8.1.1 - Addiction, dependence and withdrawal
Understand the different meanings of addiction, tolerance, physical dependence, psychological dependence and withdrawal, and use them to explain patterns of alcohol, heroin and nicotine use without treating every drug user as addicted.
Addiction and control
Addiction concerns a pattern of drug seeking and use that becomes difficult to control despite harmful consequences.
A psychoactive drug alters mental processes or behaviour through its effects on the nervous system. Alcohol, heroin and nicotine have different actions, but each can contribute to addiction. Taking a drug once, enjoying its effect or using it frequently does not by itself establish addiction. Relevant evidence includes repeated unsuccessful attempts to stop, a strong drive to use, and continued use despite damage to relationships, health or responsibilities.
Addiction
A persistent pattern of compulsive drug seeking or use despite harmful consequences, involving impaired control.
Imagine an adult who repeatedly misses work because of drinking and continues even after trying to stop. This illustrates impaired control and continued use despite harm. Compare this with someone who drinks at an occasional celebration and can choose not to drink. Amount and frequency matter, but the consequences and pattern of control also matter. These are illustrative cases, not diagnoses.
Clinical systems use terms such as substance use disorder or alcohol use disorder with specified criteria and degrees of severity. The curriculum word addiction highlights a central behavioural problem; it is not a complete diagnostic assessment. Nor is addiction an explanation in itself. Saying that someone takes heroin “because they are addicted” simply names the pattern unless we explain the mechanisms maintaining it.
Tolerance and adaptation
Tolerance means that a previously effective amount produces less of a particular effect after repeated exposure.
The body can adapt through changes in the nervous system or the processing of a drug. A person may therefore take more to obtain an effect previously obtained from less. This is a description of adaptation, not a recommendation to increase consumption. Tolerance can differ between effects: reduced feelings of intoxication do not establish equal tolerance to every dangerous effect of a drug.
Tolerance
A reduced response to the same amount of a drug following repeated use, or a need for more to achieve the same particular effect.
An illustrative smoker reports that the first cigarettes once caused noticeable dizziness but the same number no longer does. This is evidence consistent with tolerance to that effect. It does not tell us whether the smoker has lost control of use. A report of using more also needs interpretation: a different product strength or a changed social situation could alter consumption without demonstrating tolerance.
Tolerance can contribute to escalation and harm, but it is not identical to addiction. It can develop during appropriate prescribed medication use without compulsive drug seeking. It can also diminish during a period without the drug, so a previously familiar amount need not have a previously familiar effect. The distinction matters when explaining risk: feeling less affected does not mean the drug is harmless.
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