What is psychological dependence?
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.
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.
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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