Physical addiction or psychological addiction – Is there a real difference?

This is another one of the basic questions I get regarding addiction.

It seems that people think about physical addiction and psychological addiction as somehow separate processes. I think this distinction makes no sense. Even if people really meant what they were saying, the brain is undoubtedly part of the body, and therefore, psychological addictions are also physical.

The “Physical Addiction” Vs. “Psychological Addiction” truth

blackboardWhat people are really referring to when they make this comparison is the distinction between physical withdrawal symptoms and the addictive process in the brain. There’s no doubt that some substances, like alcohol, opiates, and the likes, leave long term users with horrible withdrawal symptoms that are terrible to watch, and even worse to go through. In fact, early addiction theories asserted that it was this horrible withdrawal syndrome that made people go back to drugs. This was called the Tolerance-withdrawal addiction theory.

The Tolerance-withdrawal addiction theory fell apart when addictions to substances that didn’t display such withdrawal effects became obvious (like cocaine addiction), and when getting people through the difficult withdrawal proved insufficient to cure their addiction (naltrexone was thought to be the magic cure once upon a time).

In one of my previous posts about marijuana addiction, a reader suggested that since marijuana does not produce horrible withdrawal symptoms, it can not be physically addictive. While withdrawal from marijuana, cocaine, methamphetamine, nicotine, and numerous other drugs does not result in the stereotypical “opiate-withdrawal-flu-like-syndrome,” there is no doubt that real withdrawal from these substances exists for long term users and it sucks: Fatigue, depression, anxiety, sleep disturbances, and trouble eating are only some of the symptoms that tend to show up.

Withdrawal – The real physical addiction

Withdrawal symptoms occur because the body is attempting to counteract the stoppage of drug ingestion. Just like tolerance builds as the body adjusts to chronic drug use, withdrawal occurs as the body reacts to its cessation.

As crystal meth increases the amount of dopamine present in the brain, the body reacts by producing less dopamine and getting rid of dopamine receptors. When a user stops putting meth in their body, the low production of dopamine must increase and additional receptors must be inserted. Like tolerance, the process of withdrawal, even past the initial, obvious, symptoms, is a long and complicated one. For crystal meth addicts, the initially low levels of dopamine result in what is known as anhedonia, or an almost complete lack of pleasure in anything. There’s no mystery as to why: Dopamine is one of the major “pleasure” neurotransmitters. No dopamine, no pleasure.

The process of addiction in the brain

So, if we’re going to try to dissect which drugs cause what effects on the body, it’s important that we understand the underlying causes for those effects and that we use the proper language. Withdrawal, tolerance, and addiction are different, though obviously related topics. Their interplay is key for understanding the addiction process, but their more subtle points can often be lost on those observing addicts unless they are well trained.

As I’d mentioned in earlier posts, our current best notions about addiction are that the process involves some obvious physical and psychological processes and some much more subtle effects on learning that are still being studied. A study I’m currently conducting is meant to test whether drugs interfere with some of the most basic learning processes that are meant to limit the amount of control that rewards have over behavior. Such fine distinctions are no doubt the result of the ways in which drugs alter the neurochemical reactions that take place in our brain. Such basic changes can not possibly be seen as any less important than physical withdrawal symptoms.

All in all, the only way to look at Addiction is as both a psychological addiction AND a physical addiction that are inextricably liked through our psyche’s presence in the brain, a physical part of the body. It may seem like a small thing, but this distinction makes many users feel as if their problem is less, or more, sever than that of other addicts. As far as I’m concerned, if you have a behavior that is making your life miserable and which you can’t seem to stop, it doesn’t matter if you’re throwing up during withdrawal or not. It’s an issue and you need help.

5 responses to “Physical addiction or psychological addiction – Is there a real difference?”

  1. It seems to me the common belief about the difference between physical and psychological addiction is a consequence of history. Alcohol and heroin were thought of as being more addictive because of the physiological problems caused by withdrawal. It’s a nice tidy explanation that fits with simple observations.

    The concept of psychological addiction (and the biological correlates) is difficult because it doesn’t jive with many people’s assumptions about psychology.

  2. Does anyone know if there are potential drug targets for motivation in general? There could be some amazing (although perhaps ethically troubling) experiments looking at what people might learn from experiencing a complete lack of desire. The dosage of a drug like this could also be regulated so that it just brings the desire level down in general, or might even be able to put a cap on desire so that normal levels of desire could exist but extreme desires would be cut off – this might help addicts deal with the psychological aspects of addiction while their physiological systems come back to homeostasis…

    Also, I know there are some really amazing experiemnts with fear extinguish (I think Joseph Ladoux’s lab has done some of this), has anyone looked at desire extinguishing, using similar paradigms?

  3. I think that when it comes to desire, one has to separate the aspect of wanting from the actual experience.
    The problem is that at least to some extent, both of these rely on dopamine release, though the source of their difference is still unclear as far as I know.

    There have certainly been dopamine depletion experiments that have shown great reductions in reward seeking in general. If we could come up with a way to limit the desire specifically for the unwanted reward (as in drugs), but not for natural rewards that are potentially important for recovery, there would be our silver bullet.

    If you have any ideas I’d love to get in on the research.

  4. Fascinating discussion. With curious and knowlegable, dilligent minds like yourselves we will find the answer to whether there will ever be a “silver bullet” or not. Answer might lie in a behavior concept. I’ve seen transferring a desire (using the alternative desire) to a less harmful obsession, and using that as the silver bullet. (withholding or bargaining leverage) ex: safe sex.

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