You may have heard the terms of chemical dependency, addiction, and substance use disorder used interchangeably. Similar to the terms “heavy alcohol use” and “binge drinking”, the terms do have differing means that are defined by various organizations or resources, but they can mean the same thing when used informally. However, when looking for professional help, it is important to understand what these terms do mean in a clinical setting.
What is Chemical Dependency?
When using the term chemical dependency, it is most often referring to physical dependence (or addiction) to a chemical substance. More often the term addiction may be used when referring to dependence as opposed to the other way around. When someone has a physical dependence, there is a physiological change that is observable or measurable. The most common change is the onset of withdrawal symptoms when the user stops consuming the chemical substance in question. Another observable change is an increase in the number of particular receptors in the brain.
What is a Substance Use Disorder?
A substance use disorder (SUD) is a mental health condition in which the use of addictive chemical substances affects an individual in any number of ways. Signs of physical dependence, such as withdrawal symptoms, are criteria for being diagnosed with a substance use disorder but one can be diagnosed with a SUD without presenting a physical-chemical dependence.
Addiction, Dependence, and the DSM-V
The way addiction has been defined in the Diagnostic and Statistical Manual of Mental Disorders has changed drastically over the past. In the 5th addition of the DMS, addiction diagnosis’ are broken down into mild, moderate, or severe substance use disorders. In the previous edition, there were specific criteria for both chemical addiction and chemical dependence. Essentially, the two diagnoses’ were previously separated, unlike the current criteria for diagnoses. Again, the way addiction was diagnosed was different in previous versions of the DMS.
The significant changes to the diagnostic criteria in this widely utilized text point to the fact that psychiatry is an ever-changing profession in which we are learning more every day, but there is still much to figure out.
What Causes Chemical Dependence?
Chemical dependency is caused by the use of a chemical substance that interacts with the brain in a way that causes a change in the physical structure, chemical composition, or physiological processes in the human body so that when the chemical substance is removed, the anatomy may be changed and negative side effects present. Typically, these types of changes do not happen from consuming a chemical substance one time, rather from long term and/or heavy use. One example is the decrease in dopamine receptors to adapt to the increase in dopamine caused by long-term opioid use.
Most often, chemical dependency is treated through an abstinence model. This means discontinuing the use of the chemical substance, allowing the drug to leave the body and for the physiological processes to return to normal. In most cases, withdrawal symptoms subside within about 14 days, but mild forms of symptoms such as anxiety may present for months or years (PAWS). Drug & alcohol detox facilities may utilize alternative therapies, medication, and nutrition to manage withdrawal symptoms and assist in the detox process. Medications, such as naltrexone, may also be used to slowly wean an individual off of a chemical substance while preventing withdrawal symptoms from presenting.
Additionally, some people struggle severely with chemical dependence and they relapse frequently. A highly controversial practice that may be used for these individuals is a medication maintenance program where a drug such methadone is provided to satisfy the cravings, eliminate withdrawal symptoms, and reduce the risk of overdose. The ultimate goal is to wean them off the medication, but some people begin reliant on it to avoid using other, more dangerous drugs.