For ADHD drugs it’s dependence vs abuse, not addiction vs dependence

Amy and I had a strong debate today about the difference between addiction and dependence. Both of us were using different explanations, so we resorted to the official definitions in the DSM-IV, the American Psychiatric Associations big book of disorders and definitions.

As you will read below their is no mention of addiction in the manual. They purposely excluded that term in favor of more descriptive ones. Which means that addiction is now classified as dependence or abuse.

Substance Dependence

The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological, symptoms indicating that the individual continues use of the substance despite significant substance-related problems.

There is a pattern of self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine.

Substance Abuse

The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

Unlike the criteria for Substance Dependence, the criteria for Substance Abuse do not include tolerance, withdrawal, or a pattern of compulsive use and instead include only the harmful consequences of repeated use.

Addiction vs Dependence/Abuse

The DSM views abuse and dependency as a continuum, meaning addiction is not, in their eyes, an on-or-off proposition, but a disorder with degrees of affliction. The distinction is important when compared to 12-step programs, which preach that one is either addicted or not, and if you are, you are powerless over such addiction.

via Powerless No Longer

Full Citation

American Psychiatric Association: Diagnostic and Statistical Manual of Disorders, Fourth Edition, Text Revision.  Washington, DC, American Psychiatric Association, 2000.

  • Dependence, page 192
  • Abuse, page 198

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