Define dependency vs. addiction

[CadillacJack]

I'm serious about this question; are some people simply physically dependent on a drug, and therefore get through the physical withdrawals, and go about their happy way, as opposed to addiction, which results in a mental craving long after physical withdrawals are done? Or if a duck = a bird, then a bird must equal a duck? What defines these two terms?

[worried878]

lots of defintions i think...to me dependent is physically based and addiction is mentally based...and addict would have both components where as someone physically dependent does not have the mental behavior that goes along with it

[confused456]

I do have to agree with worried about this one.

[sadinmichigan]

I also agree with worried and confused...There are many people that have never been "addicts' to anything and then find themselves addicted physically for many reasons..surgery, anxiety,tachycardia (benzos) etc..but..when you have an addictive personality and take it to the extreme, then it becomes mental. i think those in the "mental" category would agree..I have been addicted to exercise, health "stuff', drugs, etc..I have that tendency and I know it now..I think the pain killer thing bites you in the a$$ before you know it..what makes an addict??? i have no frickin clue..but..that is the way it seems to go. I have come across many people who can take what is prescribed in the way in which it was prescribed and be done with it..and the others, like myself...just go way too far. There is a difference, but once your addicted, i don't think it's necessarily any easier to get off the **** than one who has abused and is addicted..hope that makes sense.  xo Lisa

[Clamity2]

Some people have easier and faster wds. Some even go to work in the first few days.I don't know why.
The bottom line is, if you want to get clean you have to put in time. Then your mind will be clearer  to understand the whys.
This is a great place to get through withdrawal no matter how long.

[worried878]

I do think "addicts" focus too much on the physical aspect of this when quitting time has come for them...I know I did...i was so scared and imagined myself shaking and vomiting..all kinds of stuff...and it was not fun going thru the physical wds...not something i want to take off work again to do over and over for sure...the addict part of us/of me anyway is what makes this so hard...not the physically dependent part...i did not know this until i was on the ride already...i often think that had i known about this aftermath of mental crud i would have never done this...maybe i woulda anyway...i really did not understand the whole picture...i did not know this thing persisted after the physical wd part...i am an intelligent medical professional who has seen alot over the years...i did not know......would i have done it anyway?  I wonder

[s10sittnondubs]

All said is to a "T" from what I've always expeirenced.  I can say that I always thought I would die if I went through w/d's.  I didn't think that it was humanly possible, and that there was no way a person could make it.  Just seeing people that have 14+ days is inspiration enough that a person did it and didn't die to me was proof enough, and it became possible.  I still think about the d@mn pills to this day.  I was in CVS today getting a card and some stuff for my mom and something in me made me look at the pharmacy.  That's the addict in me making me look over there for some stupid reason, and I thought for about two seconds not about any certain thing in there but something just came over me.  I haven't thought twice about it today but it feels good to get out to people that understand.  I don't think there is any difference in the two, it just takes the person to realize it and be willing to do something about it.

[worried878]

I dont know how people feel i guess that are just physically dependent and not addicted...i do know that there is this other personality inside of me that i dont like that comes out when the pills are in my life...i did things and put myself in situations i would have never put myself in otherwise...drug seeking behavior...when i used post neck procedure, it scared me because that other personality was breaking thru again after a couple of days...now i am not a crazy person nor do i have multiple personality disorder...but that addict componenet of my personality did not used to be inside of me before i used, and now it is...interesting post cj

[wishforchange]

There is most certainly a difference between the addict and the physically dependant, and that is their reasons for starting, or continuing to use medications.  Most drugs of abuse are medicinal drugs, used to treat physical or mental pain.  In the same way that alchohol is an antiseptic and an anaesthetic, yet also can lead to addiction, there is the risk with these drugs.  The problem is with stereotypes in our culture, in that any heavy drug user is nagged and browbeaten into accepting the addict label, which may not be right for them.  Addicts are the way they are primarily because of who they are, if it is not drugs then it will be something else they cannot stop, be it food, exercise, alchohol, sex...Then there are others with non-addictive personalities who behave like addicts around drugs, and that's where the definitiion blurs. The non-addicts crave drugs because they crave relief from suffering, and when the cause of their suffering is removed, they are able and keen to withdraw from the drug.  The addict craves the drug to fill the needs of their addictive personality.  Many drugs cause physical dependance, so to define the difference between the addict and the dependant involves looking into the personal make-up of the user.  It is mostly the non-addicts who lose out, as we are classed as something we are not, offered support which is inappropriate to our needs, and denied the help we actually do need, as society and the medical profession places all drug users in the one category.  There needs to be so much more education about drugs, and we need to lose our fear of them  The crazed junkie mugger on the streeet may even be a normal person in severe pain who has been abandoned my their doctors and has taken corrupted poison as a result.  Why can't we just legalise drugs, like alchohol, and deal with the fall our more responsibly.  I am talking as one who has been abandoned by family, friends, and even doctors as an addict.  I have thank God found some doctors who have taken the trouble to see past the stereotype, prescribe me with what I need, and also help me with my medical needs.  For how long I don't know.  Every week is just one step away from me begging for drugs on the street (which I have never done).  I am in severe pain and will do anything will to relieve it, even drink (although I dislike alchohol).  Those of us who are dependant have nowhere to go, you cannot treat an addiction that doesn't exist.  I'm sick of the media coverage of drug users, in news and fiction, as all being manipulative frauds, when there is a world of us out here who need pharmaceutical support, and are being denied it through stereotypes and ignorance.  So good to keep getting this out of my system.  Have just taken my pills, pain is subsiding.  Is that so wrong?

[CadillacJack]

All of these responses seem reasonable. In the end, the answer is ultimately academic. Time will tell a person into which category they may fit, I suppose. The safe route seems to consider oneself an addict, regardless.

Thanks for the answers

cj

[1911]

I think dependence is when you need something in order to function in life.

On the other hand, an addiction is when you say, "I am not going to
live without this in my life."

GEORGE
C/T Jan 2007

[Sajonna]

I am so glad you posed this question.  For the past month or so I have had to ask myself am I an addict or just dependant on this one drug?  And when I joined here a few weeks ago, some people made me feel like I was definitley an addict.  At first that bothered me, but then I thought everyone thinks different on this. Had I been a person that took this med to get high, then I might feel like everyone did too.

I agree with you on the stereotype thing. But now I have to ask "Just HOW much of this med does a person actually really NEED?"  And "When a person gets to the point that this med is not helping their pain anymore, and their doctor tells them, take 2 at a time"- Then the patient reaches the level where 8 a day is not relieving their pain OR from what I have come to understand here, this drug makes your brain remember the pain and makes you crave more of it.

I was a heavy cigarette smoker- I stopped 2 years ago.  I was addicted to smokes for sure.

I went through a taper of Norco's.  I have a whole thread going (New person tapering question) that details my progress and what I went through daily. Hoping it will help just one person who is like me.  We all are the same yet differnt on this subject.  Great analogy with the duck=bird.

I was terrified to do my taper based on what I read on this board. One person here thought it was a "too fast taper." That scared me.  Plus  I read where everyone had these nasty w/d effects.  I am not bragging..just stating when I say this:  I have not had a severe w/d on my taper.  I had to do the same amount of med for 2 days then step down one pill every other day. On the first day of the next step, I did feel a little punchy (agitated). But the 2nd day of the reduced dosage I felt great.  Then the next day I would step down and felt that agitation again. And so on.  

Here's the thing that gets to me:  I was expecting my pain to really flare up.  I remembered that I use to never have to take these pills in the summer because my pain was at a minimum in the warmer months.  My pain level has been tolerable - no more or less than on those Norco's.  Interesting.

When I got to yesterday - NO PILLS DAY - I was a little reserved..anticipating feeling like cr^p.  I felt a little funny..a little tired..not too motivated..but I did follow what I read what other people did here to relieve their symptoms and I picked the ones that were do-able for me.  I took a hot bath at night (to relieve some pain)- took Tylenol & Volteran,  Zinc, did a little excercise, ate only food I really enjoyed (to treat myself) and tried to keep myself busy and not think of taking a pill.  For the past 2 years, my life was on a pill schedule.  My doctors exact words were "Stay ahead of the pain...take these pills every 4-6 hours so you do not FEEL this pain."  So..if you are taking this med on a routine schedule, then you never know IF you are going to have the pain.  In my case, my body became DEPENDANT on this med. But in the same breath, I must have become addicted too...but not a "addiction to get high."

Something else my med did to me:  I could not get on an airplane on this med because I would get all dizzy feeling.  I hated that feeling.  I also hate to feel drunk, but I love the taste of wine.  So I limit myself to only one glass of wine.  Maybe that is why I never became addicted to this stuff.  I would never take the doses that some people here took just to get high.  So as a result of this, for the past 2 years I have not been on a vacation because of these stoopid meds.

[Sajonna]

It's like gambling:  When I hear someone is going to a casino, I never say "I hope you win big"   because I had a friend who liked to gamble here and there...She won real big on her 3rd casino visit.  Now she is totally broke because she wanted to keep getting that same winning feeling.   This is just like drug addiction and why people can go up to 45 pills a day.  They are always looking for a bigger high.  But if a person does not go looking or expecting that high, will he increase his amount of med to those extremes? I don't think so.  Same for the gambler:  I went to the horse races 2x.  I lost $80 each time. I never went back.  $80 is a new pair of cool shoes for me.  And those shoes will last me alot longer than that one day high from winning a horse race.

[SableZen]

"And when I joined here a few weeks ago, some people made me feel like I was definitely an addict.  At first that bothered me, but then I thought everyone thinks different on this. Had I been a person that took this med to get high, then I might feel like everyone did too."

This is EXACTLY why they stopped using the older terms, "physical addiction" and "psychological addiction."

It used to be that when talking about the subject of psychological addiction and physical addiction, that in either case it was often just shortened to 'addiction'. And patients that were simply physically dependent did not like the insinuation that by hearing the term 'addiction' used in reference to them that they were somehow 'addicts' even if they had never abused a drug. It is a poor choice of words... there is a world of difference between the state of being physically dependent and psychologically addicted.


Physical dependency only refers to the physical signs and symptoms of taking a drug which results in tolerance building up and where the body becomes to rely on the presence of the drug to continue normal physical operation. An example would be a person in chronic pain that takes Oxycodone - and over the course of a year their dose doubles to maintain the same level of pain control. The person taking the increased dose is not doing so to chase a high or escape depression, just responding to tolerance building up to maintain control on the pain. Taking more Oxycodone is all for physical pain control - not behavioral/emotional at the core. Addiction does not result - dependency and tolerance does.

With psychological addiction, tolerance also builds up over time - but there are more distinct changes to certain parts of the brain where our survival instincts are controlled which manifests in emotional and then behavioral changes by extension. Tolerance builds, having the result of increasing feelings of not being well (emotionally but this can also extend into actual physical feelings of not being well). More drug is sought out (tolerance builds further), normalcy is felt, etc. into the cycle of addiction. One doesn't even need to actively chase a high - just take it to alter feelings of depression/sadness/anxiety/etc... tolerance will still build over time and drug seeking behavior will result to maintain feelings of normalcy.

[walternowotny]

I think definitions are interesting as an academic discussion.In real world they really don't matter very much.
There are many people who are addicted to prescription meds who are willing to admit the obvious that they are physically dependent but are"offended" when someone mentions the"a"(addict) word.It is part of  denial so characteristic of any addiction.
They describe themselves as"chronic pain sufferers"(I am not questioning their pain) and feel they are being unfairly labeled.
I think that most of the people agree that cancer patient is not an"addict" no matter how much meds he/she needs but are not willing to accept that person with fibromyalgia on Morphine pump taking huge amounts of opiates is not
Walter

[Sportsguy86]

I think this issue is extremely complex and I don't believe there is one clear answer to the question. Experts claim that actual changes in chemistry are present in the brain even after physical dependence, so why some people can be fine post-dependence and others have a mental addiction is beyond me.  Could have to do with some pre-disposition to addiction, or simply their character and the choices they make.  I do believe, however, that some people actually enjoy opiates alot more than others.  I understand its generally considered a good feeling to all human kind, but it does alot more for some than others.  So these people who were once dependent for medical reasons, can stop easily because it doesn't do the same thing for them as it does for the addicted.  It may not be because they are morally against abusing drugs or don't want to be addicted or for whatever other reason.  Myself personally, as long as I am not physically dependent I am totally fine without it.  I may enjoy it and seek it more than the average person, but as long as I don't need it to feel normal or function, then it is something I can do without.  Unfortunately, others don't feel the same way, and that is why forums like this exist.

[SableZen]

In the case of narcotic addiction... it IS a result of chemical changes. The drug is simply a chemical doing what a chemical does - causing a change in the body. We put the chemical in our bodies and there is an immediate chemical result we feel right? Narcotics are just naturally occurring chemicals (it's not coincidental that most of them come from living organisms - plants) that resemble our own natural endorphins.

Endorphins are sometimes called 'endogenous opiates' (naturally made endorphins within the body). The similarities in-between plant produced opiates and our own bodies produced endorphins are so close, that our body uses them thinking they are the real deal. It's not coincidental that our bodies have those little receptors on brain cells that respond to these chemicals. But the foreign opiates work because they are so similiar to our own endorphins. They fit the key to the lock on cells and result to changes in that cell. Even cells which impact our feelings of euphoria/depression and perceptions of reality.

There is no arguing that natural endorphins alter how we feel. Everything from pain perception to states of euphoria and excitement. It's just a chemical. Any narcotic alters natural endorphin production, control and use by the body. Endorphins make us feel good - the lack of endorphins make us feel bad, increases pain perception, increase anxiety, etc... basically telling our active mind that something is wrong and something must be done to correct things and survive. They motivate us to anticipate reward or to fear failure at a very basic emotional level. As far as the body is concerned, survival behaviors make us feel good and release endorphins as a reward. Not meeting survival behaviors and we literally feel as if our lives are threatened or about to end. Otherwise we couldn't care less if we didn't have food (negative state) or find a mate (positive state). And the same cells and receptors involved with our survival instincts in the brain are the ones being screwed up by the opiates that don't really belong there.

Sorry to blather on - just a fascinating subject to me. lol

[wishforchange]

So the only drug users who can confidently declare themselves as not addicts are cancer sufferers?  Anybody else in severe pain is subject to the judgements of others and obviously in denial.  What if one of these people then gets cancer?  Does there addict status automatically leave them as now they have a cultural right to be in pain?  As far as I'm concerned if someone has a paper cut and declares they need morphine then just maybe they do, maybe their experience of pain is just different from the next person.  Nobody can judge another's pain, the question of addiction is one which lies within the personality of the user, the judgement of another's pain is nobody's right.  If we could all just get over this hysteria about drugs then we could just stop labelling each other and help would be so much easier to find.  Addicts are not going to stop just because something is declared illegal or difficult to obtain.  People in pain are not going to calmly nod their heads in agreement at other's judgements of their personal experience.  Drugs are never going to go away.  What is the point of labelling people, controlling substances, and creating more suffering by forcing sections of society to meet their needs through either deception or at the mercy of criminals.  The only people in denial are those who think that labelling themeselves or others is somehow productive.

[Crispy]

to sum it up dependant ppl who need them for legit pain and can take as prescribed. Addicted ppl are abusers and use for the effects instead of the relief. Some will say they take for relief but your only taking to avoid the w.ds. Most abusers stop feeling euphoric and the heavy buzz and keep taking just to feel "normal" or atleast what addicts think normal is

[walternowotny]

Purpose of correctly labeling people is to traet them in a right way and sometimes try to protect rest  of the population from their actions.
Person with paper cut has no legal"right" obtaing narcotics.Those are"controlled substances"...because they are...controlled.
Walter

[toomanytimes]

yes it is a great topic, what you said, worried878, sounds just like me..

[worried878]

Personally I would not really care what people labeled me..I am a chronic pain sufferer with fibro, scoliosis, fusions, arthritis and DDD....But I did end up abusing drugs and my tolerence was climbing..I did not intend to abuse them but like sable mentioned...they chemically altered my brain to where i felt mentally bad without them...I could tolerate my back hurting when i did without but not the mental pain i would feel....but then again...the endorphin thing is in a way a physical aspect of use but affects ur mental well being...I would feel anxious, depressed, overwhelmed and i would seek pills to be sure this did not happen so i could work etc...
I as well do not notice any increased pain since quitting...they were no longer working for me in a dose that was acceptable ...i was not an outrageous user and was stablizing at 80 mg a day...could make it on 60 when i quit...but i felt horrible mentally if i ran out...i was scared that in 5 years i would need 20 pils a day or what woulda happened is i would have gone to a stronger drug.....i chose to quit as i was not getting anywhere at all
Cancer patients in the medical community who r in pain and dying...when death imminent..are allowed as much pain relief as possible...called "Keep Comfortable" This persons life is almost over...a physician will not be worried about tolerence etc as this patient will be dead soon,,,A patient who has cancer that has metastasized to multiple organs, some have an odor due to the rot...i will not continue...it is very different than a 32 year old fibromyalgia patient.....I see no comparison comparison in these 2 situations

[SableZen]

"So the only drug users who can confidently declare themselves as not addicts are cancer sufferers?  Anybody else in severe pain is subject to the judgements of others and obviously in denial.  What if one of these people then gets cancer?  Does there addict status automatically leave them as now they have a cultural right to be in pain?"

Really good questions that gets to the heart of the stigma of addiction...

Every wonder why it is that one person in severe, chronic pain can take a narcotic for years without ever becoming an 'addict'? While *any* other person *not in pain* that was put on the same medication for the same amount of time would become 'addicted' within weeks... including drug-seeking behavior if they found out what they could do to make themselves feel better? It's not because one person is inherently weaker or more defective than the other! Consider that addiction will develop to people *even if they do not know* they are actively being given a narcotic. Conscious choice is not a part to become addicted to something! The conscious part is only in seeking to alleviate the feelings of not being 'well' that come about later in the process - which is a completely normal and healthy behavior under normal conditions we have to have to survive. No different than wanting to pull a thorn out that is stuck in your foot instead of continuing to walk on it and be in pain. The chemical part to addiction isn't started by conscious choice - it takes place behind our active thoughts.

When a person is in pain, endorphins are released (ever wonder why it is that some people even enjoy pain?). With minor pain, like from acupuncture - it's normal to even feel better overall than before the pain because of the amount of endorphin release is more than adequate to control it! But what happens when a person is in severe pain and all the natural endorphins being released aren't enough to keep up with controlling the pain? Usually depression sets in, anxiety sets in, other systems in the body start malfunctioning - a person emotionally and physically gets stressed beyond the point of being ignorable and socially would need to rely on others to help them (and naturally we respond to help the people we care about). Endorphins are powerful, powerful stuff that even extends into effecting our social behavior and effecting other people in their responses to us. And the control and release of endorphins is found in a specific part of the brain - the same part that controls survival instincts - the same part of the brain that narcotics alter.

In either case, someone that's dependent or someone that's addicted - neither one consciously chooses for the effects. They happen over time to alterations in the brain from the chemicals to the same cells and receptors. The difference is just that a person in chronic pain is using up both the endorphins and/or opiates to chemically control pain. It's simply being used up for a specific purpose even though it's not natural to the body. While a person *not in pain* is putting WAY more availability of endorphins/opiates in their bodies than the body needs to control pain and so instead the body just feels better than normal or euphoric.

Which alters behavior - it does feel good to have a rush of endorphin-like feelings! At first, not a big deal - we are in control of how often we want to feel good. But when tolerance level begins to rise (i.e. receptors are getting blocked and altered by opiates that the body can't break down like our own natural endorphins), we start to feel bad due to lack of a normal level of endorphins/opiates hitting receptors - the brain responds the same as if we are under threat of death or not surviving when this is the case as one part of the brain considers a lack of endorphins reaching cells to be a sign that all is going to end if something doesn't change (back to survival instincts)... and the cycle starts for an addict. As it continues, tolerance (damage to receptors from the incorrect opiates) increases, new receptors are made available by the body to correct for this, need increases proportional to the amount of receptors waiting on endorphins, the newer receptors get damaged by the opiates, the body makes more, etc...

A physically dependent person never really alters the cells in the survival portion of their brains, the endorphin-like opiates are doing their job correctly at controlling pain perception and tolerance - and not for euphoria/depression. They cause some damage to the physical operation of the body as a whole (this is the dependency portion) but not so much to the brain as it effects survival emotions/behavior (addiction).

[CadillacJack]

Well... Seems to be a hotly debated topic, and a very fine line between the two "labels". I say a fine line, because the person who is taking for pain relief is at risk of being given more than is necessarily required for the pain relief. When this happens, as I'm sure is often the case, then we set off the alteration of receptors, hence resulting in addiction, as well as dependency. Seem reasonable? I, personally, don't care how I may be labeled, you understand. In reality, it seems to be meaningless to say one person is simple dependent (needs the drug), while another is addicted (also needs the drug). Great discussion. Thanks.

[wishforchange]

SableZen you nailed it.  You have actually for the first time I have read on this site explained properly the difference between those using drugs for pain and those using for recreational purposes.  Yes there is a fine line between the two, but as in my case, as I keep explaining to doctors and family and whoever else who asks, who just look at me incredulously, I do not take these drugs to feel euphoric.  I take these drugs to enable me to move.  I am not perfect and have on occasion taken more than I needed, and then felt the pscyhcological changes others may seek.  Personally though I do not like them, and once I get into such a state immediately decided to reduce my dose back down to the pain relieving levels.  I am not superhuman, it is just how I work.  I do not like to have my mind altered by drugs, and am so tired of being accused of it directly and indirectly.  Thank you for so articulately experessing the difference.

[J_friend]

One can take an opiate as prescribed and, if done long term, will become physically dependent.  For example, if someone is taking  Oxycontin 40  3 times daily, and perhaps 2/3 Percocet daily (as needed for breakthrough pain) ... they can take as directed, yet they will eventually end up physically dependent on the pills.   On the contrary, someone who addicted will most likely take more than is needed, mentally obsess on their next "rush", possibly doctor shop, try to increase dosage because they want more of a rush ... the list goes on.

[Sajonna]

Someone explain this then:  People here told me that even after a taper off the meds (my case Norco's) I would still feel a withdrawal.   I followed the taper to a T.  I had no one to dole them out. Never once in the whole taper did I feel like taking more than I should.   I am on day 2 of NO PILLS.  I am not suffering mentally.  And not even physically.  My taper was 5 pills for days; 4 pills for 2days etc...ending with a 1/2 pill for the final 2 days.   I did notice on everyday that I stepped down a pill (the first day of the taper dosage) I felt a little punchy and irritable. But by the 2nd day of the step down I felt fine. Other than that, I had none of the other horrible w/d symptoms everyone else here claims.  Everyone else sounded like they had a bad flu.

Could it be that I did not get these symptoms because I did not take these pills to chase a high or as some would say abuse them?

[avisg]

Some people get withdrawals some don't I have known people that have used and abused heavily for years get minimal to no withdrawl. So you cant really use that as an indication of abuse

[bubbaganoosh]

For myself i think its dependancy although i could be wrong, I've had friends in the past say have a bottle of something take alot from it as sometimes  i wouldnt, but years ago when i drank i drank or binge drank, But i also have anxiety issues and i think i may have used to cover up socially to be comftorbale, so does that make me an addict if per say its a seconday condition the substances?? I havnt drank in 8years so if i was an addict surely i would no??

[bubbaganoosh]

Also im sure the dependant's of the world have some mental worry about will they be ok without it too, be good if there was a quiz we could take lol

[SableZen]

CadillacJack: I agree, it's a VERY fine line because the same drug can result in addiction if taken one way under certain circumstances and be perfectly fine if taken in another way under different circumstances - even the same drug taken by the same person at different times.

But it's really important for medical practitioners to define and know the differences between the two things without the weight of stigma interfering... The differences between psychological illness (as it applies to addiction in many different ways) and physical illness (as it applies to dependency and tolerance) when a patient is under their care has to be correctly defined or else a patient is going to be harmed (happens all the time). Because addiction or dependency require almost *opposite* treatment plans, medications and action to help someone and more importantly, not to cause them even further harm.

[Toomanyadvil]

There really is no such thing as an addictive personality because the reasons for addiction do not lie in the personality at all.  Your personality is who you are what you believe, an addiction is a disease not who you are as a person. Thus addictive personality is just a misconception.  I remember my professor getting so passonate about this very subject.  I went to school for substance abuse counseling and my profesor happened to be in reccovery.  
What I was taught during university and what I learned through my career is that what 'causes' addiction has many components.
The biggest being a combo of genetics and enviorment. Or just one or the other sometimes. Enviorment being a family where drugs and alcohol are the norm or a city or town where drugs are often seen being sold and used.  If your father or grandfather gas a problem you are I believe 3 times more likely to develop a substance abuse problem.

The difference between addiction and dependance is psychological.  Both involve physical dependance of a substance, meaning if it is stopped you will have withdrawls. But with dependance there is no psychological compulsion to take the drug.  If there was no pain you would feel no need to psychologically take the drug.  Addiction involves psychological dependance and physical dependance.  Despite problems that occur from taking the drug the compulsion to take them is still there.  Like if you drank and got into an accident you would be out drinking the next day or night despite a direct negative consequence.  That is also what seperates social drinkers and alcoholics.  A psychological need to have the substance despite negative consequences.  
With physical dependance alone for cases of pain medication or ant-anxiety medication there is an abscence of negative consequences.  If someone is using pain meds for medicinal puposes and starts mis using pills by taking more than prescribed or crushing them or snorting them then they are seen as having a substance abuse problem. Same as if they start being unable to control anger when they cant get any.

I can understand why it seems like such a fine line.  But really it isnt because of the psychological part.  Someone who is physically dependant because they take it for pain will be okay with stopping it if the pain goes away.  

Most pain specialists are now being educated in what is called 'suedo' addiction.  Which is when a patient is experiencing so much pain that they appear to be showing behaviors someone who abuses medication would show.  Most Pain specialists are also being educated on the new research showing that those who are suffering from chronic pain have an extreamily low chance of ever becoming addicted to pain meds.  Mostly because people in chronic pain have a different brain reaction to the medication and do not experience the 'high' that people who are not in pain experience.  Although that is not true in every case and some people like the feeling they can feel and start exaggerating symotoms to get more medicine in hopes of increasing or continuing the feeling. But most do not get the feeling and many DRs are aware of that than in the past, so things in that regard are improving.

Geez, sorry about this purely imformative sounding post.I guess I didnt realize how much I miss my job.  That must have been boring sorry!
But I do hope that clears some things up from someone who has been in the addiction field for many years.

[Toomanyadvil]

Did someone seriously take pills while they were talking on this forum and say so whats the big deal?
This forum is for people trying to get support in order to try to stop or maintain sobriety, why would you boast about something like that?
Sometimes it only takes a comment like that to trigger someone else.

Why even come here saying you dont have a problem and then go into what you just did
That doesnt make any sense to me infact it makes me upset as someone who deeply cares for people who are trying to change things and get support for substance problems.
You dont mess around with that.

[bubbaganoosh]

TMA What if the person has underyling issues? or a mental illiness per say rather than a pain issue? isnt that the same once the pain of the MH issue goes away then the need to stop self medicating goes too? you say addiction is psychological etc.. that could also apply for the above the fear of will i cope without????? be it anti anxiety or pain meds or whatever the DOC is..whats your thought's on that

[bubbaganoosh]

addiction to me would be more when nothing is wrong IE no MH issues, No Pain issues, and a person just wants to get high? yes/no? as long as there is a legitmate reason to use a medication  then that would come under dependance.

[Toomanyadvil]

I know I sent you a pretty long explination bubbaganoosh...but incase anyone else was wondering the same thing I thought maybe I would post a little bit of my answere to this...

No matter if the medication is for pain or anxiety, if the medication is abused in any way it is always considered substance abuse.
When I said addiction is the psychological need to take a substance and what is missing when someone is just dependant, I ment that despite any further pain or feelings of uncontrollable anxiety. Being afraid that you will not be able to cope with your anxiety or it will come back and the same thought about pain isnt considered psychological dependance. The thought in and of itself is anxiety and is expected when stopping narcotic anxiety meds. And when that thought comes about when stopping pain meds is a fear of having to feel the intense pain and being unable to tolerate it. Those thoughts are expected.
But if the person refuses to try or is unable to stop despite a lack of pain or anxiety then it would be considered substance abuse.
But if the person still has extream pain or anxiety and is told to stop and they cannot because of those problems and continues to use it illegally(meaning using other means after the DR ends the scripts) then that person could then be referred to a specialist who deals with addiction and there specific problem to maybe learn other ways to stop. There are defenitly practitioners with substance abuse specialities who also specialize in treating anxiety and pain. Most MD's like pain management docs are not trained to treat substance abuse. Psychiatrists would refer an anxiety patient who he believed couldnt stop taking the meds to a therapist who specializes in substance abuse and anxiety disorders.

It kind of seems like a jumbled mess when you get to a subject like this. But when it comes down to psychological dependance of a drug versus physical dependance there are clear cut lines as to what behaviors are thoughts are seen as acceptable and what behaviors and thoughts indicate a problem.