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The notion that behavior can be separated into mutually exclusive components, such as mental or psychological aspects of behavior and purely physical aspects of behavior, is not sustainable given the current understanding of behavior. All psychological and emotional processes have a physiological basis, and all complicated behaviors (behaviors that are not simply reflex actions) have a significant emotional and psychological component. The old dualistic separation of mind and body is a myth and an unrealistic way to view nearly any type of behavior. This includes behaviors associated with substance use disorders and process addictions (e.g., compulsive gambling).
Any designation of something as being “purely physical” or “purely psychological” reflects a misunderstanding of behavior in general. This applies to disease model concepts of addiction that claim that “addiction is not a choice” because individuals with substance use disorders do make choices regarding their substance abuse. In addition, the alternative extreme viewpoint that “addiction is a choice” is also equally invalid because individuals with substance use disorders are driven by a number of physiological processes that influence their behavior in a number of contexts, and it would be a misconception to infer that anyone “chooses to become an addict” in the same way that few people would argue that most smokers who develop cancer chose to get cancer. Thus, when attempting to understand the aspects associated with the development of addictive behaviors, trying to do so from either extreme viewpoint is unrealistic and not supported by research. This includes the notions of physical dependence and psychological dependence. There is no such thing as pure physical dependence or pure psychological dependence.
What Is Psychological Dependence?The term psychology is generally meant to refer to behavioral processes that relate to the emotions or the mind. The term psychological dependence is generally meant to describe the emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder or process addiction. However, there can be no total separation of emotion and cognition from physiology. To imply that “psychological dependence” is not as serious as “physical dependence” represents a myth; in reality, these two designations do not exist as mutually exclusive categories and therefore cannot be contrasted as if they exist separately from one another.
- Issues with anxiety that occur when someone tries to stop their addictive behavior
- Issues with depression when one is not using their drug of choice or tries to stop their addictive behavior
- Irritability and restlessness that occur when someone is not using their drug of choice or trying to quit
- Any other issues with mood swings that occur when one is not using their substance of choice or attempting to quit
- Appetite loss or increased appetite associated with not using the substance of choice
- Issues with sleep associated with quitting or not using the drug of choice
- Issues with uncertainty about being able to stop using the substance of choice
- Denial that one has a substance use issue or romanticizing one’s substance use/abuse
- Obsessing over obtaining or using the drug of choice
- Cognitive issues, such as issues with concentration, memory, problem-solving, and other aspects of judgment, etc.
The aspects associated with physical dependence are typically focused around the issues of tolerance and physical withdrawal symptoms, such as nausea, vomiting, diarrhea, seizures, hallucinations, etc. The presentation of the symptoms that are most often associated with the development of psychological dependence are most likely viewed as being far more variable in their intensity than the symptoms associated with physical dependence on drugs; however, since there is no objective way to measure an individual’s subjective level of distress either emotionally or physically, this assumption cannot be empirically validated.
In addition, even symptoms that are considered to be primarily psychological in nature, such as cravings, have a large body of empirical evidence that theorizes the physiological basis and physiological processes that are associated with them, whereas both the symptoms of physical dependence (physical tolerance and physical withdrawal) also have significant empirical evidence to associate these processes with a number of psychological variables that can affect their presentation.
- Substances Associated with Psychological and Physical Dependence
- The Treatment of Psychological Dependence
The general observation here is that all substances of abuse are associated with both psychological and physical aspects of dependence; however, many sources separate the aspects of the development of a substance use disorder and the withdrawal process into substances that are associated with withdrawal symptoms that are primarily psychological in nature. Typically, these substances include:
- Most stimulants, including cocaine and Ritalin
- Most hallucinogenic drugs, such as LSD
- Cannabis products (although there is mounting evidence that there may be a significant physical process of withdrawal that occurs in chronic users of cannabis products)
- Many inhalant products
- Many psychotropic medications, such as antidepressant medications
Substances associated with the development of strong physical dependence typically include:
- Opiate drugs, such as heroin, morphine, Vicodin, etc.
- Benzodiazepines, such as Xanax, Valium, Ativan, etc.
- Barbiturates, such as Seconal and phenobarbital.
Numerous drugs of abuse are described as having both physical and psychological withdrawal symptoms and fostering both forms of dependence.
One very important distinction that can be made regarding the difference between drugs that are considered to result in physical versus psychological dependence is that the withdrawal process from some of the drugs that are considered to be strong candidates for physical dependence, such as alcohol, benzodiazepines, and barbiturates, can result in the development of potentially fatal seizures. However, this condition does not generally occur with withdrawal from opiate drugs, which are also considered to be extremely physically addicting. The recovery process for individuals who have developed substance use disorders to these substances should be strictly monitored by a physician or psychiatrist who specializes in addiction medicine to identify any potential seizure activity and immediately address it.
Nonetheless, there are reports of seizures occurring in individuals recovering from other substances as well, and even though these instances may be rare, the overall approach to treating any substance use disorder should consider an initial program of physician-assisted withdrawal management. This approach should always be considered because initial recovery from any substance of abuse can be associated with significant emotional and physical distress that can lead to any number of potentially dangerous situations for the individual, such as an increased probability to overdose during a relapse, to become involved in accidents, or even to become suicidal.
In essence, long-term treatment for individuals who have “psychological addictions” or “psychological dependence” compared to individuals who have developed “physical addiction” or “physical dependence” should not differ significantly in terms of the overall plan of recovery. These individuals should still be thoroughly assessed, followed by a physician, treated for any co-occurring issues, be involved in substance use disorder therapy as the main component of the recovery, get involved in social support groups, get support from family and friends, and get involved in other adjunctive therapies that can contribute to their recovery given their own personal circumstances.
The separate notions of physical dependence and psychological dependence are artificial and represent a myth regarding addictive behaviors. This myth is actually detrimental to the understanding and treatment of any substance use disorder.
Psychological dependence is associated with numerous emotional and cognitive symptoms, whereas physical dependence is typically associated with the development of tolerance and withdrawal symptoms that are not primarily emotional or cognitive in nature. However, understanding addictive behaviors leads to the conclusion that this artificial designation is based on invalid notions of dualism and that addictive behaviors represent the interplay of psychological and physical mechanisms. The treatment of any addictive behavior should be holistic in nature and consider all empirically validated treatment options that are appropriate for the individual in recovery.