Addiction or compulsive drug use despite harmful is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).
Physical dependence can happen with the chronic use of many drugs including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it may accompany addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
Although sometimes used interchangeably, the terms addiction; and dependence; are clinically thought of as two separate things. The National Institutes of Health says drug addiction is present when a person compulsively uses a drug despite negative and dangerous consequences and effects. A physical drug dependence means a person needs the substance to function and can have intense cravings, according to the organization.
Dependence does not always entail addiction. For example, some blood pressure medications can cause physical dependence but don’t lead to addiction, and drugs like cocaine can be addicting without physical dependence. Withdrawing from cocaine can produce depression and other psychological changes, but don’t leave users with physical problems such as chills and other flu-like symptoms.
The American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, in a collaborative effort, have adopted the following definitions: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Addiction is a chronic disorder with a strong potential for relapse. This means users who are trying to get clean fall back into old patterns of drug use and abuse. Because opiates are so potent, they have a particularly high relapse rate. Strong cravings and other withdrawal symptoms can trigger relapse, even after a period of abstinence.