Opioid Dependence vs. Addiction: What’s the Difference?

Opioids are frequently prescribed medication used to treat both short-term and chronic ailments. They are highly effective at helping patients deal with pain but also have a high risk of reliance.

While they have various legitimate medical uses, opioids can also produce feelings of euphoria—though always with diminishing returns as tolerance increases. Hence, they carry with them the potential for abuse as users take more or stronger medication to chase the feeling of their original highs.¹

Abuse takes a few forms depending on the severity of the user’s reliance on opioids. This article will detail the differences in opioid dependence vs addiction and relay where to find help if you or someone you love wants to end their reliance on opioids. 

What Does Opioid Addiction (OUD) Look Like?

Opioid addiction, often referred to as Opioid Use Disorder (OUD), is a reliance on opioids despite its negative impacts on the user’s life. Individuals with OUD will continue to take opioids even if it affects their relationships, career, and body negatively. Opioid vs. opiate addiction are one in the same, however, the substances vary.

While some users may cover their addictions better than others, there are a few outward indications that opioid use is becoming a problem in someone’s life:

• Negative bodily changes such as rapid weight loss or gain
• Neglecting their appearance and scoffing at self-care
• Behavioral changes such as frequent mood swings
• Sudden, unexplainable financial insecurity²

If you or someone you know is exhibiting these symptoms, know that anyone has the potential to lose control over their hold on opioids. Unfortunately, certain individuals are more susceptible to slipping into OUD than others.

Factors That Can Predict a Person’s Susceptibility to OUD

While OUD is a disease that can affect any person, some people are more prone to be affected by opioid dependence vs addiction than others. There are a few factors that determine if someone is more likely to fall into opioid addiction: 

• Genetics – Some people are born with a tendency to succumb to addiction. Variations in the brain cell receptors and enzymes that process opioids in the body cause certain individuals to respond more potently to the positive chemicals (endorphins) released by the body when consuming opioids. This strong reaction fosters a greater compulsion towards habitual use and addiction.
  
• Personality – Individuals who exhibit certain character traits are more prone to developing OUD. Sensation-driven, anxious, impulsive, and hopeless people have a higher chance of experiencing addiction. 

• Mental health – OUD often arises in conjunction with, or in response to, other mental health disorders. People with Personality Disorders such as Bipolar Disorder and unmanageable anxiety have a far greater degree of susceptibility to addiction than those without them.³

OUD is a harsh and undiscriminating disease. Even if someone is clear of these predispositions, it’s still entirely possible for them to develop an opioid addiction. If you’re worried someone you know is losing control of their opioid use, they may have already developed an addiction.

Signs of Addiction

Sometimes, it can be difficult to distinguish between medical use of opioids and abuse, especially when they’ve been prescribed by a doctor. Still, there are ways to determine when one is taking it too far. Some telltales signs of opioid addiction include:

• Feeling compelled to use opioids regularly
• An overwhelming fixation on the drug that leaves the user unable to think of anything else
• Failing to meet work or social obligations due to the use
• Taking higher than recommended doses in search of the high, rather than for its medical qualities
• Attempting to quit and failing
• Experiencing withdrawals when attempting to quit²

If you or a loved one is going through any of these, there’s a good chance opioid addiction may have already taken hold. Thankfully, all is not lost, and there’s hope for recovery.

Addiction Treatment Options

While opioid addiction is a multifaceted issue and the factors behind it are complex, only a couple of different treatment methods are commonly considered effective. To treat the effects of OUD, one can choose:

• Medications such as methadone – In order to curb the effects of withdrawal symptoms, many quitting users elect to use methadone or other similar drugs. These medications don’t deliver the high of harder opiates when professionally administered, but can help users feel relief from the intense discomfort and pain quitting opioids inflicts on the body.

• Rehabilitation – Users often seek out rehabilitation facilities in conjunction with withdrawal-relief medications to help them stay off opioids. Counseling and psychiatric guidance can help treat the root causes of why an individual began abusing and set them on a healthy path forward post-recovery.³

What Does Opioid Dependence Look Like?

While they may sound similar in name, Opioid Use Disorder vs. dependence differ significantly. Dependence refers to a user’s reliance on a substance—either physically or psychologically—whereas addiction is an unshakable compulsion to do that drug, despite the costs. 

While users with OUD are indeed dependent on opioids, not all people who are dependent on opioids have OUD. So then, what are the signs of opioid dependence?

• Frequent use of opioids to deal with pain or a recurring medical condition
• Increasing doses to achieve the same effects and feelings of relief
• Physical symptoms of withdrawal between periods of use
• Maintaining a high degree of normalcy in social and work life whilst using⁴

Even users who are prescribed opioids can develop a dependency on them. Opioids can alter brain chemistry in the user until they rely on them more to feel normal. Users with a medical necessity for opioids that still feel a degree of reliance are a prime example of opioid dependence vs addiction. 

Types of Opioid Dependence

Unlike addiction, which is driven primarily by the user’s physical need to do more opioids until they achieve a state of high or normalcy, dependency materializes in a few forms. 

Like any chemically-addictive substance, opioids create a physical dependence in the user over time and repeated use. They can foster a psychological dependence in their users as well, however, even if physical dependence has yet to manifest.

But what are the differences between the two, and how can one determine which an opioid-dependent user is dealing with?

See related: How Long Do Opioids Stay in Your System?

Physical Dependence

Physical dependence on a drug means one’s body literally needs to ingest certain chemicals to feel and function normally. Physical dependence isn’t an immediate consequence of opioid use, but instead sets in via a recognizable process:

1. A user begins using opioids and experiences the intense rush of endorphins associated with early use.
   
2. The effects wear off and the user experiences a low, driving them to seek more opioids.

3. With continued use, the body begins to slow its natural endorphin production.

4. The user begins to rely on opioids to feel the positive feelings normally instigated by endorphins.

5. As the body produces fewer endorphins and more of its receptors are blocked, a user must increase their dose to reach a high (or even normal) state.⁵

Once the body has reached a state of physical dependence, it can be very difficult to wean off opioids. It can be equally as difficult to quit for those who have developed a psychological addiction, however.

Psychological Dependence

Psychology plays a large part in why people end up dependent on drugs. Not only do opioids present an escape from physical pain, but can alleviate feelings of stress, depression, and self-loathing. This relief is always temporary, however, and requires the user to keep feeding their habit to obtain this state of peace.

Psychologically-dependent users are generally more self-aware about their relationship to opioids. A few signs of psychological dependence include:

• The user knows opioids are causing them harm but continues to use them anyway.
• They use opioids as a form of escapism rather than to deal with physical pain.
• They turn to opioid use to deal with feelings of stress and other psychological burdens.⁶

Symptoms of Opioid Dependence

Whether a user exhibits dependence psychologically or physically, the symptoms remain the same. Some are similar to the symptoms of addiction, including:

• Opioid withdrawal
• Increasing dosages
• Fear or anxiety over not being able to use

In individuals with OUD, these symptoms may be more pronounced, they can also manifest in people with dependence. Some symptoms more unique to dependent individuals include: 

• Erratic, shifting sleep patterns
• Unpredictable changes in mood
• A reduction in decision-making abilities
• Taking opioids preemptively to avoid future pain or withdrawals⁷

Now, how long does opioid withdrawal last in addicted individuals? Usually, the most intense symptoms of withdrawal occur after 24 to 72 hours after the last dose. However, the psychological effects can last months. If you notice these symptoms in yourself or someone you care about, there are options available to help break dependence before it develops into addiction. 

Opioid Dependence Treatment Options

Much like OUD, there are options available to help users curb their opioid dependence. And, also similar to those with OUD, dependent individuals can choose chemical and psychological routes to help end their reliance:

• Medication – The withdrawal symptoms associated with physical dependence can drive users back to opioids. Many elect to use methadone and other medications to help get clean, even if they haven’t yet developed a full-blown addiction.

• Psychological counseling – Identifying the patterns that lead users to become psychologically dependent on opioids can help them avoid such issues in the future. Dealing with the trauma or mental conditions that initiated one’s dependence increases the chances of staying off drugs—especially if they no longer seek to mask or hide from these feelings.⁶

Rehabilitation and Psychological Counseling To Get and Stay Clean

If you or someone you know is struggling with opioid addiction or dependence, rehab might be the best place for them to kick their habit and start with opioid detox. Rehabilitation can help users get to the root cause of why they began to use, deal with the personal issues that fuel their drug habit, and help them reach a state of mind where they want to stay clean.

Elevate Rehab offers holistic rehab, including opioid treatment, with physical, mental, and spiritual guidance to get users back on the right track in life. 

If you or someone you know could benefit from opioid addiction treatment, contact us to learn how we can help.

Sources: 

1. Government of Canada. Opioids. https://www.canada.ca/
2. The Mayo Clinic. Drug addiction (substance use disorder). https://www.mayoclinic.org/
3. Center for Addiction and Mental Health. Opioid Addiction. https://www.camh.ca/
4. National Library of Medicine. Opioid Addiction. https://medlineplus.gov/
5. The Mayo Clinic. How Opioid Addiction Occurs. https://www.mayoclinic.org/
6. National Library of Medicine. The Neurobiology of Opioid Dependence: Implications for Treatment. https://www.ncbi.nlm.nih.gov/
7. The Mayo Clinic. How to tell if a loved one is abusing opioids. https://www.mayoclinic.org/
8. Families for Addiction Recovery. What are the risk factors?. https://www.farcanada.org/