ICBioethics Blog 

Differentiating between Addiction and Dependency

Written by: Leah Jeunnette, Ph.D.(c)

Addiction is made up of many aspects.  The most important being that it is a multidimensional concept that involves varying factors, physiological, psychological and social.  It differentiates itself from dependency based upon the many dimensions of its nature.

Addiction is discussed, debated and affects millions of people each year.  Addiction is a complex chronic disease that is multidimensional. Addiction occurs with repeated drug use is rewarded and triggers biological changes that involves cravings or compulsions and continues despite harm that the drug use causes.  It involves a compulsion to obtain and use the drug no matter the harms and is taken regardless of the consequences.  Addiction goes beyond the idea of being physically dependent or developing a tolerance for a substance; it involves behaviors that are out of the societal or cultural norm.  Those who suffer from addiction act in ways to obtain the drug of choice; the addiction has become the driving force behind their actions.

Addiction differentiates itself from dependency because of the push by major groups.  The definitions of dependency and addiction provided by the World Health Organization and the American Psychiatric Associate have undergone an evolution to create this distinction.  While dependency is part of addiction, addiction is not a part of dependency.   Dependency is a physical reliance on a drug.  It can be coupled with anxiety and some psychological factors as well.  However, dependency differs from addiction because there is no compulsion factor.  Physical dependence on a substance does not mean a change in behavior outside of societal norms.  Dependency does the opposite; it restores some semblance of normalcy to the person.   One of the simplest examples is chronic pain.  A patient may request medication to treat a chronic lower back pain.  He or she may physically be dependent on the medication to relieve the chronic lower back pain; stopping the medication means the return of the pain and even the symptom of withdrawal.  This does not mean that the patient is addicted to the drug.  The dependency here is physical and may even be psychological, but does not include a compulsion or an impaired control.  Addiction also differs from dependency because of the possibility of harm.  Physical dependency does more benefit than harm.  The side effects that comes with the drugs,  if the dosage is correct, are minimally harmful.  It provides relief from the pain.  Addiction however causes harm, and behaviors continue despite the risk of continued harm.

The major ethical difference goes beyond benefit and harm to intentions.  With physical dependency alone, one has the intention of relieving pain or whatever the reason for taking the medication.  With addiction, there is a sense of relieving pain, but intention goes beyond that.  Addiction to medication provides pleasure and relief for more than physical ailments.  Addiction also creates the intention of getting relief at all costs.  Dependency seeks to only relieve the physical.  Trying to determine the intentions of a physician, patient or family at the end of life is critical to discussion too, but cannot be relied upon to provide a solution.  People who murder clearly have negative intentions.  Palliative care intends to relieve the suffering of the patients, while addiction may be the unintended result.  The action of medicating the patient is not morally wrong, and the bad effect does not cause the good effect.   Though the argument for double effect is successful in the case of palliative care, it is not necessary to justify the provision of the medication.  If palliative care is done correctly, then the medication is given proportional to the pain and suffering of the patient.  The patient gets the relief from pain and suffering.  This is seen heavily in the palliative care setting.

Mitch GennusoComment