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?

[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.

[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).

[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

[toomanytimes]

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

[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

[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