Fully Understanding Dependence vs. Addiction

Addiction is not the same as dependence. Neither is just the inclination to use drugs or drink excessively regularly and both can disrupt and derail lives. Both are substance use disorders, but not all substance use disorders are addictions. Addiction is the most severe form of a substance use disorder, but its preceded by dependence. Recognizing the signs can lead to rehab sooner.

Addiction vs. Dependence

Addiction and dependence are two words often used almost interchangeably. They go hand in hand with one another, but they’re not quite the same thing.

The National Institute on Drug Abuse (NIDA), gives a one-word answer to the question: “Is there a difference between physical dependence and addiction?”

Yes. Yes, there is a difference.

NIDA defines addiction as “compulsive drug use despite harmful consequences.” It’s chronic, or ongoing, and relapse — a return to substance use — isn’t a given, but it’s a real possibility. (That can hinge on a number of factors, including biological or genetic components such as gender or co-occurring mental disorders or environmental triggers such as school or peers.)

There is a list of 11 characteristics (more on that later) from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) manual. The more boxes a user ticks, the more severe their addiction is.

There are psychological components, such as neglecting work or family responsibilities or being unable to stop using. But there are physical ones, too, such as building a tolerance to the substances or experiencing withdrawal when someone tries to quit using. If a person needs more to achieve the same effect, or it hurts to stop, the addiction has veered into physical dependence territory.

“Physical dependence in and of itself does not constitute addiction, but it often accompanies addiction,” NIDA explains.

Substance Dependence Definition

Dependence is “a state in which an organism functions normally only in the presence of a drug,” according to NIDA. If the use stops, withdrawal takes place, and that can range from mildly uncomfortable to life-threatening.

In the grand scheme of things, for example, caffeine isn’t so hard to quit — though many may jokingly disagree. In comparison to alcohol, however, going cold turkey off caffeine means drowsiness and headaches.

Those symptoms are minor inconveniences, especially when compared to the dangers of instant alcohol abstinence. That approach of quitting alcohol — depending on how severe the dependence — can produce a condition known as delirium tremens (which involve hallucinations, anxiety, cardiovascular problems, and confusion) and lead to seizures, a stroke, or a heart attack.

Abuse vs. Dependence

An earlier edition of the Diagnostic and Statistical Manual of Mental Disorders (the DSM-IV) defined two disorders: substance use disorder and substance dependence. Its definition of substance use disorder focused more on negative behavioral results, such as legal troubles or dangerous behaviors. Meanwhile, its description of substance dependence included physical symptoms such as tolerance and withdrawal. Those were eventually blended into the DSM-V’s definition of substance use disorder, which for diagnostic purposes is another word for addiction.

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Addiction vs. Dependence

The American Psychiatric Association’s more recent DSM editions break down the sub-classifications of substance use disorder. It can be rated as mild, moderate, or severe, depending on 11 criteria used to evaluate the level of addiction.

Signs of addiction include:

  • Using more drugs or using them for longer than planned
  • Wanting to slow or stop use, but not being able to
  • Devoting excessive time to secure, use, or recover from taking drugs
  • Experiencing powerful cravings
  • Being unable to manage time for work, social, and/or family responsibilities
  • Using even when it strains or damages relationships
  • Ignoring important obligations due to use
  • Continuing use even when it puts you or others in danger
  • Using even though you know it’s bad for you
  • Growing tolerance
  • Experiencing withdrawal symptoms

If a person has two or fewer symptoms, they do not have a substance use disorder. If they have two or more, they may be classified as addicts. The addiction levels include:

  • Two or three symptoms: mild
  • Four to five symptoms: moderate
  • Six or more symptoms: severe

Differences Between …

When comparing substance use disorder vs. addiction or addiction vs. dependence, it matters little to split hairs among the terms. If you’re using and want to stop and can’t, or it’s affecting personal relationships, your job performance, your health, or putting you at risk for prison or probation, it’s a smart idea to consider getting help.

Addiction, substance use disorder, and dependence were long seen as moral failings, as lapses in judgment. The perception is shifting, though. Scientists are finding more evidence than ever before that these compulsions rewire the brain rather than soften the mind’s resolve.

Facing Addiction in America, a report presented by the office of former Surgeon General Vivek Murphy, MD, MBA, stresses treating addiction as a disease. “We must help everyone see that addiction is not a character flaw — it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”



  • Drugabuse.gov – Drugs, Brains, and Behavior: The Science of Addiction: Drug Misuse and Addiction
  • Addiction.SurgeonGeneral.gov – Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health
  • Drugabuse.gov – The Neurobiology of Drug Addiction: Definition of Dependence
  • Drugabuse.gov – Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Is There a Difference Between Physical Dependence and Addiction?

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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