By David Joel Miller
What is the difference between addiction and chemical dependency?
A lot of different terms are applied to the usage of substances and problems that arise when people begin to experience difficulties with their use.
Various professions use different terminology to describe the same or similar problems and we don’t all use the same severity points to identify problems.
One way of understanding these differences is to think of substance use as being on a continuum. Let’s start with something most people are familiar with, alcohol use and then add various drugs to the picture.
Alcohol use might range from no use to chronic daily drinking to the point of passing out. Fully 50% of the people in the U. S, who are old enough to drink, did not have a drink in the last 30 days. Clearly not everyone drinks and among those who do, not everyone has a problem.
At the other end of the scale, the 10% heaviest drinkers consume 60% of all the alcohol drunk. The top 20% heaviest drinkers consume 80% of the alcohol sold in America. People at the high end of the drinking scale develop more and more serious alcohol use problems than those who consume less.
Among those who do drink, some people have one or two drinks on a special occasion such as a wedding or New Years. People who drink at this level rarely have any problems. It is possible however to drink only once a year on New Year’s and end up drunk every time resulting in DUI’s or arrests.
The labels that will be attached to the person as their consumption of alcohol increases and problems begin to arise will vary with the profession and the reason the person is being given the label.
The person who has one drink and no ill effects would be considered by most of us an alcohol user but nothing more. The person who only drinks occasionally by when they drink has problems might be thought of as abusing alcohol.
The chemically dependent.
The medical profession often has special units which are called “Chemical Dependency units.” The people who reach these units have the most severe form of substance use disorder. They have reached the point of a physical dependence on their drug of choice. Those who are chemically dependent on Alcohol are at risk to die during withdrawal.
If someone has ever had a stroke, seizure or experienced the D.T,s if there are any hallucinations occurring when the level of alcohol in this person’s bloodstream begins to drop, this person is at high medical risk and should be detoxed in a hospital or other medically managed facility. People can and do die from alcohol withdrawals.
People who are chemical dependent on other drugs may have severe physical withdrawal symptoms. The heroin or opioid user, for example, will have diarrhea, nausea, vomiting, shakes, and goosebumps. The withdrawals from opiates may feel like the person will die but deaths from opiate withdrawals are rarer than from alcohol. Overdose deaths are another issue.
Short of physical withdrawal is a form of substance use disorder that is called Substance Dependence. Clearly, not all cravings for a drug of choice are the result of physical withdrawal.
Someone goes through a 30-day treatment program, they have not used for over a month but the day they are discharged they use again. The craving is not a result of physical chemical dependency but is a psychological need. Therapists would diagnose this as Substance Dependency. For the Therapist, this would include both physical and psychological dependency.
Alcoholism and addiction.
Twelve-step programs draw a different distinction. They would call this problem use of substances, addiction or alcoholism. This addiction level of problem use may be reached even before psychological dependency has occurred. Addiction may begin at the point of wanting, craving and thinking about the drug of choice even before the person has lost the ability to control usage. If you are struggling to control your usage then you have already reached a point of problem usage and probably would fit the description of an alcoholic or addict.
The lowest level of problem use would be referred to as substance abuse. This might be binge drinking, drinking more than planned or doing something dangerous after having consumed alcohol or another drug. The person who has a few too many drinks and then drives may be abusing alcohol but may not yet have developed alcoholism.
If this alcohol abuser can realize they have a problem and stop drinking to excess, they may be able to stop their progression to alcohol dependence, alcoholism or chemical dependency.
Substance use disorder makes its debut.
The newer trend, now reflected in the DSM-5, is to avoid making fine distinctions between substance abuse, dependency, addiction and chemical dependency and call all problem relationship with drugs including alcohol simply a substance use disorder.
Substance use disorder can come in mild, moderate or severe forms.
Wherever the substance use disorder starts, it needs treatment long before it becomes an addiction or chemical dependency.
Whatever happens (It has happened with the DSM-5 and the new OCD-10 as of 10/1/15) with the DSM-5, expect the various professions and the recovery community to cling to their own special perspectives and their preferred terminology.
Did that explanation help with understanding the differences between Substance use, abuse, dependency, addiction, alcoholism and chemical dependency?
Best wishes on your journey towards a happy life.
David Joel Miller, LMFT, LPCC
- Mental illness and substance abuse only strikes certain zip codes (counselorssoapbox.com)
- 6 Myths about alcoholism (counselorssoapbox.com)
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