Psychological dependence
Psychological dependence refers to a strong desire for a substance or behavior that provides enjoyment or satisfaction, and it can occur alongside physiological dependence. While physiological dependence involves physical withdrawal symptoms when a substance is discontinued, psychological dependence is characterized by cravings, emotional distress, and a compulsive need to engage in an activity. This type of dependence can arise from using substances to alleviate anxiety, depression, or pain or from engaging in behaviors that provide pleasure, such as gaming or shopping.
Addiction treatments often adopt a holistic approach, addressing both the psychological and physiological aspects of dependence. Techniques such as cognitive-behavioral therapy, twelve-step programs, and alternative therapies like meditation may help individuals manage their psychological cravings and improve coping mechanisms. Relapse rates for addiction are notably high, suggesting that psychological dependence can be remarkably persistent, and some researchers argue it may be even more challenging to overcome than physical dependence. Understanding the interplay between psychological and physical dependence is crucial in developing effective treatment strategies for addiction.
Psychological dependence
DEFINITION: Psychological dependence is marked by a strong desire for a substance that provides enjoyment or satisfaction. Psychological dependence and physiological dependence are not mutually exclusive. Human behaviors have a psychological foundation that influences 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 can also become addicted to behaviors that are primarily characterized by psychological 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 online 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 physiological or psychological dependence or addiction, there are few differences in terms of therapy and care plan options. A holistic approach that addresses an individual's overt dependence or addiction use disorder, as well as any underlying mental health conditions, is critical for a successful treatment program. Relapse rates in treating addiction are extremely high (over 80 percent for most substances), 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 psychological dependence may be even stronger than 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 or Narcotics Anonymous. These programs often focus on behavior modification to address psychological dependence, such as substituting a positive behavior for an addictive behavior when cravings strike. 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 made no distinction between psychological dependence and physical dependence in substance addiction because the problem remains the same: A person is addicted to a substance or behavior. Others believe that psychological dependence can be even stronger than physical dependence and that even after physical dependence is overcome, psychological dependence can linger, increasing the risk that an individual in recovery may later relapse. However, most clinicians agree that, whether physical or psychological, these dependencies are inseparably intertwined, thus making addiction a complicated and difficult condition to treat.
Bibliography
Blane, Howard T., and Kenneth E. Leonard, eds. Psychological Theories of Drinking and Alcoholism. New York City, Guilford, 1999.
Edwards, Griffith, and Christopher Dare, eds. Psychotherapy, Psychological Treatments, and the Addictions. New York City,Cambridge UP, 1996.
Gao, Guodong, et al. “Clinical Study for Alleviating Opiate Drug Psychological Dependence by a Method of Ablating the Nucleus Accumbens with Stereotactic Surgery.” Stereotactic and Functional Neurosurgery, vol. 81, 2003, pp. 96–104.
Hart, Carl L., and Charles Ksir. Drugs, Society, and Human Behavior. 18th ed., New York City, McGraw, 2022.
Jaffe, Adi. "Physical Addiction or Psychological Addiction—Is There a Real Difference?" Psychology Today. 26 July 2010.
Kuhn, Cynthia M., and George F. Koob, eds. Advances in the Neuroscience of Addiction. Boca Raton, CRC, 2010.
Orford, Jim. Excessive Appetites: A Psychological View of Addictions. 2nd ed., reprinted, Hoboken, Wiley, 2007.
Raypole, Crystal. "Everything You Need to Know About Psychological Dependence." Healthline, 28 May 2020, www.healthline.com/health/psychological-addiction#takeaway. Accessed 1 Dec. 2022.
"What Is Psychological Dependence?" American Addiction Center, 10 May 2024, americanaddictioncenters.org/the-addiction-cycle/psychological-dependence. Accessed 20 Sept. 2024.