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Drug and Alcohol Addiction: Understanding Psychological Dependence

Dr. Alan Weiner MD

Medically reviewed by

Dr. Alan Weiner, MD

March 7, 2019

Individuals who abuse drugs or alcohol for a long period of time may begin to experience psychological dependence. This occurs when the abused substances have altered the chemicals in the brain and result in emotional or mental unrest.

As drug or alcohol abuse accelerates to addiction, certain elements of a person’s thought processes and behaviors change. Dependence is when a person becomes reliant on drugs or alcohol to function. Most typically this term is used in reference to physical and physiological effects accompanied by withdrawal. But an individual may also become dependent on a substance from a mental or emotional standpoint. This is referred to as psychological dependence.

The Australian Government Department of Health says that “Dependence on a drug can be physical, psychological or both. Many daily drug users demonstrate signs of both.The physical and psychological aspects of drug dependence are closely related and can be difficult to separate.” They continue to tell us that both, together, are often collectively referred to as dependence.

How Does Drug And Alcohol Abuse Affect A Person?

When an individual abuses a drug (including alcohol), the substance impacts them not only physically, but also mentally and emotionally. It is these latter two elements which are connected to a psychological addiction. These effects happen two ways: a primary effect is that the drug’s chemical components actually create chemical changes within your brain. These alterations result in mental or emotional unrest (i.e. acute stress reaction, anxiety, depression, mood changes).

The secondary effect occurs when a person begins to witness adverse effects on their life which result from the drug abuse (i.e. failing marriage, poor health, career troubles). In response to these negative circumstances, an individual may experience the aforementioned mental and emotional changes, as well as others.

What Is Self-Medication?

Have you found yourself or witnessed a loved one using drugs or alcohol as a way to escape anxiety, depression, financial or marital problems, grief, or another distressing situation? Self-medication entails any situation where a person abuses a substance instead of dealing with a situation, its effects, or the emotions attached to it. A vicious cycle begins—as the abuse creates more dysfunction within both their life and emotional state the user will continue using drugs in an attempt to control it, and so forth. Self-medication can quite commonly lead to compulsive drug use and dependence, especially that which is psychological.

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What Is Dependency?

As we previously touched upon, dependency actually has two components: the physical and psychological. The Substance Abuse and Mental Health Services Administration (SAMHSA) gives us succinct definitions of each:

  • Physical dependence is a physiological adaptation to a substance, defined by a growing tolerance for its effects and/or withdrawal symptoms when use is reduced or ends.
  • Psychological dependence is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations.

A person may exhibit signs of withdrawal here too, including:

  • Anxiety
  • Agitation
  • Cravings
  • A decreased ability to feel pleasure
  • Depression
  • Irritation
  • Mood swings

More On Physical and Psychological Dependence

While it is common for an addicted individual to experience both physical and psychological dependence, some people don’t experience both at the same time. For example, many prescribed medications can create a physical dependence even when they are taken as directed by your physician. Examples include various stimulant medications for attention deficit hyperactivity disorder, benzodiazepines (for anxiety or sleeping disorders), or opioid painkillers. This type of dependence does not mean an individual is mentally addicted to the medication; rather, it means on a physiological level their body is reliant on the drug’s components.

Continuing, SAMHSA explains that psychological dependence “may occur with or without physical dependence and is conceptually characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving for the psychic effects of the drug.” Now, think about this—if you separate these aspects of dependence we see two very different things. Looking closely, the latter speaks strongly of addiction. Why is this?

What Is Addiction?

Dependence is a term you quite often hear associated with addiction, and for good reason—it is a characteristic of addiction marked by tolerance and withdrawal. Tolerance occurs when a person can no longer achieve the desired effect with their current dose, requiring them to take more to create this effect. Withdrawal is a set of symptoms which occur when an individual suddenly stops using a drug.

Despite this, and contrary to what some individuals mistakenly think, dependence does not equal addiction. While it is an important and defining characteristic, the American Society of Addiction Medicine stated that addiction is characterized by the following symptoms:

  • Cannot abstain from use even if they want to.
  • Struggles to control their behaviors.
  • Has urges or cravings.
  • Cannot clearly see behavioral or interpersonal issues.
  • Has emotional dysfunction.

In order to stop drug abuse and prevent addiction, it is important to fully understand how dependency plays a role within a substance use disorder.

Why Is It Important To Recognize Dependency?

Though any measure of dependency, either physical or psychological, can present problems, it is important to distinguish which aspect an individual is contending with. This aids providers in understanding how they can help a person re-balance their life, mind, body, and brain without the crutch of an abused drug.

To Prevent Prescription Drug Abuse

As we’ve discussed, certain prescription drugs can create physical dependence, while also having a strong potential for abuse. Because of this, medical professionals need to understand exactly how these drugs are affecting a person. In doing so, they can alter the dosage or take preventative measures should an individual exhibit worrisome signs.

It is important to understand why certain symptoms are occurring and if, in fact, its psychological dependence. If it is, it can create setbacks within a person’s treatment, as well as raising potential for abuse. The SAMHSA article continues, noting that “Psychological dependence not only can hinder the effective treatment of pain, but also can lead to increased pain and related health and social effects.”

Some people exhibit what appears to be psychological dependence when in reality, it’s symptoms of improper pain management. This is called a pseudo-addiction. If a patient’s medications are not adequately addressing their needs they may exhibit drug-seeking behaviors. If a doctor wrongly pins these behaviors on psychological dependence the patient could suffer.

On the other hand, if a person is truly psychologically dependent, a proper evaluation will reveal this. The physician can then incorporate patient-specific knowledge into the individual’s treatment plan. This awareness can help them to prevent what could, if left unchecked, become compulsive patterns of addiction.

To Curtail Abuse

Substance abuse care isn’t just for individuals who have full-fledged addiction. If a person is abusing drugs or alcohol, the proper attention can stop these problems before they gain momentum and create psychological dependency and addiction.

To Prevent Addiction

In the case of addiction, a person is most likely dependent in both of these ways; however, even then, this information can be helpful as it directs providers to the best and most individualized route of care.

How Is Psychological Dependence Treated?

While each element of addiction should be treated to obtain the maximum effect and highest chance for sobriety, it is counterproductive to treat just one since each influences the other. A good treatment program will thoroughly evaluate a person to determine the scope of their physical, mental, and emotional needs. This information helps the staff to create an individualized treatment program.

As psychological dependence is mental and emotional in nature, therapy and counseling are strongly suggested. Leading to and resulting from addiction are a variety of negative thoughts, emotions, and behaviors. These often become so heavily intertwined within the drug use that a person struggles to understand how to adopt more healthy behaviors. This is where behavioral therapy comes in. Behavioral therapy helps an individual to overcome maladaptive behavioral patterns, develop coping skills, and to enact healthy and positive behaviors.

The following are often used in treatment:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavioral therapy (DBT)
  • Motivational interviewing (MI)

Medication-assisted treatment may be used to address the underlying physical needs associated with addiction and withdrawal. This approach integrates these and other behavioral therapies with medications. Some of these medications may even be used to address a person’s psychological needs which led to or resulted from the drug or alcohol abuse.

Treating any co-occurring disorders (a disorder, often a mental illness, which occurs alongside of addiction) such as anxiety and depression is key towards a full recovery. Left untreated, these mental health issues will only aggravate a person in a way which could lead them towards relapse. Each program offers an assortment of other modalities that will help an individual balance body and mind. These may include adventure therapy, art therapy, equine therapy, holistic therapies, and more.

Find Sobriety: Balance Your Body And Mind

At we understand how complex addiction is and also how overwhelming it is to be caught in the middle of it. Because of this, we employ only the most compassionate and highly-trained individuals to help you or a family member get help today. We can help you to find more information on many drugs of abuse, treatment, and financing options. Contact us today.

American Society of Addiction Medicine - Definition of Addiction

Department of Health - Physical and psychological dependence

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