Psychological vs. Physiological Dependence – The idea that behavior can be divided into components independent of each other, such as being purely mental or physical, does not mesh with what we now know about behavior and the processes that influence it. Moreover, all psychological processes have physical underpinnings, and all complex behaviors have significant psychological elements.
Classifying something as being either wholly physical or purely psychological indicates a misunderstanding of behavior as well as the brain and body connection. This erroneous belief is pertinent to the disease model of addiction in that it purports that “addiction is not a choice” because people with substance use disorders do make decisions regarding their substance abuse.
Also, the alternative viewpoint that “addiction is a choice” is also incorrect because people with substance use disorders are motivated by many physical processes that affect their behavior in a number of ways.
Therefore, psychological and physiological dependence should probably not be perceived as entirely separate entities, but rather two sides of the same coin. In fact, most modern evidence-based treatments are based on the understanding that there some crucial distinctions.
Physical dependence is characterized by the body relying on an external (exogenous) source of a chemical substance to prevent withdrawal. Physical dependence is predictable, efficiently managed with medication, and can sometimes be managed by a tapering off of the substance or through participation in a medical detox program.
Many substances, such as caffeine, nicotine, anti-depressants, can cause physical dependence. The condition is not, by any means, a result unique to illegal drugs. In fact, physical dependence can be a distraction from another problem—addiction. Physical dependence is sometimes simply called dependence, but this phrasing can cause confusion because addiction is sometimes referred to as dependence as well.
Psychological vs. Physiological Dependence and Addiction
Unlike physical dependence, addiction is not normal and considered to be a disease. Addiction is a central condition that is characterized by unmanageable cravings, an inability to control drug use, compulsive drug use, and use despite inflicting harm on oneself or others. The destructive behaviors of addiction are borne of uncontrollable cravings—they are among the primary motivators of addiction itself.
Intense cravings are universal to all addiction and are based on altered brain chemistry. Recovery is the process of reversing these brain changes. Recovery is achieved through psychotherapy, counseling, and substituting the addictive behaviors for healthy alternatives.
Addiction can occur without the presence of physical dependence—for example, withdrawals related to cocaine and methamphetamine are less outwardly apparent than, say, heroin, but addiction to either of these substances can destroy lives. Non-substance (process) addictions, such as gambling, sex, video games, or porn, also have no physical dependence associated with them. What is underlying all of these addictions is the abnormal cravings that motivate the compulsive behaviors.
Also, physical dependence can occur without addiction—this is the common experience for many chronic pain patients who continue to take their opioid medications as prescribed for an extended period but don’t experience unmanageable compulsions or a loss of control. A desire to avoid withdrawal is not necessarily addiction.
What Is Psychological Dependence?
The term psychological dependence is typically used to describe the emotional and mental processes that are related to the development of a substance use disorder or process addiction. Most individuals or sources that use the term psychological dependence are referring to the cognitive and emotional features of addictive behaviors or the withdrawal process from drugs or alcohol—this is in contrast to attempting to categorize specific substances or activities as being psychologically or physically addictive.
The symptoms associated with psychological aspects of addictive behaviors or with psychological dependence are typically listed as the following:
- Anxiety that occurs when one attempts to stop engaging in addictive behavior
- Depression that occurs when one is not able to use their drug of choice or attempts to stop their addictive behavior
- Feelings of irritability and restlessness that happen when a person is not using their drug of choice or trying to quit
- Mood swings that arise when one is not using the substance of choice or trying to stop
- An increase or loss of appetite associated with not using the substance of choice
- Sleep problems/disturbances associated with attempting to quit using the drug of choice
- Feelings of ambivalence about being able to stop using the substance of choice
- Denial that one has a substance abuse problem or glamorizing one’s substance use/abuse
- Obsessive thoughts and behaviors associated with obtaining or using the drug of choice
- Cognitive problems, such as those associated with concentration, memory, problem-solving, and other aspects of judgment
The features associated with physical dependence are mostly focused on the issues of tolerance and withdrawal symptoms, such as nausea, vomiting, diarrhea, seizures, etc. The symptoms most often associated with psychological dependence are often viewed as being far more variable in their severity than the symptoms linked to a physical dependence on drugs. However, since there is no non-subjective approach to evaluating a person’s level of stress/dysfunction either emotionally or physically, this assertion is more or less conjecture and cannot be validated using mere clinical observation.
Symptoms that are considered to be psychological in nature, such as cravings, are theorized to have a physiological basis and physiological processes associated with them. Likewise, symptoms considered to be physiological in nature, such as physical dependence, tolerance, and withdrawal, have significant empirical evidence that connects these symptoms with myriad psychological factors that affect their presentation.
Substances Associated with Psychological and Physiological Dependence
The conclusion, here, is that all substances of abuse may be associated with aspects of psychological and physiological dependence, although perhaps not observed in the same person at the same time. Moreover, the following substances may be associated with addiction or quote-unquote psychological dependence, but not necessarily a significant chemical/physiological addiction:
- Most stimulants, including cocaine, meth, and amphetamines
- Most hallucinogenic drugs, such as LSD and psilocybin mushrooms
- Cannabis products (Note: There is increasing evidence that there may be a physical process of withdrawal that can occur in chronic users of cannabis products)
- Many inhalant substances
- Many psychotropic medications, such as antidepressant medications
Conversely, substances typically associated with the development of a significant physical dependence include:
- Opiate/opioid drugs, such as heroin, morphine, and oxycodone
- Benzodiazepines, such as Xanax, Valium, and Ativan
- Barbiturates, such as phenobarbital
Many drugs of abuse are described as producing both physical and psychological withdrawal symptoms upon discontinuation and fostering both forms of dependence.
Treatment for Substance Use Disorders
Whether characterized by abuse/misuse, dependence, or addiction, the problematic use of substances can be treated using a comprehensive, integrated approach that includes evidence-based modalities such as psychotherapy, psychoeducation, individual and family counseling, and group support.
Our center employs caring, professional medical staff with expertise in addiction who deliver these services in both inpatient and outpatient program formats. We provide clients with the tools they need to attain sobriety and enjoy long-lasting wellness free from drugs and alcohol, as well as offer aftercare treatment planning and long-term peer support in the form of alumni activities.
Contact us now to find out how we can help you on your path to recovery!