Physical Dependence Is a Side-Effect. Addiction Is More like Stockholm Syndrome
Drug dependence is not addiction, and addiction is not drug dependence. In understanding the difference between these two phenomena, we must understand that addiction is driven predominantly by the brain’s reward system, whereas physiological dependence occurs mostly in the body’s nervous system. In short, you don’t need to be physiologically dependent on something to be an addict, and you don’t need to be an addict to be physiologically dependent on something. What most people think of as ‘being addicted’ is based on this notion of physical dependence: the idea of a sweating, shaking and vomiting individual. Someone you don’t want in your house. Someone you don’t want around your grandmother. But the fact is, while I was such a wretch, and maybe you were too — many drug users are not.
The reason people equate physical dependence (and some of its characteristics like withdrawal) with addiction, is because physical withdrawal is very dramatic and highly visual. We can see it. It is all on the outside. We see a heroin addict or alcoholic in withdrawal and say, “look…that is what addiction is!” But in reality, only central nervous system depressants such as alcohol, opioids and benzodiazepines cause this kind of physical withdrawal. Many other serious drugs of abuse (stimulants such as cocaine and methamphetamine for example) do not cause this physical dependence and withdrawal. When they are abruptly stopped (after long term high-dosage) they trigger an opposite type of withdrawal called hyperdepression. To most naïve observers, the infamous ‘crash’ induced by stimulant withdrawal looks like a simple case of ‘arsehole-itis’, but believe me, it’s no joke. Nevertheless, it’s not physical dependence.
Likewise, gambling and other process addictions, whilst being highly addictive, do not cause any notable physiological symptoms upon cessation because they are not even substances — they are behaviours. So, we can readily see that we are not dealing with a physiological condition as much as a psychological one. What really defines addiction is what is happening on the inside.
The common denominator in all addictions is not physical dependence, it is craving. Cravings often feel physical, but, in reality, they are more of a psychological form of dependence. Abrupt cessation of any addictive drug or process is accompanied by cravings and their accoutrements — those vivid mental pictures, memories, and waking fantasies that addicts know so well. Cravings manifest as urges which appear stronger than our will to resist, and they are a universal feature of all addictions regardless of which substance or behaviour is involved.
In this way we can see that it is the salience of the ‘drug’ and what it means to us, with all our imagistic talents, that drives addictive behaviour, not simply the need to quell physical withdrawal symptoms. This is why people who are seriously addicted often decide to become abstinent. They choose to immerse themselves in a recovery community because they understand intuitively that addiction is a chronic condition which is more psychological than physical in its dominion. It’s not gone when the withdrawal symptoms are gone.
The Kidnap Analogy
Perhaps a short and frankly inappropriate analogy might serve to illustrate this difference between dependence and addiction, or to put it another way, the difference between an addict and a non-addict.
I take two people, say you and your friend. You are both currently abstinent from all drugs and alcohol. But you have a history of addiction and he does not. I kidnap you both and take you to my cellar where I forcibly inject you both with high grade heroin every day for two weeks. In short order you would both become heroin dependent, meaning that if I were to suddenly release you, you would both experience unpleasant withdrawal symptoms which are basically like the most depressing and anxiety provoking flu you’ve ever had, but not much worse. Upon release, you would no doubt run screaming down the road to the nearest police station, after which time you would proceed onwards to the nearest hospital in order to obtain some medications (such as methadone) which might ease the unpleasant withdrawal symptoms.
So, you reach the police station and recount the details of the kidnapping. Incredulous, the police demand that you give a full witness statement. While sitting there in the interview room describing me — “bald, glasses, mad staring eyes” — you both begin to go into withdrawal. And this is where we see the difference between you (an addict) and your friend (a non-addict).
You make an excuse and go to the bathroom. You have realised that giving a statement to the police is taking too long. You are experiencing an overwhelming sense of anxiety and meaninglessness which is quite unbearable and what’s more — you know what to do about it. Having noted that the hospital is a long way off, the thought comes into your mind that the medications they have in stock might not be potent enough to take the edge off your withdrawal symptoms, or that they might not give you enough of the drug. It’s worth mentioning at this point that your friend is not experiencing these kinds of persuasive cognitions and fantasies as he continues to give his statement to the police. He is just feeling ill but is sticking to his original plan nonetheless.
Without any conscious thought at all, you suddenly realise that you are halfway through the bathroom window. You are actually breaking out of the police station undetected because you can’t be bothered to make excuses, and because you know full well that what you intend to do next will make no sense to them whatsoever.
Now you are running back to my house. This feels right. You knock on my door and apologise profusely for running away. You politely ask me — your former captor — if it would be at all possible to procure some more heroin.
In short, we could say that your friend didn’t have ‘what it takes’ to be an addict. Because what it takes to be an addict is a deficit of reward and meaning, an overabundance of stress and nihilistic feelings, a diabolic talent for building compelling pictures and fantasies of any available rewards in the environment, and the drive to acquire such things with demonic single mindedness which steel plate you against any sense of shame. In other words, the common denominator in addiction lies not within any innately addicting quality that drugs may have, but within us, the human being.