A person’s dependence on substances may be physical or psychological. More often than not, both types of conditions can take place.
What is Physical Dependence?
Physical dependence is manifested by the presence of withdrawal symptoms when an addictive substance is not taken. This occurs because the body has already adapted to the long-term use of the substance. As a result, the person takes more and more amounts to experience the ‘high’ he/she had before. Without so, he/she stands to experience the unpleasant effects of withdrawal.
The speed with which physical dependence occurs due to several factors, including:
- The substance used
- The frequency with which the substance is consumed
- The manner with which the drug is taken
- Individual family history
Physical dependence can be brought about by the following substances:
- Opioids such as codeine, heroin, morphine, oxycodone, nalbuphine, methadone, and fentanyl
- Barbiturates such as sodium thiopental and phenobarbital
- Benzodiazepines such as valium, diazepam, and alprazolam
With physical dependence, the following symptoms can occur:
- Mood swings
- Memory loss
- Constricted pupils
- Dry mouth
- Shortness of breath
- Pulse rate variations
- Body aches
- Tremors and shaking
- Restless legs
What Is Psychological Dependence?
Psychological dependence, on the other hand, occurs when the substance becomes the focal point in the user’s life. It becomes the cornerstone of his/her activities, thoughts, and emotions. This is hallmarked by the strong compulsion to use the drug, despite knowing its ill effects.
Psychological dependence occurs due to 2 changes in the brain. First is the change in the activity of neurotransmitters, which carry the messages from the neurons to their respective target areas (other neurons, glands, or muscles). Serotonin and dopamine levels are markedly decreased, which could lead to the anxiety and depression felt with psychological dependence.
An altered receptor expression is another reason for dependence. In some cases, there is downregulation or a decrease in the quantity of RNA, protein, or other cellular elements. Again, this could lead to symptoms associated with psychological dependence.
Psychological dependence is usually caused by the following substances:
- Stimulants such as Ritalin and cocaine
- Hallucinogenic drugs such as LSD
- Anti-depressant medications
- Behavioral activities such as gambling or watching porn
Psychological dependence can come with the following manifestations:
- Intense cravings for the substance
- Denial of addiction
- Mental obsession with how to secure the substance
- Anxiety when not using drugs
- Inability to imagine life with the drug
- Feeling of restlessness when not using
- Insomnia due to drug use or lack thereof
- Mood swings
- Loss of appetite
- Sporadic cravings that may occur even with years of being ‘sober’
Like physical dependence, psychological symptoms can also lead to a condition called post-acute withdrawal syndrome (PAWS). Even if the physical symptoms have subsided, the mind can bring about the following symptoms:
- Insomnia and other sleep disturbances
- Mood swings
- Emotional problems
- Memory, concentration, and decision-making problems
- Trouble managing stress or personal relations
PAWS, which is also known as prolonged withdrawal syndrome, can persist from a few days to a couple of months. According to the UCLA Dual Diagnosis Program, it can affect 75% of individuals recovering from alcoholism and roughly 90% of those dealing with opioid addiction. Those at the highest risk are benzodiazepine users, even after they have stopped taking the drugs for years.
Treatments for Substance Dependence
The treatment varies according to the substance. Generally, it follows the principles that make treatment effective. According to the National Institute on Drug Abuse, the key outtakes for these are the following:
- There is no one/single treatment for all users. It usually involves a mix of medications and psychotherapy, among many other interventions.
- ‘Addicts’ need to have immediate access to treatment for best results.
- Treatment does not have to be voluntary to be effective.
- Effective treatment sees through the patient’s many needs, not just his/her addiction.
- Staying in treatment for the prescribed amount of time is vital for recovery.
- Treatments should consider the occurrence of other mental problems, as well as other infectious conditions such as HIV, Hepatitis B/C, and Tuberculosis.
Medically-assisted detoxification is the first step to treatment. The goal here is to keep the person mentally and physically stable throughout the withdrawal process.
This usually starts with the treatment team determining the interventions the person needs. As such, the patient will need to undergo a physical examination, medical history, and blood works.
Detox can be done in an inpatient basis. For more severe cases, this is best spent in a rehab center, detox clinic, or hospital. For patients with milder circumstances, detox can be done at home on an outpatient basis.
Treatment may then include the provision of another drug, especially for a substance that needs to be tapered/cannot be discontinued right away. For example, a cross-tolerant medications such as a benzodiazepine is given to those experiencing alcohol withdrawal.
The treatment might also include the gradual dose reduction of an addictive substance through a certain period.
3. Behavioral Counseling
The protocol can also include behavioral counseling, which includes the following concepts:
- Incentivization for the user to remain ‘abstinent’
- Modification of behaviors and attitudes that lead to substance abuse
- Improvement of life skills that will help prevent the triggers of substance abuse
Examples of widely-used behavioral counseling methods include:
- Cognitive-Behavioral Therapy for alcohol, cocaine, marijuana, nicotine, or methamphetamine users
- Contingency Management Interventions or Motivational Incentives for alcohol, nicotine, marijuana, opioid, and stimulant users
- Community Reinforcement Approach with Vouchers for codeine, alcohol, and opioid users
- Motivational Enhancement Therapy for marijuana, nicotine, and alcohol users
- The Matrix Model for stimulant users
- 12-Step Therapy for opiate, alcohol, and stimulant users
- Family Behavior Therapy
- Adolescent Behavior Therapy
4. Treatment of Other Co-Existing Conditions
More than just focusing on the dependence, the treatment also includes the diagnosis of other co-occurring mental conditions. As mentioned, the alleviation of these problems is vital. After all, these may end up worsening the addiction.
5. Follow Up
Perhaps the most important aspect of treatment is long-term follow-up. When done regularly, this can help prevent relapse – an all-too-familiar problem for people with physical or psychological dependence.
Physical and psychological dependence are conditions that affect many substance users. With the right treatment and follow-up, their impact on a person’s life can be reduced.
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