What’s the Difference?
There is a difference between addiction, physical dependence, and tolerance to pain medication. It is imperative that each of us understands the difference.
What Is Addiction?
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definition of addiction as it relates to the use of opioids for the treatment of pain:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definition of physical dependence:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definition of tolerance:
Characteristic Features and Behaviors
Impaired control, craving, and compulsive use of the drug, as well as continued use of the drug despite negative physical, mental, or social consequences are considered characteristic features of addiction. But, it can be a bit more complicated than simply recognizing the presence of those features. The same features could be related to inadequate pain relief. A doctor must be able to exercise their judgment and to discern between addiction and another cause.
There are specific behaviors that point to the possibility of addiction. Those behaviors include:
- not adhering to the prescribed schedule for the drug
- taking more than one dose at a time
- repeated reports of stolen or lost drugs
- doctor shopping (getting the drug from more than one doctor)
- isolation (wanting time alone)
- additionally using non-prescribed psychoactive drugs
- using pain medications for sedation, intoxication, to boost energy, or to lower anxiety levels
- requesting certain formulations or routes of administration of the drug
- an avoidance of or disinterest in non-opioid treatment options
The Bottom Line
Addiction is mostly a behavioral disorder, although it can overlap with physical dependence. Typically, addiction involves using the drug despite negative consequences, craving the drug even when not in physical pain, and using it for reasons other than the prescribed indication. Physical dependence is evident when someone develops a tolerance to a drug or if one would experience withdrawal symptoms from stopping the drug suddenly. Tolerance is present when the same dose does not garner the same result, thereby requiring higher doses to achieve the desired result. In and of itself, physical dependence does not mean that there is addiction, but it may accompany addiction when there is addiction.
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