Addiction affects both the mind and the body. Some people experience the adverse effects more in one area than another, but is there really a difference in psychological and physical addiction?
This article will review the facts, discuss the differences, and explore the similarities between both forms of addiction.
The American Psychiatric Association wrote The Diagnostic and Statistical Manual (DSM). The DSM is the definitive guide on mental illness and provides a template for American physicians to match symptoms and characteristics for specific diagnoses.
The first edition of the DSM was released in 1952 and has undergone several revisions and updates since. Over the years, the DSM has faced criticism for giving the pharmaceutical industry an unhealthy influence on the revision process, pathologizing patterns of behavior and moods to encourage medicating patients¹.
However, with this criticism in mind, many clinicians successfully use the DSM as a blueprint to identify patterns in symptoms while they consider medical history, rule out possibilities, and then come to an accurate diagnosis.
The current manual is the DSM-V. The previous edition of the manual, the DSM-IV-TR, distinguished between “substance dependence” and “substance abuse,” with the criteria for each disorder aligning with the physical versus psychological addiction dichotomy.
Criteria for Substance Dependence in the DSM-IV-TR
According to the DSM-IV-TR, the criteria for substance dependence were:
- Increasing substance use
- Inability to control substance use
- Spending an excessive amount of time on pursuing substances, using them, or recovering from their effects
- Loss of interest in other activities
- Continued use despite physical consequences
At least three criteria need to be met to be diagnosed with substance dependence.
The criteria for this disorder focused on a physical addiction. The general idea was that people could become physically dependent on a substance without “abusing” it, an example being someone prescribed opioids by their physician.
Criteria for Substance Abuse in the DSM-IV-TR
Substance dependence was a separate entry from substance abuse, which had the following criteria:
- Substance use interferes with role obligations such as school, work, or family responsibilities
- Repeated substance use in hazardous situations, such as driving a car
- Legal problems resulting from substance use
- Continued substance use despite social or interpersonal consequences
Unlike substance dependence, meeting just a single criterion would result in a diagnosis of substance abuse. However, meeting the criteria for both substance abuse and substance dependence would only result in a diagnosis of substance dependence.
The criteria for substance abuse focused more on the legal, social, and occupational consequences of substance use. It implied that people could have psychological problems with addictive drugs even if they were not physically dependent, such as a binge drinker who never experienced withdrawal symptoms or tolerance.
The implication was that dependence was the more severe problem, and the physical aspects of addiction were prioritized over the psychological effects.
The Current Definition: Substance Use Disorder in the DSM-V
The fifth edition of the DSM removed the distinction between substance abuse and substance dependence under the umbrella term of “substance use disorders.” This removed the distinction between physical versus psychological addiction in terms of diagnosis and helped to remove the stigma against substance use from diagnostic language.
The criteria for substance use disorder are the combination of both previous disorders, with three fundamental changes:
- First, the legal consequences criteria were removed.
- Second, the DSM-V added the criteria of cravings or a strong urge to use substances.
- Lastly, meeting two of the eleven criteria will result in a substance use disorder diagnosis.
In summary, the DSM-V incorporates elements of both psychological and physical addiction into the diagnosis of a substance use disorder and does not prioritize one over the other.
This shift implies that the American Psychiatric Association’s view of current science sees no meaningful difference in physical dependence or psychological addiction and encourages clinicians to treat both ailments as the same.
Is There a Difference Between Psychological and Physical Addiction?
Knowing the stance of the American Psychiatric Association, can we still assume there is a difference between psychological and physical addiction? Absolutely, but the distinction all depends on the particular experiences of the person struggling with a substance use disorder.
Psychological addiction implies that substance use has become a coping strategy for dealing with mental issues. People may use drugs to self-medicate, cope with stress, or try to enhance positive emotions or social aptitude.
The psychological effects of addiction include²:
- Not being able to control substance use, even with effort
- Experiencing intense emotional cravings
- Problems with attention and focus
- Feeling a loss of interest in activities that used to bring joy
- Needing a substance to function, sleep, or socialize
- Spending an unusual amount of time using or thinking about the substance
If someone is experiencing any of these symptoms, they have likely become psychologically addicted to a substance.
Physical addiction implies that the consequences of substance use apply mostly to physiological factors. This could include the development of tolerance, experiencing withdrawal symptoms, physical cravings, or the development of medical disease due to substance use.
For example, somebody who drinks a few drinks every day for years will almost certainly develop a physical alcohol addiction. They might experience shakes, heart palpitations, and anxiety if they were to stop suddenly.
Yet if they experience no social or occupational consequences from their drinking and don’t have trouble stopping if they have to, we might not consider them psychologically addicted.
But physical addiction comes with its own set of consequences. Alcohol use can cause irreversible liver damage and breaks down within the body into a known carcinogen³. The physical side effects of drug use are often enough for people to want to stop, but they may require medical treatment to overcome their withdrawals safely.
Is There an Overlap Between Psychological and Physical Addiction?
Behavioral addictions, such as kleptomania, gambling addiction, sex addiction, or video game addiction, have all been shown to share the qualities of both psychological and physical addiction, even though they don’t involve introducing any substances to the body.
People who suffer from gambling addiction, for instance, can experience intense withdrawal symptoms when they suddenly stop gambling. They may also develop tolerance: feeling a need to bet more and more to obtain the same “rush” from gambling.
Neuroscientific evidence indicates that behavioral addictions affect the brain similarly to substance use⁴. Many of the symptoms associated with physical addiction stem from impairment in the brain’s reward systems, which can be attributed to carrying out a behavior to excess.
This evidence suggests that the physical versus psychological addiction comparison could result from changes in brain chemistry from addictive behaviors rather than solely a result of substance use.
Holistic Treatment for Addiction
Whether someone is suffering from the effects of physical or psychological addiction, holistic addiction treatment is the best course of action. Addiction treatment centers use various evidence-based techniques to teach people to manage cravings, overcome withdrawal, and build a life outside of substance use.
With targeted medication, intensive psychotherapy, professional care, and social support networks, clients can recover from addiction within the safety of an optimal healing environment.
If you’d like to know more about how All Points North Lodge uses a variety of cutting-edge treatments to help people overcome addiction, contact us at (855) 510 4585 or start a to connect with a recovery expert.
- Collier, Roger. “DSM revision surrounded by controversy.” CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne vol. 182,1 (2010): 16-7. doi:10.1503/cmaj.109-3108
- “Signs and Symptoms of Addiction.” Psychology Today, Sussex Publishers, https://www.psychologytoday.com/us/basics/addiction/signs-and-symptoms-addiction#signs-of-addiction.
- “Alcohol Metabolism: An Update.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, July 2007, https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm#:~:text=Most%20of%20the%20ethanol%20in,CHO)%2C%20a%20known%20carcinogen.
- Alavi, Seyyed Salman et al. “Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views.” International Journal of Preventive Medicine vol. 3,4 (2012): 290-4.