Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of
withdrawalWithdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol...
result from abrupt discontinuation or dosage reduction. Physical dependence can develop from low-dose therapeutic use of certain medications as well as misuse of recreational drugs such as alcohol. The higher the dose used typically the worse the physical dependence and thus the worse the withdrawal symptoms. Withdrawal symptoms can last days, weeks or months or occasionally longer and will vary according to the dose, the type of drug used and the individual person.
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of
withdrawalWithdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol...
result from abrupt discontinuation or dosage reduction. Physical dependence can develop from low-dose therapeutic use of certain medications as well as misuse of recreational drugs such as alcohol. The higher the dose used typically the worse the physical dependence and thus the worse the withdrawal symptoms. Withdrawal symptoms can last days, weeks or months or occasionally longer and will vary according to the dose, the type of drug used and the individual person. From the point of view of the dependent person, "dependence is duress," argues addiction researcher
Griffith EdwardsGriffith Edwards, CBE was born in India and received his M.D. from Oxford University, since which time he has focused on the study and treatment of alcohol and other drug dependence and related aspects of addictions...
.
Symptoms
Physical dependence can manifest itself in the appearance of both physical and psychological symptoms but which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Some symptoms which may be experienced during withdrawal or reduction in dosage can include increased heart rate and/or blood pressure, sweating, and tremors are common signs of withdrawal. More serious
withdrawalWithdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol...
symptoms such as
confusionConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...
, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical care. Sedative hypnotic drugs such as
alcoholEthanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug, best known as the type of alcohol found in alcoholic beverages and in modern thermometers. Ethanol is one of the oldest recreational drugs...
, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as
opioidAn opioid is a chemical that works by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract...
s or psychostimulants, can exaggerate mild to moderate
neurotoxicNeurotoxicity occurs when the exposure to natural or artificial toxic substances, which are called neurotoxins, alters the normal activity of the nervous system in such a way as to cause damage to nervous tissue. This can eventually disrupt or even kill neurons, key cells that transmit and process...
side effects due to
hyperthermiaHyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate...
and generation of free radicals, but life-threatening complications are very rare.
Treatment
Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued. Physical dependence is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual. A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms.
Difference from addiction
Physical dependence is different from psychological dependence (
addictionThe term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The...
). The latter is often characterized by a compulsive need for a drug for psychological reasons, while the former is characterized by need for the drug due to tolerance and the need to prevent withdrawal symptoms on discontinuing the use of a drug. Physical dependence however, commonly occurs with both addiction and therapeutic use of drugs.
Drugs that cause physical dependence
- nicotine
Nicotine is an alkaloid found in the nightshade family of plants which constitutes approximately 0.6–3.0% of dry weight of tobacco, with biosynthesis taking place in the roots, and accumulating in the leaves...
- opioid
An opioid is a chemical that works by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract...
s
- barbiturate
Barbiturates are drugs that act as central nervous system depressants, and, by virtue of this, they produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, hypnotics and as anticonvulsants. They have addiction potential, both physical and...
s
- benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s (see benzodiazepine dependenceBenzodiazepine dependence or benzodiazepine addiction is the condition when a person is dependent on benzodiazepine drugs. Dependence can either be a psychological dependence or a physical dependence or a combination of the two...
and benzodiazepine withdrawal syndromeBenzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or reduces the dosage too rapidly...
)
- nonbenzodiazepines, such as zopiclone
Zopiclone, sold as Imovane in Canada, and Zimovane in the UK, is a non-benzodiazepine hypnotic agent used in the treatment of insomnia. In the United States, zopiclone is not commercially available, although its active stereoisomer, eszopiclone, is sold under the names Lunesta...
- ethyl alcohol (alcoholic beverage
An alcoholic beverage is a drink that contains ethanol . Alcoholic beverages are divided into three general classes: beers, wines, and spirits....
)
- GHB
γ-Hydroxybutyric acid , also known as 4-hydroxybutanoic acid and sodium oxybate, is a naturally-occurring substance found in the central nervous system, wine, beef, small citrus fruits, and almost all animals in small amounts. It is also a neuroprotective therapeutic nutrient that is...
- methaqualone
Methaqualone is a sedative drug that is similar in effect to barbiturates, a general CNS depressant. Its use peaked in the 1960s and 1970s as a hypnotic, for the treatment of insomnia, and as a sedative and muscle relaxant...
(Quaalude)
- caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that is a psychoactive stimulant drug. Caffeine was discovered by a German chemist, Friedrich Ferdinand Runge, in 1819. He coined the term kaffein, a chemical compound in coffee, which in English became caffeine...
- blood pressure medications such as beta blockers
- androgenic-anabolic steroids
- glucocorticoids
Rebound syndrome
A wide range of drugs whilst not causing a true physical dependence can still cause
withdrawalWithdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol...
symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal. These can include stimulants,, antidepressants, anticonvulsants, steroidal drugs and antiparkinsonian drugs. Antipsychotics are another drug class that do not cause true physical dependency but if discontinued too rapidly can cause an acute withdrawal syndrome. Drugs like
cocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system and an appetite suppressant...
, marijuana, amphetamines, and hallucinogens can be associated with minimal physical dependence but can still cause withdrawal or rebound symptoms. However, with sustained and heavy cocaine abuse signs of physiological dependence may occur. When talking about illicit drugs rebound withdrawal is, especially with stimulants, sometimes referred to as "coming down" or "crashing".
Some drugs, like anticonvulsants and antidepressants, describe the drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalize their potential for physical dependence or incidence or severity of rebound syndrome as a group so need to be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect. SSRI drugs, which have an important use as antidepressants, are not considered to cause physical dependence, but it's generally accepted that they cause a
discontinuation syndromeSSRI discontinuation syndrome is the withdrawal that can occur during or following the interruption, lowering of dose, or discontinuation of regular SSRI or SNRI antidepressant drug use...
. Due to this, in Europe these drugs cannot be advertised as "non-habit forming". There has however been case reports of dependence with venlafaxine (Effexor).
See also
- Addiction
The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The...
- Addiction recovery groups
Addiction recovery groups are voluntary associations of people who share a common desire to overcome drug addiction. Different groups use different methods, ranging from completely secular to explicitly spiritual. According to surveys of members, active involvement in any addiction recovery group...
- Alcohol withdrawal syndrome
Alcohol Withdrawal Syndrome is the set of symptoms seen when an individual reduces or stops alcohol consumption after prolonged periods of excessive alcohol intake. Excessive abuse of alcohol leads to tolerance, physical dependence, and an alcohol withdrawal syndrome. The withdrawal syndrome is...
- Benzodiazepine dependence
Benzodiazepine dependence or benzodiazepine addiction is the condition when a person is dependent on benzodiazepine drugs. Dependence can either be a psychological dependence or a physical dependence or a combination of the two...
- Benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or reduces the dosage too rapidly...
- Discontinuation syndrome
- Drug and Alcohol Dependence
Drug and Alcohol Dependence is an international scientific journal on biomedical and psychosocial approaches. Its mission is to publish original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence.It is sponsored by the College...
- Drug tolerance
- Rebound insomnia
- Substance dependence
According to the current Diagnostic and Statistical Manual of Mental Disorders , substance dependence is defined as:Substance dependence can be diagnosed with physiological dependence, evidence of tolerance or withdrawal, or without physiological dependence.The related concept of drug addiction has...
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