Dependency and Addiction Discriminated

"Dependency" has taken on a darkly suggestive meaning in the modern world, especially when it comes to the use of substances. But, is dependency always a bad thing? Ask a person you know who has Type I ("Juvenile", insulin dependent) Diabetes if they feel that their need for insulin on a regular basis is tantamount or in any way comparable to a destructive addiction.

Sometimes the medicines which bring the greatest risks into our lives are the ones that work! There are the substances, some of which are medicines that do exactly what we hope they will do for us. The risk, of course, is that we may become dependent upon them.

Dependency can be a destructive thing at the point where it becomes an addiction. This point is understood to be reached when the substance being used in the quest for relief, actually 'fixes' the problem as a permanent condition requiring ongoing (or increasing) administration of the substance to relieve the discomfort and pain associated with it. This is often, but not always, the path to alcohol and drug addictions.

The distinctions between regular use of a necessary medicine and addictions are clear and well described. Two good resources on the subject are here and here.

Certain medical conditions require ongoing medicinal interventions, not to keep the illness form healing, but to supplement body chemistry that may be lacking and therefore, inhibiting a person's otherwise greater resiliency.

Certainly, dependency and addiction can go hand in hand, but dependency can be a function of medical necessity and a deliberate intervention while addiction is, more often, a consequence of other problems.

The management of chronic pain is another area in which the two issues seem to overlap and the issues get a bit obfuscated.

The waters in these two areas have become increasingly muddied in recent years with concepts like "Medical Marijuana." While there is no question but that the chemically active ingredient in Marijuana (THC Delta9) can generate appetite in those whose other treatments are destroying their urge to take nourishment (like many people undergoing radiation chemo-therapy for cancers of different types), it is also well known that many people who have used 'weed' for year, not of medical necessity but out of habit and life-style choices, have obtained Medical Marijuana Cards from physicians sometimes too quick to authorize them so that their addictive behavior can be both sustained and argued as being medically necessary. After all, they say, "I have a note from my Doctor."

Is the daily blunt to someone who cannot tolerate not being high to be regarded as an equivalent phenomenon to the diabetic's need for Insulin? I hope not. Is the need of an alcoholic for a six-pack on return from work every day the same thing as a person with high blood pressure taking corrective medicine for it to stay off the risks of heart attack and stroke?

I am aware as I write this that some people reading it will come to the conclusion that these are the ravings of a medically conservative zealot who does not understand that street drugs and alcohol can be 'real' medicine.

In 35 year of direct clinical practice, much of it in tandem with physicians and osteopaths, I plead guilty to insisting that street drugs and alcohol, though they may share some superficial attributes with prescribed medications, are not medicines but the fuel for destructive addictions.

Of course, as with most other things, there are exceptions, like using Marijuana with certain Cancer patients and with some people who experience chronic pain. The literature in both areas, remains strangely short and limp given the number of years the issue has been subject to controlled clinical investigation.

Contemporary research links have established relationships between disorders like Depression and Drug Dependence. The suggestion is that it takes the pain away in the moment, but renders the life of the pain eternal.

Dependence can be a function of addiction, but in and of itself, does not destroy the individual's life. Professionally evaluated and prescribed medicines are simply not the same thing as available street drugs and alcohol that people use in an attempt to 'self-medicate' conditions their efforts will only make worse over time.

Dependence can be necessary and good for you. Addiction can never, by definition, be.