What is psychological dependence?

Introduction

Addiction is a complex issue, and persons
who are addicted may become physically and psychologically dependent on the
substance they abuse. People also can become addicted to behaviors, which are
generally thought to be solely characterized by psychologically dependence.

Dependence

A person can become physiologically and psychologically dependent on the same substance. Physiological dependence
occurs when the body becomes dependent on a substance, and physical withdrawal symptoms develop when the substance is no longer used. These withdrawal symptoms may include accelerated heartbeat, hypersensitivity, nausea and vomiting, sweating, tremors, insomnia, and agitation. Some of the substances most likely to cause physical dependence are alcohol, amphetamines, barbiturates, opiates, and nicotine.

Psychological dependence occurs when a person derives reward or pleasure from a
substance or an activity and when the desire to participate in that activity is
irresistible. Substances may be used to relieve anxiety, seek elation, avoid
depression, and relieve pain (physical or psychological). Behaviors involve
activities of avoidance (such as playing computer games to avoid work) and provide
pleasure and reward (such as sexual activity). Psychological withdrawal symptoms
occur when the activity (including substance use) is discontinued. These symptoms
may include craving, depression, insomnia, and irritability. However, because of
the significant overlap between psychological and physical withdrawal symptoms,
some researchers question whether the distinction between physiological and
psychological dependence has any clinical relevance.

Treating Psychological Dependence

In treating any kind of addiction, it is important to consider psychological
dependence as integral to the treatment program. Relapse rates in treating addiction are extremely high (80
percent for drug addiction and 86 percent for alcohol addiction), even when the
person has gone through a physical detoxification process to ensure that
the body is no longer experiencing physical withdrawal symptoms. This phenomenon
adds weight to the argument that a psychological dependence may be even stronger
than a physical dependence. Cognitive-behavioral
therapy or traditional psychotherapy may help to address
underlying psychological reasons for addiction.

Another type of treatment that attempts to address the psychological underpinnings
of addiction is the popular twelve-step
program, such as that of Alcoholics
Anonymous. These programs often focus on behavior
modification to address psychological dependence, such as substituting a positive
behavior for an addictive behavior when craving strikes. Experimental treatments
for psychological dependence have involved surgeries to attempt to block those
areas in the brain, such as the nucleus accumbens, that are thought to lead to
psychological dependence. Other treatments involve alternative therapies, such as
hypnotherapy, meditation, or acupuncture, to try to overcome psychological
dependence. Still other treatment combinations addressing both physical and
psychological addiction boast relapse rates as low as 15 percent, though these
numbers have been disputed.

Some addictions have no real physical component, leaving the psychological component as the only element involved. Behaviors that may become addictive, such as gambling, shopping, and Internet use, should be treated psychologically. Even in these cases, however, a physical component exists. Addictive behaviors may allow the brain to release certain chemicals that enhance the pleasure-giving aspect of addiction. Amphetamine and cocaine use are strongly associated with the brain’s dopaminergic, or reward, system.

Persons who become psychologically dependent may have certain personality or
behavior characteristics that reinforce the tendency toward this type of
addiction. Often, they have difficulty with consistency, commitment, impulse
control, and project completion. Genetic studies are looking at how gene mutations
or certain genotype combinations may affect these tendencies.

Many clinicians make no distinction between psychological dependence and physical dependence in substance addiction because the problem remains the same: A person is addicted to a substance. Others believe that psychological dependence can be even stronger than physical dependence, and that even after physical dependence is overcome, a psychological dependence can linger, increasing the risk that a recovering addict may later relapse. However, most clinicians agree that whether physical or psychological, these dependencies are inseparably intertwined, thus making substance addiction a complicated and difficult condition to treat.

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