PHYSICAL VERSUS PSYCHOLOGICAL DEPENDENCE

 

INTRODUCTION:  Whether a substance is addictive is related to how easily an individual can stop taking the agent on a repetitive basis. When a person has an overwhelming desire to take a drug and cannot stop, this condition is referred to as substance dependence. Substance dependence is classified into two categories, physical dependence and psychological dependence. 

PHYSICAL DEPENDENCE:  This refers to an altered physical condition caused by the adaptation of the nervous system to repeated substance use. Over time, the body’s cells become accustomed to the presence of the unnatural substance.  With physical dependence, uncomfortable symptoms known as withdrawal result when the agent is discontinued. Alcohol, sedatives, nicotine, and CNS stimulants are examples of substances that with extended use may easily cause physical dependence. Repeated doses of opioids, such as morphine and heroin, may produce physical dependence rather quickly, particularly when the drugs are taken intravenously.

PSYCHOLOGICAL DEPENDENCE:  In contrast, psychological dependence refers to a condition in which no obvious physical signs of discomfort are observed after the agent is discontinued. The user, however, will have an overwhelming desire to continue drug-seeking behavior despite obvious negative economic, physical, or social consequences. Associated intense craving may be connected with the patient’s home or social environment. Strong psychological craving may continue for months or even years and can be responsible for relapses during therapy. For psychological dependence to occur, relatively high doses of drugs are usually taken for a prolonged period. Examples are marijuana and antianxiety drugs. On the other hand, psychological dependence may develop quickly after only one use, as with crack cocaine, a potent, rather inexpensive, form of the drug. 

WITHDRAWAL SYNDROME:  Once a person becomes physically dependent and the substance is discontinued, withdrawal syndrome may occur. Prescription drugs are often used to reduce the severity of withdrawal symptoms. For example, alcohol withdrawal might be treated with the short-acting benzodiazepine oxazepam; opioid withdrawal might be treated with methadone. Symptoms of nicotine withdrawal might be relieved with replacement therapy in the form of nicotine patches or chewing gum. 

For withdrawal from CNS stimulants, hallucinogens, marijuana, or inhalants, specific pharmacologic intervention is generally not indicated. Symptoms of withdrawal may be particularly severe for those who are dependent on alcohol or sedatives. Because of the severity of the symptoms, the process of withdrawal from these agents is probably best accomplished in a substance abuse treatment facility.  With chronic substance abuse, people will often associate use of the substance with their conditions and surroundings, including social contacts with other users who are also taking the drug. Users tend to revert to drug-seeking behavior when they return to the company of other substance abusers. Counselors often encourage users to refrain from associating with past social contacts or having relationships with other substance abusers to lessen the possibility for relapse.

RELATED;

1.  PHARMACOKINETICS  

2.  DRUG METABOLISM

3.  CENTRALLY ACTING MEDICATIONS

4.  SEDATIVE-HYPNOTICS

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