdrawal symptoms upon abrupt cessation or drastic dose reduction of a drug, s/he is considered drug-dependent (dependence).
Early addiction theories asserted physical withdrawal symptoms as the cause of addiction. According to the ‘tolerance-withdrawal addiction theory’, a drug user continues the use of a substance to avoid the withdrawal symptoms. However, this theory failed as some drugs have nominal physical withdrawal symptoms but are very addictive (cocaine and nicotine). Moreover, if some users get over the withdrawal symptoms, their drug consumption may not cease.
Many researchers, however, argue that psychological dependence is also ‘physical’ as the psychological need for a drug arises due its physical effects on our brain. As Adi Jaffe writes, “Psychological addiction and physical addiction are the same…since brain is technically part of our body”. So it can be said that physical dependence simply accompanies the addiction.
So let’s take a look at the effects of the three most addictive drugs on our brain (heroine, cocaine and nicotine) to provide a testimony to the above claim.
Heroin, Cocaine, Nicotine and Other Psychoactive Drugs
Q: What’s common among heroin, cocaine and nicotine?
A: All these psychoactive chemicals, directly or indirectly, affect the brain’s nervous system by “flooding the circuit with dopamine”.
Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. Psychoactive drugs create an over-stimulation of dopamine nearly five to ten times the normal level. This results in a euphoric feeling.
When the drug starts to wear off, the dopamine level declines. This is because the process of artificially flooding the brain with dopamine can lead to desensitization of the dopamine receptors. This can happen after consuming the drug just once. With the reduction in the dopamine level comes a reduction in pleasure and the result is depression. This is why the latter is common among drug users.
So, the user starts craving the drugs in its absence, he starts feeling a slight emptiness-that something is missing. If it is prolonged, the user becomes anxious, restless and agitated. However, when the drug is consumed again, his craving ends, resulting in a feeling of relaxation and security.
This is the base experience of psychological dependence on a drug: the user is craving it to feel relaxed. He never experiences the initial high again but continually seeks it.
Psychological dependence originates from the physical
As the body develops a tolerance to the drug, the user starts increasing his consumption. Soon, this becomes an addiction- the user needs the drug all the time. It takes over his mind and habits. All he is concerned about is getting the next dose of the psychoactive.
While withdrawal symptoms make it harder to get over drug addiction, it can be argued that they are nothing but psychologically created ailments in the absence of drugs (like anxiety, sleeplessness, mood swings, depression and so forth). However, what characterizes addiction is that a user wants to continue using a drug to get a psychological relief from the stress the psychoactive chemical created in the first place.
Dependence originates in craving
So, we can conclude that psychological dependence starts from a physical change in the body chemistry. A person uses a psychoactive drug and LIKES the effect. This sensitivity to euphoria ensures the drug user begins to crave the substance. In fact, craving is common in people with lots of stress and problems, as drugs help them achieve a sense of pleasure that is absent in their life.
But what begins as a coping mechanism can quickly devolve into a problem. When psychological dependence on a drug triggers continued use, physical dependence can follow, making it very difficult to break a brain-based reward system. Both need to be addressed (if present) and the underlying psychological compulsion, the mental dependence on a drug, requires work, if a person is to remain drug-free for an extended period of time.