Tolerance, Dependence, Addiction: Is There a Difference?

Man suffering from addiction feels hopeless

Dane O'Leary July 8, 2020

Tolerance, chemical dependence, and addiction are often-used terms when talking about substance use issues. If you, or a loved one, are struggling with substance use, it’s important to understand the differences implicated in these terms. Accurately describing a serious mental health condition matters. 

It’s also important to keep in mind that words carry the weight of connotation. 

In this blog post, we channel our inner word nerd and explain the differences between these three inter-related terms and discuss some benefits of accurate terminology. 

Definitions of Tolerance, Chemical Dependence, and Addiction

Let’s look at definitions of each of these terms. 

Tolerance or Chemical Tolerance

Tolerance is when someone takes the same dosage of a drug or chemical they regularly take but their body reacts differently. Usually, this difference is a decreased or diminished reaction, or in severe cases a lack of reaction at all. 

When the body is tolerant to the effects of a drug, it needs a higher dosage to create the same effect. A person taking increasing amounts of a drug to recreate the same intensity is a telltale sign they’ve developed chemical tolerance. 

Tolerance isn’t specific to illicit drug use. A person can develop a tolerance to drugs like caffeine and nicotine too. Becoming tolerant of prescribed medications is also possible. 

Dependence or Chemical Dependence

Someone who is chemically dependant experiences withdrawal when they stop using a substance. It’s a term that refers to the physical dependency the body develops from long-term drug use. 

For example, studies show that consuming a lot of coffee causes chemical dependency on caffeine as it blocks the brain’s adenosine receptors. As a result, caffeine withdrawal occurs when we stop drinking coffee. Considering stronger substances, a person who stops taking heart or anxiety medication may need to taper their daily dosage to avoid experiencing withdrawal symptoms as their bodies adjust to functioning without the drugs. This means they are chemically dependant on the medication but don’t necessarily have an addiction.

Addiction

Addiction, tolerance, and chemical dependence all result from repeated drug use but are three separate and different conditions.

Addiction is a chronic brain disease known as substance use disorder. It’s hallmarked by compulsive drug-seeking behavior and the presence of drug cravings. If a person keeps using drugs despite negative consequences caused by their drug use, or tries to stop but can’t, they’re considered addicted. Addiction, tolerance, and chemical dependence all result from repeated drug use but are three separate and different conditions.

Comparing Tolerance, Chemical Dependence, and Addiction

Let’s highlight the differences between these conditions through comparison. 

Tolerance vs Dependence

Although the two terms are related, there are distinctions to make between them. Tolerance is the term that refers to how a person’s body becomes accustomed to a drug over time. When the body has become tolerant of the substance, the individual has to increase his or her dosage over time to achieve the desired effects.

On the other hand, chemical dependence is more akin to physiological addiction. When a person has become dependent on a substance, this usually means that he or she experiences withdrawal symptoms after stopping his or her intake of the substance for only a moderate period of time. 

Is Chemical Dependence the Same as Addiction?

No, chemical dependence isn’t the same as addiction. In other words, a person experiencing chemical dependence doesn’t necessarily have an addiction.

As more of about a person’s physical and physiological response to substance use, dependence denotes the body’s physical response to repeated drug use. By comparison, addiction is a more complex condition that is both physiological and neurological with a wide mental health scope. As for the relationship between the two, you might consider dependence to be both a possible forerunner to addiction as well as one facet of an addiction diagnosis as a whole. 

Addressing chemical dependence is actually the first step of most addiction treatment programs through a type of treatment program called detoxification, or detox for short. But unlike chemical dependence, an addiction calls for much more than medical management of withdrawal side-effects since a person who’s addicted to alcohol or drugs isn’t only dependent on the substance physically. When actually addicted, a person must contend with the impulse to use, relentless drug-seeking behavior, cravings, and other aspects of addiction that are addressed over the course of an integrated addiction treatment program. 

Chemical dependence is addressed in detox. Then the patient contends with drug-seeking behavior, cravings, and other aspects of addiction over the course of treatment.

Grasping the differences in terminology like chemical tolerance, chemical dependence, and addiction not only provides a better understanding of the facets of addiction, it also carries other important benefits. 

The Importance of Accurate Addiction-Related Terminology

As we continue to have discussions about substance abuse and addiction, it’s important that we make an effort to use the correct language. And it’s not just a matter of making sure that we’re conveying our thoughts with accuracy.

Reliability of Addiction Diagnoses 

In 2006, the medical community voiced a need for change when it comes to the terminology surrounding addiction. To address these concerns, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is what doctors use to diagnose mental health disorders, combined what was previously two separate conditions — substance abuse disorder and substance dependency — into a singular condition: substance use disorder. 

This simplification was beneficial for a number of reasons. For one thing, it eliminated much of the confusion that resulted from having addiction effectively split between two separate disorders. Additionally, this move strengthened the reliability of addiction diagnoses by minimizing the likelihood that chemical tolerance or withdrawal symptoms resulting in an automatic diagnosis of addiction. 

Another notable benefit is that it helped to address the fear, bordering on paranoia, that some individuals have when it comes to the possibility of being prescribed opioid medications for pain management. This was largely the result of how the DSM previously classified tolerance and its relationship to substance abuse disorder, which was widely considered to be why so many people had been refusing pain medication and sacrificing their quality of life. This serves as a powerful demonstration of the influence that accurate language can have on a mental health diagnosis. 

Ending Addiction Stigma

With addiction-related language being more distinct and clear, many people find themselves with a deeper understanding of addiction. Since this elevates the way people speak about this treatable illness, a pleasant side effect is that we’re seeing the long-standing addiction stigma begin to fade. Even something as simple as replacing the word “abuse” with “use,” which is what was done in the latest edition of the DSM, has done a lot to reshape semantics in addiction language. 

Consider the difference between “drug use” and “drug abuse.” While the latter may technically be more true, it’s also more inflammatory and has negative connotations. By comparison, “drug use” is less stigmatized unbiased, cultivating more compassion and a more level-headed approach to issues of chemical tolerance, dependence, and addiction.   

Woman receives support while in rehab for addiction

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