What is drug dependence?

Drug dependence occurs when you need one or more drugs to function. The American Psychiatric Association (APA) used to distinguish between dependence and abuse. Abuse was considered the mild or early phase of inappropriate drug use that led to dependence. People viewed dependence as a more severe problem than abuse.

The APA replaced “dependence” and “abuse” with “substance use disorder” in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This diagnosis focuses on the disorder involving the use of the substance.

People sometimes use the terms “addiction” and “dependence” interchangeably. Dependence is not the same as addiction.


Addiction can occur without being dependent on drugs.

Addiction may involve:

  • using drugs despite the consequences
  • being unable to stop using drugs
  • neglecting social and work obligations because of drug use


It’s possible to be dependent on drugs without being addicted. Dependence can be a bodily response to a substance. This often occurs if you rely on medications to control a chronic medical condition. These conditions may include:

  • high blood pressure
  • diabetes
  • glaucoma

Dependence may involve:

  • some or all the symptoms of addiction
  • development of a high tolerance for the substance as your body adapts to the drug, leading to a desire for larger or more frequent doses
  • physical symptoms of withdrawal when you attempt to stop using the drug

The National Institute on Drug Abuse estimates 22.7 million Americans need help treating a drug or alcohol problem. In some cases, people may take a prescription medication for pain or another medical condition. This kind of use can sometimes develop into a substance use disorder.

The following are known triggers for substance use disorders:

  • having a family history of addiction
  • living in an environment where illegal drugs are often used and easy to access
  • having a history of anxiety
  • having a history of depression
  • having a history of other mental health conditions

Drug users typically pass through certain stages on the way to drug dependence. One way that healthcare providers describe these stages is with the Jellinek Curve. The curve tracks typical stages experienced through occasional use, dependence, disorder, and rehabilitation.

These stages include:

  1. You use drugs for recreation. You take them infrequently and in social settings.
  2. You start using drugs on a regular basis, often abandoning family and friends in favor of drug use. You become concerned about losing access to drugs.
  3. You become addicted to drugs as you become more tolerant to their effects and preoccupied with getting them. You may abandon most or all your previous interests and relationships.
  4. You become dependent on drugs and unable to live without them. Your physical and mental health deteriorates.

You can often determine if an addiction has turned into dependence by looking at behavior. When a person addicted to drugs hasn’t had them for a period of time, this can cause a physical reaction. Physical symptoms of withdrawal occur when the body becomes stressed without the drug. These symptoms include:

  • anxiety
  • depression
  • muscle weakness
  • nightmares
  • body aches
  • sweating
  • nausea
  • vomiting

When drug abuse escalates to dependence, treatment becomes complicated. You must stop using the drug, but doing so abruptly can cause physical symptoms. You may need the help of a healthcare provider to rid your body of the substance. This can be done on an inpatient or outpatient basis.

Substances that mimic the effects of illegal drugs may help reduce the symptoms of withdrawal during treatment. Detox programs use a combination of therapy and medical treatment to ease dependence and treat the disorder. Ongoing therapy sessions may be needed after you’re released from a treatment program.

Extreme cases of intoxication, withdrawal, or overdose may need emergency care before addiction and dependence can be treated.

If left untreated, dependence on illicit drugs can be dangerous. You may increase your drug use as your body adapts to the drugs. This can result in overdose or death.

Treatment can reverse dependence, but you must want to be treated. Sometimes, treatment is successful the first time, but relapse is common. Ongoing therapy and support groups can help you recover, stay on track, and address symptoms of relapse.