Dependence
dependence The physiologic or psychologic need to continue taking a particular DRUG. In physiologic dependence, predictable changes occur within the body that reconfigure or adapt a particular facet of function and result in the body's reliance on the substance to maintain that function. Often the body then reacts in unpleasant ways (WITHDRAWAL SYNDROME) when the person stops taking the substance. Physiologic dependence ends when the body completely clears all chemical traces of the drug. Drugs often subject to abuse that cause physiologic dependence include ALCOHOL, HEROIN, and opiate NARCOTICS such as morphine, hydrocodone, and oxycodone.
In psychologic dependence taking the drug results in pleasurable sensations and the desire (craving, when intense) to take the substance to obtain them. Though the drug causes chemical changes in the body that result in temporary alterations of function, the drug does not establish any physiologic adaptation. Psychologic dependence can be intense and does not correlate to the drug's
presence in the body. Because the body develops TOLERANCE to many drugs taken on a long-term basis (requiring a higher DOSE to achieve the same effect), the longer the person uses the substance the more likely he or she may experience some physiologic and psychologic symptoms when stopping the substance, representing the body's adaptation to the drug's absence. The nature of such symptoms depends on the drug. Drugs often subject to abuse that cause psychologic dependence include COCAINE, AMPHETAMINES, BENZODIAZEPINE drugs, and HALLUCINOGENS.
Though drug dependence is often a key factor in substance abuse and ADDICTION, it is not synonymous with either. Substance abuse and addiction encompass the ways in which people use the drugs and the behaviors in which they engage to obtain the drugs. Physiologic dependence occurs in numerous therapeutic applications-for example, with therapies involving systemic CORTICO-STEROID MEDICATIONS, ANTIDEPRESSANT MEDICATIONS, and antihypertensive medications. As well, a person may develop dependence on a substance commonly abused (such as a narcotic PAIN reliever or antianxiety medication) when taking it to legitimately treat a health condition and yet not abuse or have an addiction to that substance.
Symptoms and Diagnostic Path
Indications of drug dependence vary according to the drug. In a therapeutic context such symptoms reflect achievement of the desired effect of the drug-for example, suppression of the IMMUNE RESPONSE with corticosteroid medications or relief of symptoms with antidepressant medications or pain relief medications. In the context of substance abuse or addiction, indications of drug dependence may include attempts to obtain increasing quantities of the drug, taking the drug inappropriately, and obvious differences in behavior between when taking the drug and when not taking the drug.
Treatment Options and Outlook
Treatment for undesired or unintentional drug dependence, such as with corticosteroid or antide-pressant medications, consists of controlled weaning from the drug, a process that may take several weeks to complete. In circumstances in which
there is also substance abuse or addiction, extensive support and treatment such as PSYCHOTHERAPY are also essential. Though physiologic dependence ends when the drug is no longer present in the body, psychologic dependence can persist for weeks, months, or even years after stopping the drug.
Risk Factors and Preventive Measures
The primary risk factor for drug dependence is taking repeated doses of the drug. When doing so is to achieve therapeutic outcomes, drug dependence is desired and appropriate. When the purpose of taking a drug is other than therapeutic, not only is dependence possible but there is a high likelihood for substance abuse or addiction. As such use is detrimental to health, prevention efforts include restricting access to the drug along with education and therapy, if appropriate, to understand the health consequences of continued dependence and behavioral approaches to avoid use of the drug.
See also ANALGESIC MEDICATIONS; ILLICIT DRUG USE; PRESCRIPTION DRUG ABUSE; SCHEDULED DRUGS; SUBSTANCE ABUSE PREVENTION; SUBSTANCE ABUSE TREATMENT.
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