What Is Dependence

What is meant by dependence? Is there a real distinction between dependence and addiction or is the difference only semantic? Examination of the DSM-IV-TR criteria for Substance Dependence reveals that the above criteria cited for addiction (e.g., compulsive use, loss of control, and continued use despite adverse consequences) are included in the Dependence criteria. However, the Substance Dependence criteria also include the additional factors of tolerance and withdrawal. Thus, traditional distinctions that viewed dependence as a stage below addiction, where the choice to continue taking drugs or alcohol or to continue certain behaviors can be stopped if the person really wants to stop, may be of reduced utility (Kleiman).

In any event, once a person's drug use progresses from abuse to dependence, the capacity for voluntary control is significantly reduced. The addicted brain becomes an impaired brain because the original drug free condition has been replaced by a drug present new normality. As drug policy expert Mark A. R. Kleiman explains, people act and make decisions differently when they are intoxicated than when they are sober. Making decisions such as having another round, Kleiman points out, may lead to further bad choices. The nature of the drug—to reduce inhibition when intoxicated—brings about drugged choices.

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