Counselling for People with Dependence. Changing the Life Paradigm

Addiction and Dependence

Entering recovery from addiction and dependency is a life changing event for people suffering from substance use disorder (SUD). This brief article will define a few key concepts to increase understanding of Substance Use Disorder (SUD) and answer questions related to dependency counselling. The alcohol abuse treatment sets the state for sustained recovery from drugs and alcohol.

Neither dependence nor addiction is present in the DSM-V criteria of a substance use disorder (SUD). Researchers, however, distinguish between addiction and dependence as follows:

Addiction is a condition of craving and subsequent uncontrollable and compulsive consumption of substances/drugs despite being aware of harmful consequences.

Physical dependence is a condition of adaptation to the drug. Person who developed the physical dependence will get withdrawal syndrome upon the sudden termination of the drug. Tolerance, where the body needs more of the drug to produce the same effect, is another aspect of dependence.

Most substance-addicted individuals develop dependence; thus, tolerance and withdrawal are often a part of drug/alcohol addiction. However, in behavioural addiction (i.e. gambling disorder), physical dependence (tolerance and withdrawal) is not markedly present. In such case the physical dependence does not substantially influence the maintenance of this addiction.

Dependence Without Addiction

Yet, physical dependence can also exist without any presence of addiction. It can be developed by longer administration of prescribed medications. By using for example painkillers, the necessity for increased doses usually signals tolerance. Consequently, people may develop drug dependency without becoming compulsive drug addicts.

Craving and Relapse

Addiction-related detrimental processes occurring in the body are complex, as they normally result from the interaction of

• genetic effects/predisposition (such as initially abnormal functioning of the brain pathways even before the very first dose) and
• environmental factors (e.g. social environment and stress).

These interacting effects can cause alcohol cravings and relapses long after a person is not physically dependent anymore. Thus, adequately planned relapse prevention is crucial for alcohol addiction recovery. The process of planning the rehabilitation steps should be initiated during and immediately after closing the process of alcohol detoxication.

Conclusion

To sum up, addiction counsellors offer alcohol abuse treatment and drug abuse treatment by applying different methods. Thes methods varied whether we are dealing with addiction or dependence (or both). In a substance use disorder, addiction tends to co-occur with dependence. Nevertheless, a person may remain addicted long after they are not physically dependent anymore. Therefore, comprehensive relapse prevention is critical.