Alliance for Substance Abuse Progress

Ask the Expert: How do I know if it’s dependence or if it’s addiction? 

December 13, 2017 By Dr. Theodora Saddoris

Everyone who takes an opioid regularly for more than three weeks will develop some physical dependence. The symptoms of physical dependence can be mild or severe based on how long a person has taken the drug, the frequency of taking it and the potency of the narcotic. If a person takes one hydrocodone per day, the symptoms of physical dependence would be mild because the drug only lasts about 6 hours and is not as potent as other drugs like Opana, Dilaudid, or fentanyl. Symptoms of physical withdrawal may be:

  • Increased joint and back pain
  • A feeling of restlessness
  • Some abdominal discomfort

Many times these feelings of withdrawal can be confused with increased pain and increased need of medication because of the aches and discomfort. This physical withdrawal from lack of opioid medication is NOT addiction.

Then, what is addiction?

Addiction is caused by repeated exposure to a drug, which causes changes in the brain that lead to a set of behaviors that we call addiction. A lot of times, these changes occur because of genetic predisposition (40-60% of the time) and environmental factors. The environmental factors can be:

  • Emotional trauma a person has experienced (physical, sexual or mental trauma)
  • Bullying, causing isolation and emotional pain
  • Mental disorders, such as chronic anxiety, depression, bipolar or personality disorders such as borderline personality, antisocial behavior or ADD/ADHD

Another component of developing addiction is the age of onset and frequency of drug use. A person less than 25 years old has increased risk of developing an addiction than an older person who initiates drug use. Before age 25, the brain is still developing and drug use can cause permanent changes to the brain’s information processing system when exposed to drugs.

The behaviors we see with drug addiction are due to these changes that happen in the brain:

  1. The compulsion to keep using drugs is driven by the reward pathways in the brain. Once this compulsion starts, the person loses all free will to stop without some type of intervention. The person may know they have to change, but when this obsessive-compulsive response happens, they are helpless. People have told me they cry as they inject themselves because they can’t stop. The reward system is altered and set so high to be stimulated that the person finds no pleasure or enjoyment in doing basic things of living. Everything becomes an effort.
  2. The part of the brain that makes it so easy to relapse is located in the memory and emotional parts of the brain. The brain remembers every time the person took the drug. So, when the person sees a former drug user, it sets up a trigger for drug use. Smells, sights, sounds, people, places and things can all be triggers to take drugs again. Life becomes walking in a minefield. At any moment, one misstep and life could fall apart.
  3. The emotion center in the brain is all messed up. The person in recovery is extremely sensitive to anything painful, upsetting or disappointing. Their brain is flooded with chemicals that cause them to feel bad all the time, coupled with an inability to express how they are feeling. The compounds in the brain that make the person feel good are very low, and the compounds in the brain than make them feel anxious and on edge all the time are high.

When a person is taking a drug—even when they know it is destroying their life—they are helpless in this struggle. They need our help and understanding to get into treatment. They cannot fix this problem on their own.




Dr. Teddy Saddoris

Category: Ask the Expert, General