Dependence and Tolerance

There is a Difference Between Dependence and Addiction

Physical dependence and addiction are two different sides of the same coin. It is difficult to discern the difference for some people, especially regarding pain medication. With pain pills, the need to increase dosages for pain relief can indicate either addiction or dependence. Review the basic criteria for each to better identify dependence versus addiction.

What is Drug Dependence

Physical dependence may occur during the use of many drugs, even if prescribed for medical reasons. Dependence is not addiction. Two characteristics of physical dependence include:


The human body adjusts to support the physical and psychological functions which is automatic and uncontrollable. When any foreign substance is added to the body, it will adjust itself accordingly, for better or worse. The body will compensate by producing highly complex interactions to maintain balance or return systems to functioning within a normal range.


Physical dependence on a drug or substance means the body adapts to drugs in order to maintain homeostasis and continue to function at the new normal level. Less natural dopamine is produced in the brain in order to compensate for dopamine triggered by drugs. When the drugs are stopped, dysphoria, depression and withdrawal symptoms kick in.

What Tolerance Means

Tolerance is the body’s way of creating balance when more of the drug is needed to achieve the same effect. The body essentially gets used to the drugs in the system and compensates accordingly. Withdrawal is drug-specific physical or mental symptoms which manifest if drug use is cut back or ceased altogether. Tolerance and withdrawal are two defining features of physical dependence but psychological compulsion and cravings may also be present which will characterize use as ‘addiction.’

What is Addiction

During any addiction, the person will seek out the drug of choice compulsively. What makes addiction different to dependence is that psychological impairment or distress is present. Tolerance and withdrawal are diagnostic indicators of addiction and may be accompanied by mental health problems. Three or more of the following must be present in the same 12 month period to characterize addiction:

  • Tolerance, defined by a need for increased amounts of a substance or diminished effect with continued use of the same amount of substance over time
  • Withdrawal, defined as symptoms which start when the substance is taken in lower doses or stopped or when a substance is used to avoid or defer withdrawal symptoms
  • Persistent desire or unsuccessful attempts to curb use
  • Spending lots of time on activities necessary to obtain the substance, use or recover from the effects
  • Forfeiting or reducing important activities related to social or recreational obligations due to use
  • Continued use despite known consequences

Clinical Diagnosis

The American Psychiatric Association (APA) holds the standard for addiction diagnosis. Currently, the outlined characteristics represent what needs to be present in order for addiction to be diagnosed. Dependence was used in the past but now has alternative meaning as noted here.

If you believe a loved one exhibits some or all of the above symptoms and needs help, call The Villa. Let us help you discover the best next steps for the recovery journey.