Physiological Dependence

Physiological dependence is a huge component of substance use disorder. Essentially, your body becomes so reliant on a substance that you start experiencing tolerance and withdrawal symptoms when you try to cut back or quit.

It can develop with all sorts of substances, including recreational drugs and prescription meds. Recognizing the warning signs is a big first step toward getting better and achieving lasting wellness.

Today, we’re covering how physiological dependence develops and what you can do about it.

What Is Physiological Dependence?

Physiological dependence is another way of saying you’re physically reliant on a substance. You feel like you need it to survive, even though you know that’s not true.

When this happens, your central nervous system goes haywire. You get these intense signals, insisting you can’t function without this substance. You crave it and look forward to your next fix.

The biggest red flags about physiological dependence are tolerance and withdrawal. Tolerance is when you need higher doses of the substance to achieve the same effects. Withdrawal, on the other hand, is how your body reacts to its absence.

How Does Physiological Dependence Develop?

Many substances affect our neurotransmitters, the chemicals in the brain that help regulate mood, behavior, and many other bodily functions.

For instance, opioids can pump up your levels of the feel-good hormone dopamine. They block pain and reward you with temporary bliss.

The problem is that the longer you use them, the more your body adapts—you start building up a tolerance. Your brain constantly expects the flood of dopamine, and it takes more and more of the drug to get the same high.

When you suddenly stop or reduce intake, your body struggles to cope. It doesn’t just snap back to how it was before you started it. Instead, your nervous system goes into panic mode, trying to compensate for the lack of these chemicals.

That’s when the withdrawal symptoms hit, which can be painful or even life-threatening. They can be so bad that you start using again just to make them stop. It then becomes a vicious cycle that can be impossible to break without help.

Symptoms of Physiological Dependence

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the hallmark sign of physiological dependence is withdrawal.

Withdrawal can look different for everyone, but the most common symptoms include:

• Muscle aches or spasms
• Anxiety or depression
• Restlessness or irritability
• Insomnia
• Nausea and vomiting
• Diarrhea
• Elevated heart rate
• Poor concentration
• Delusions or hallucinations

Symptoms can fall under two categories: acute withdrawal syndrome and post-acute withdrawal syndrome, or PAWS for short.

Acute withdrawal usually lasts briefly, while PAWS can drag on for years, although the symptoms are less severe.

The specifics of what you’ll experience and how long it will last can vary depending on a few factors. What kind of substance are you taking? How high are the doses and how long have you been taking it?

It’s always best to have professional guidance when managing withdrawal to keep you safe and as comfortable as possible.

High-Risk Substances for Physiological Dependence

Below are substances that are most likely to lead to physical dependence:

1. Antidepressants

Antidepressants help with anxiety, depression, and other mental health conditions by changing the levels of certain chemicals in your brain. Experts don’t consider them addictive, but some people can develop a dependence.

Withdrawal symptoms may occur if you suddenly stop taking the antidepressant or abruptly reduce your dosage after a month of use or longer. The exact term for this is antidepressant discontinuation syndrome, which affects 20% of patients.

Common side effects include flu-like symptoms, insomnia, nausea, mood swings, and electric shock sensations in your head.

2. Opioids

Doctors prescribe opioids to treat acute pain in patients recovering from an injury or surgery, as well as chronic pain from diseases like cancer.

You might be familiar with some common prescription opioids. Codeine, oxycodone (OxyContin), hydrocodone (Vicodin), and morphine are a few examples.

These medications are proven effective at relieving pain. However, they also come with a high risk of dependence and abuse, especially if taken in higher doses or for longer than recommended.

Opioid abuse has become a major public health crisis. Many who develop an addiction to prescription opioids end up turning to street drugs like heroin when they can no longer get scripts.

If you’re prescribed opioids, make sure you take them exactly as directed, and never share them with anyone else. Be honest with your doctor about any history of substance abuse, and speak up if you start noticing symptoms of physical dependence.

3. Benzodiazepines

Benzodiazepines, or just benzos, are prescription drugs for anxiety, panic disorders, and insomnia. Some well-known brand names include Xanax, Valium, Ativan, and Klonopin.

Benzos work by enhancing the effect of the neurotransmitter GABA, which calms the brain. If you quit taking benzos suddenly, your brain is left with a deficit of GABA activity. This can trigger withdrawal symptoms, such as

• Intense anxiety
• Insomnia
• Tremors
• Sweating
• Heart palpitations

In severe cases, benzo withdrawal can cause seizures. Long-term benzo use can lead to memory problems, mental impairment, and an increased risk of fractures.

4. Barbiturates

Barbiturates are a class of drugs that were once widely prescribed for anxiety, insomnia, and seizure disorders. They’re still sometimes used in hospital settings as anesthesia and to treat certain types of seizures.

Like benzos, they work by depressing the central nervous system, producing a calming effect.

The danger with barbiturates is that they have a high potential for physical dependence, even more so than benzos. Attempting to quit “cold turkey” can be extremely risky.

What Are the Types of Treatment for Physiological Dependence

Physical dependence on a substance, whether it’s an opioid, benzo, or something else, can be a real struggle. But the good news is, there are effective treatments available to you.

1. Detox

The first line of defense against physiological dependence is detox. This is where you safely stop using the substance under medical supervision. It can happen in a hospital, a specialized treatment center, or even on an outpatient basis with close monitoring.

Typically, you take medications to help wean you off the substance and manage your withdrawal symptoms. For example, methadone or buprenorphine might be used for opioid withdrawal.

These medications either mimic the effects of the substance in a controlled way or block them altogether.

2. Aftercare

Once you’re through the acute withdrawal phase, the real work of recovery begins.

Aftercare is all about treating the psychological side of addiction and building your support network. Because even though your body might be physically free from the substance, your mind is still catching up.

Many different types of therapy can help with dealing with the aftermath of physiological dependence. Rehab offers more flexibility, and a counselor can help figure out the best approach for you.

Some people do well with regular outpatient care, where they schedule therapy sessions around their other commitments. Others benefit from more intensive programs, like partial hospitalization, where you go to treatment during the day but sleep at home at night.

Addiction vs. Physiological Dependence

The tricky part is that physiological dependence can also happen with prescription drugs, even when you’re taking them exactly as advised. It’s also a doctor’s dilemma, especially for medications like opioids, which they prescribe for managing acute and chronic pain.

Regular use builds tolerance. Or, it could indicate that the underlying problem isn’t being properly addressed, with the pain worsening or other factors needing attention.

If you’re worried that you’re developing dependence and considering coming off your prescription meds, talk to your doctor. They can safely taper you off it and explore alternative treatments with you.

Remember, physiological dependence doesn’t equal addiction. For instance, people who rely on pain meds for chronic pain can have physiological dependence or even high tolerance without having an addiction to them.

Addiction is more complex and involves compulsive drug use despite negative consequences. It almost always includes both physical and psychological dependence.

Addiction is when using a substance becomes the most important thing in your life, even if it’s harming you or the people you care about. You might find yourself doing things you never thought you would just to get your hands on your substance of choice.

Bottom line: It’s a fine line, and physiological dependence can quickly escalate to addiction if not managed correctly.

Final Thoughts

Physiological dependence is simply your body’s way of telling you to quit. Withdrawal symptoms can be painful, but sometimes, they’re the wake-up call you need to commit to getting better.

Please, don’t ever feel ashamed to seek help for substance abuse issues. Drug dependence is a medical condition, not a personal failure.

If you or your loved one is struggling with physiological dependence, let us help you. We can find a treatment plan for your unique situation and needs.

You deserve to have your concerns taken seriously and receive compassionate care. Recovery is possible, and you don’t have to do it alone.

References:

• https://my.clevelandclinic.org/health/articles/22513-neurotransmitters
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449237/#b1-189e747
• https://www.hrsa.gov/opioids
• https://pubs.acs.org/doi/10.1021/acschembio.8b00144
• https://www.aafp.org/pubs/afp/issues/2013/0815/p224.html
• https://www.ncbi.nlm.nih.gov/books/NBK310652/

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