Like cancer, the disease of addiction is commonly recognized as having different subtypes: psychological and physical. But are physical and psychological addiction truly two separate illnesses?
Breast cancer and melanomas are by definition certainly both cancers, but they are vastly different diseases. Similarly to cancer, addiction has many variations in how it presents itself, making a working definition hard to pin without breaking it into classifications.
The American Society of Addiction Medicine generally defines addiction as a “primary, chronic brain disease of reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations.”
Mind Vs Body When it Comes to Addiction
Any drug or process addiction falls neatly under this broad definition. But this leaves many more questions about the specifics regarding addiction to particular substances. After all, all drugs have different effects on the body, so naturally they will have their own specific sets of symptoms once a person has succumbed to addiction.
It is prudent to acquire in-depth, intimate knowledge of whatever substance or process you or someone you care about is struggling with after you have realized that there is a problem. This knowledge will provide clues to the best sorts of treatments for handling this specific problem. For, while the disease of addiction is universal, each specific substance or process addiction comes with its own host of issues.
Knowing what you’re up against will help you to decide if a medical detox is needed, or if an inpatient or outpatient rehab should be considered. It can help you decide what kind of therapist to look for, of if you think meetings will be enough.
What is Psychological Addiction?
Working with the ASAM’s definition of addiction, all forms of addiction are psychological by default. Since the disease of addiction develops in the prefrontal cortex and limbic system of the brain, it greatly alters the thinking of anyone suffering from it.
People can become psychologically addicted to anything. What the offending substance or behavior is does not particularly matter except for how the particular substance or behavior is specifically, negatively impacting the life of the sufferer.
Psychological addiction can sometimes be hard to detect because it shows up in so many areas of a person’s life. Someone suffering from a psychological substance-use disorder might recklessly binge drink for a few weeks, then move on to gorging himself on unhealthy foods, or compulsive shopping.
The focus of the addiction isn’t what matters; what matters is the need to take action or act out to feel in control when in the face of uncomfortable situations. There is a deep-seated, underlying issue that the sufferer hasn’t been able to resolve. The focus of the addiction allows the person to ignore the pain that the problem causes and feel in control once again, however briefly.
The substance or negative behavior that the addict is engaging in causes a surge of dopamine, serotonin, endorphins, and other powerful neurotransmitters. These are the brain’s feel-good, happy chemicals. This overstimulates the brain’s reward system and reinforces the addict’s decisions, even in spite of unwanted consequences.
Certain substances are known to release more neurotransmitters than others, and this can lead to the development of a psychological addiction to a particular substance faster than it would with another drug.
Symptoms of Psychological Addiction
While a psychological addiction can manifest itself in various ways that are unique to the individual suffering from it, there are generally some specific symptoms to look for:
- A person psychologically addicted to a process or substance will likely suffer from depression when withdrawing.
- They tend to be overly happy when actively using the substance or participating in the process.
- Wide mood swings.
- Concern about going somewhere that the focus of their addiction is not allowed.
- Cravings, or strong emotional cues to engage the addiction.
- Behavioral problems such as missing work, school, or important engagements.
Psychologically Addictive Substances and Behaviors
Almost anything can turn into a psychological addiction if a person is consistently willing to use that substance or behavior as a crutch to mask underlying emotional duress that he or she has been unable to effectively deal with or heal from. However, some drugs and behaviors are much more likely to lead to a psychological addiction than others.
While this list is by no means comprehensive, it should give a good idea as to how broad a range of drugs and behaviors can lead to the development of a psychological addiction:
- Crack cocaine
- Opioids, such as pain medication or heroin
- Benzodiazepines, such as Xanax and Valium
Treatment of a Psychological Addiction
Due to how the focus of a psychological addiction can shift at times, the problem can sometimes be hard to spot. But if you believe you are suffering from a psychological addiction, you should begin by scheduling a meeting with a therapist to discuss the problem. An inpatient stay in a drug rehab might be necessary to initially get you off of the substance you are abusing.
Afterward, there are many anonymous meetings, covering topics from overeating to gambling, that are all based off of Alcoholics Anonymous’ 12 steps and traditions. These meetings provide a strong support group of people who understand because they have dealt with the same issues.
Medication such as antidepressants can also be invaluable in the treatment of a psychological addiction. Prescription of antidepressants is very common, especially in the beginning stages of treatment where a person will likely be suffering from depression due to withdrawing from the addiction as well as having to face the issues that caused them to end up addicted in the first place.
What is a Physical Addiction?
The condition of a physical addiction develops when there is chronic use or abuse of a tolerance-forming drug. It is wise to note that there is a distinct difference between physical dependence and addiction. Knowing the difference can save someone’s life.
A physical dependence upon a drug will develop even when a person is using a tolerance-forming drug as prescribed. The dependence is unfortunately a necessary side-effect if the doctor deems the severity of the condition being treated as worthy of being treated with this type of drug.
Opioids are a common example. While they are extremely addictive if abused, some people that are prescribed the pills for chronic debilitating pain can successfully take them for long periods of time without ever becoming addicted. However, this doesn’t mean that they don’t have a physical dependence. The fact is, if they have taken opioids for an extended period of time, they will suffer withdrawal symptoms when coming off of them.
Other common medications that can lead to physical dependence are benzodiazepines, antiepileptics, and antidepressants. While benzodiazepines are a common drug of abuse, no one would ever dream of calling someone dependent on antiepileptics or antidepressants an addict because they regularly need their medication.
Process addictions such as gambling, sex, or food do not lead to a physical addiction. Physical addictions are limited to drugs.
Why Does Physical Addiction or Dependence Occur?
The human body is extremely efficient and adaptive. As it becomes more used to regularly having a drug in it that can do certain functions for it, the body will cease those functions without the cue from the drug. An opioid-dependent brain will not produce endorphins, its natural painkiller, without opioids. This leads to very uncomfortable withdrawal symptoms.
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Symptoms of Physical Addiction
Someone suffering from a physical addiction will have all of the same symptoms of someone suffering from a psychological addiction, because all physical addictions are in fact psychological. There will be a few additional cues and difference to notice though:
- Generally, when someone is suffering from a physical addiction, the focus of the addiction will not shift as often as it would if the addiction were just psychological. This is due to the body being dependent upon the drug to not suffer from withdrawal symptoms.
- Varying physical withdrawal symptoms will begin to appear like clockwork after a certain period of time has passed without the addict having the drug.
- There will be a fear of withdrawal that can lead to risky negative behaviors that the addict might not engage in otherwise, such as lying or stealing to fund his or her habit.
- After suffering through the initial withdrawal phase of a physical addiction, the addict will like go through post-acute withdrawal. This is a wide range of symptoms that can occur at various times and last for up to two years after the initial detox from the drug.
Drugs That Cause Physical Addiction
You will notice several drugs that overlap on this list with the previous one under psychological addictions. This is because some drugs will become psychologically addictive well before the physical dependence begins to develop.
Opioids are the most commonly thought of drug of abuse that comes to mind when speaking of physical dependence.
In the case of alcohol, a physical dependence can take years to develop. However, it would be dangerous, reckless, and foolish to not consider that someone might be an alcoholic because they don’t show signs of physical dependence at the present time.
- Opioids, such as painkillers or heroin
- Benzodiazepines, such as Xanax, Klonopin, or Valium
- Barbiturates (Phenobarbital and Secobarbital)
- Gamma-hydroxybutyric acid (GHB)
This is not an exhaustive list of drugs that can cause physical dependence. Before starting any drug it would be wise to discuss with your physical whether or not development of a physical dependence on the drug is possible. If it is possible, ask if there is a prescribed protocol for weaning off of the substance in as safe and comfortable a way as possible.
Ask if the physician has ever successfully weaned someone off of the drug or if he can refer you to another physician who has successfully weaned someone from physical dependence from the drug.
Treatment of a Physical Addiction
Treatment of a physical addiction can be tricky, because on top of all of the issues that a person will deal with in the recovery from a psychological addiction, there will be withdrawal symptoms with varying degrees of severity that the person must suffer through. Withdrawal from a physical addiction to alcohol, benzodiazepines, and barbiturates can be fatal if not addressed properly.
After someone has made the decision to remove a physically addictive substance from their life, it is wise to discuss the decision with a medical professional or addiction specialist. They can let you know your options for treatment. They can also help you locate a bed in a medical detox facility or hospital that can monitor you and safely wean you from the drug if necessary.
Even if you decide to wean yourself from the drug at home, you should still talk about it with your doctor. He or she can give you warning signs to watch for and advice on how to do it.
Though it isn’t common, some people can manage to go through a cold-turkey withdrawal from a substance that they are physically dependent on. This is hardly ever medically advised. More commonly a knowledgeable doctor can put the addict on a tapering schedule to come off of the medication. This way the dose of the medication can gradually be reduced and withdrawal symptoms will be minimized.
Medication-assisted treatment (MAT) is generally considered to be the gold standard of treatment, particularly in opioid addiction. This can eliminate the addiction aspect of the problem. That is, the addict will no longer need to engage in drug-seeking behaviors that can be dangerous or criminal, because they will not have to worry about going through opioid withdrawal while on the medication.
While they are on the medication, such as Suboxone or Methadone, they can receive therapy to begin treating the underlying cause of the addiction. This allows the addict to begin to focus on their recovery, which the dose of the medication is gradually reduced, providing a more comfortable tapering schedule.
One should be wary when considering this route though. Discuss the withdrawal protocol for the drug with the clinic that you choose. If they do not have a withdrawal protocol for the drug, do not go with this clinic. It is unfortunate that some clinics are exploitative and willing to keep the addict on the drug for too long, simply for the profit of the clinic.
Recovering from a Psychological or Physical Addiction
When the addict is first considering getting clean, recovery can seem impossible. At this point in someone’s addiction, they are likely friendless, jobless, penniless, and feeling completely broken. Remember that many recovered addicts have felt this way though. You are never totally alone when dealing with this problem because so many have come before you and successfully made it through to the other side.
Reach out to every resource available to you. If you still have friends and family, speak with them. Many communities have outreach programs for those suffering with addiction that can help you get placed into the proper treatment that you need. With proper treatment and care, a healthy, successful, long-term recovery is always possible–no matter the odds that you face when you begin the climb up that mountain.