While withdrawal symptoms associated with some classes of drugs tend to be mostly emotional or psychological compared to severe physical withdrawal symptoms associated with other drugs, researchers and clinicians recognize that a withdrawal syndrome from any substance of abuse includes both physical and psychological components.
What Is Addiction?
The National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM), and similar organizations define addiction as a complex condition (often stated as a brain disease) that is characterized by compulsive substance use in spite of detrimental consequences.
People with addictions, or substance use disorders, maintain a very strong pattern of using their substance of choice even though they know it will cause them problems.
Earlier conceptualizations of addiction were heavily influenced by physical dependence on drugs or alcohol being the defining characteristic of addictive behaviors. This was essentially the development of a withdrawal syndrome when someone stops or cuts down on use of a substance.
Although withdrawal symptoms remain an important component in the definition of substance use disorders, they are neither necessary nor sufficient for anyone to be diagnosed with a substance use disorder.
How Are Addictions Diagnosed?
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 19 to 20 million people in the United States suffer from some form of substance use disorder.
The diagnosis of a substance use disorder is based on behavioral criteria that are formulated into diagnostic symptoms by APA. In order to be diagnosed with an addiction, a person must meet a specific number of these diagnostic criteria, and the substance use must also result in the person experiencing significant distress and/or impairment in everyday functioning.
There are no medical tests that can be used to diagnose any type of addiction.
What Is Physical Addiction?
Older notions concentrated on the physical aspects of withdrawal as defining features of addiction. Even today, the term physical addiction is used to primarily refer to two aspects of addictive behaviors that commonly occur in substance abusers: tolerance and withdrawal.
People who experience withdrawal symptoms always develop some level of tolerance to the drug first. Withdrawal symptoms signify physical dependence on the substance. Displaying physical dependence alone does not necessary  mean that you have developed a substance use disorder.
What Is Tolerance?
Tolerance is a common result of repeated use of a drug. When you continue to use a drug on a regular basis, your body makes adjustments by increasing its production of hormones and neurotransmitters that offset the effects of the drug. Use of the drug itself results in an increase or decrease in certain hormones or neurotransmitters.
Over time, the effects of the drug are counterbalanced by the adjustments your body has made. You will then need more of the drug to get the same effects you once received.
In people who regularly abuse substances, tolerance means they take larger and larger amounts of the drug but get diminishing returns on its effects. Their bodies continue to offset the effects of the drug, so they experience less of a high while taking more of the drug.
What Is Physical Dependence?
A withdrawal syndrome occurs from chronic use of many different drugs. As described above, your body produces certain hormones and neurotransmitters that act in opposition to the effects of the drug.
When you stop taking the drug or significantly cut down on the amount you use, it results in severe discomfort. The higher levels of hormones and neurotransmitters your body is producing result in physical symptoms like nausea, vomiting, heartbeat irregularities, fever, chills, sweating, pain, and even seizures, in some cases.
In many cases, withdrawal syndromes are so severe that users continue to seek out their drug of choice just to avoid withdrawal.
What Is Psychological Addiction?
Based on some of the older notions of addiction, a psychological addiction means that the person does not experience significant physical withdrawal symptoms when they cut down their dosage or stop using the drug.
Instead, they primarily suffer from emotional symptoms. Psychological symptoms include cravings, depression, anxiety, trouble sleeping, and problems with concentration.
In the past, many clinicians considered psychological addictions to be less severe than physical addictions.
A Mixed Picture
The reality is that all psychological behaviors have a significant physical component to them, and all physical reactions are associated with significant psychological consequences.
Someone who is severely nauseated and ill will often also be emotionally distraught. Psychological symptoms like anxiety and depression are known to have complicated physical mechanisms that contribute to their severity.
In the current conceptualization of substance use disorders, there is no such thing as any form of addiction that is just a physical addiction or just a psychological addiction. Some types of drugs produce more prominent emotional or psychological symptoms during withdrawal, and others produce more powerful physical reactions, but all substance use disorders involve a combination of both physical and psychological mechanisms.
Is It Possible for a Substance to Be Habit-Forming and Not Addictive?
Yes, you can use a habit-forming substance regularly but not be addicted to it.
A substance use disorder (an addiction) has the following features:
- The use of the substance results in significant distress or impairment in everyday life.
- The person demonstrates issues controlling their use of the substance in numerous contexts or according to the diagnostic criteria.
- The person continues to use the substance despite it causing issues with physical health, emotional functioning, at work, at school, or in other important areas of life.
- The person may develop significant tolerance to the substance.
- The person may develop a withdrawal syndrome associated with discontinuing the substance.
Based on these criteria, people who only use a specific drug for medical reasons and according to the instructions provided by their physician would not be diagnosed with a substance use disorder, even if they develop tolerance and withdrawal. Medicinal use of a substance is not considered to reflect addictive behavior.
When the person begins to lose control of their use of the substance and to compulsively use it in different contexts, they have developed a substance use disorder.
You may habitually drink caffeine and feel lousy when you do not get your cup of coffee in the morning, but that does not necessarily mean you have an addiction. Remember that your use of a substance must cause significant distress or impairment in functioning, and you must demonstrate noteworthy problems controlling your use of the substance over different instances.
You can use certain substances, like caffeine and other drugs that could be considered habit-forming, but not struggle with addiction to them. On the other hand, you can be diagnosed with a caffeine use disorder (a substance use disorder as a result of caffeine use) if you met the diagnostic criteria for that disorder based on your use of caffeine.
Signs of Concern
If you are concerned you have developed an addiction to a substance, that concern itself is a sign that you should speak with a licensed mental health care professional. You cannot diagnose yourself, and substance use disorders require an evaluation and formal diagnosis from a medical professional.
The following are other general signs that should be concerning:
- Continuing to use a substance even though it is causing problems with relationships, at work, or at school
- Continuing to use the substance even though it is causing you problems with physical health or emotional functioning
- Spending a lot of time using the substance, trying to get the substance, or recovering after you use the substance
- Frequently using any controlled substance without a prescription, using any illicit substance, or frequently combining a drug with other substances like alcohol
- Using any medication in a manner that is contrary to its intended use, such as grinding up capsules or pills and snorting the powder, or mixing them with water and injecting the solution
- Using drugs or alcohol to relieve stress
- Feeling ill, irritable, and unmotivated when you stop using a substance
- Hearing repeated comments from other people that you may be abusing drugs or alcohol
The Modern Definition of Addiction
Ultimately, today’s definition of addiction doesn’t account for substance use disorders that are purely physical or purely psychological. Instead, addictions include elements that are both physical and psychological.
Physical dependence, illustrated by withdrawal symptoms when not using the drug, requires specialized medical care to ensure a safe and comfortable withdrawal process. If physical dependence is not present, medical detox is generally not needed. That being said, the supervision and support of medical detox can greatly help to prevent relapse during the particularly vulnerable phase of early recovery when a person first attempts to go without their substance of choice.
Whether or not withdrawal symptoms are present, addiction involves a psychological process that must be addressed in comprehensive therapy. While a prior delineation between psychological addictions and physical addictions indicated that psychological addictions were not quite as serious, this has been shown to be untrue. All addictions require comprehensive care.
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