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How Can You Know You Have a Psychological Dependence on a Drug?

It is no longer accepted that there are mutually exclusive facets to behavior, such that a person’s psychological functioning and physiological functioning can be categorized as separate entities. Research has indicated that so-called psychological processes have a physiological basis and that many physiological functions are affected by the person’s mental state (psychological processes).

Trying to divide any form of behavior into purely physical components and purely psychological components represents a misunderstanding of behavior. The notion of dualism, the separation of the mind and body, has long been abandoned.

What Is Psychological Dependence?

When the term psychology is used in any context, it refers to behavioral activities that relate to a person’s thinking (their mind). However, as explained above, there is no situation where any type of behavior can be performed free from a biological or physiological process, and many of a person’s physical actions have a psychological component to them.

Likewise, the propensity of some to divide withdrawal symptoms that occur from certain types of drugs into psychological dependence and physical dependence is a repetition of this false dichotomy. Moreover, many assume that the emotional symptoms labeled as forms of psychological dependence are “all in someone’s head” and not as serious as the symptoms that occur with physical dependence.

Sleeping woman next to pills and water

Withdrawal symptoms from different types of drugs and alcohol can be symptoms that are more emotional in nature, more physical in nature, or a combination of both. For instance, when a person is undergoing withdrawal from some form of stimulant, they often experience severe apathy and depression (categorized as being primarily emotional or psychological symptoms), whereas someone undergoing withdrawal from opiates will very often experience significant anxiety, nausea, vomiting, and flu-like symptoms (a combination of physical and emotional symptoms). 

Some individuals undergoing withdrawal from stimulants may primarily experience a rapid heartbeat, sweating, and headaches (primarily physical symptoms), and some individuals undergoing withdrawal from opiates may primarily experience mood swings, anxiety, and depression (primarily emotional symptoms). No hard and fast rule can determine what any single person will experience during a specific withdrawal syndrome.

Certain types of withdrawal symptoms will typically be considered either emotional or psychological. These include:

  • Issues with anxiety
  • Mood swings or depression
  • Restlessness and irritability
  • Changes in appetite, weight, or sleep cycle (either insomnia or hypersomnia)
  • Strong feelings of uncertainty regarding one’s ability to remain abstinent from the drug of choice
  • Denying that one even has a substance use issue and romanticizing prior substance use
  • Issues with thinking that can include problems with attention/concentration, memory, judgment, and problem-solving abilities
  • Cravings to begin using the drug of choice

Anyone who is undergoing a withdrawal syndrome and primarily experiencing several of the symptoms listed above might erroneously be labeled as having a psychological dependence on that substance. This does not mean the withdrawal symptoms are only “in their head” because there is a physiological basis for all of these symptoms, and these symptoms can be just as dangerous as many of the symptoms usually associated with physical dependence. 

Individuals may become emotionally distraught or be prone to making impulsive or bad decisions that can lead to harm, such as being at an increased risk for overdose or engaging in suicidal behaviors.

Most individuals exhibit a combination of physical and emotional symptoms when they go through withdrawal. Often, their withdrawal symptoms are labeled as either psychological or physical, depending on their severity.

Someone who has significant depression may find that this overshadows their other symptoms, and they may be referred to as having “psychological dependence,” whereas someone who is very nauseated and vomiting would be more likely to be labeled as having primarily physical withdrawal symptoms even if they are also experiencing some depressive symptoms. 

Certainly, some substances are more likely to produce rather mild physical withdrawal symptoms or more noticeable emotional withdrawal symptoms than others

According to the diagnostic criteria for different withdrawal syndromes listed by the American Psychiatric Association (APA), these substances include:

  • Many stimulant medications such as cocaine and methylphenidate (Ritalin)
  • Most hallucinogenic drugs, such as LSD
  • Psychotropic medications like antidepressants
  • Various types of inhalants
  • Cannabis products

Conversely, substances like opiate drugs, alcohol, and benzodiazepines are more likely to be labeled as producing physical withdrawal symptoms. In some cases, such as withdrawal from alcohol or benzodiazepines, the physical symptoms can be potentially dangerous, such as the development of seizures, which can cause brain damage or even be fatal.

Some individuals may display psychosis (hallucinations and/or delusions) during withdrawal. This may occur during withdrawal from alcohol, stimulants (like cocaine), hallucinogenic drugs, inhalants, and numerous other drugs. Although psychosis is considered to be a manifestation of a mental health problem, the process that produces psychosis is believed to be associated with certain neurotransmitters in the brain. 

Therefore, when someone displays psychosis during withdrawal, it is believed to be due to a physiological process, again stressing the strong connection between physical processes and psychological constructs.

Diagnosis and Treatment

The diagnosis of a withdrawal syndrome is based on the type of drug one has used. The diagnosis is not made according to the notion that the person may be psychologically dependent on a drug.

Treatment for any withdrawal syndrome is based on the type of drug the person has abused and the specific symptoms that they express. There are protocols to address withdrawal from numerous drugs, such as alcohol, benzodiazepines, opiates, and other drugs, and these protocols do not distinguish between physical and psychological dependence. 

The protocols are usually adjusted based on the severity of the person’s symptoms and not whether these symptoms are considered to be primarily psychological or physical.

Anyone who experiences drug withdrawal symptoms will display some form of psychological dependence on the substance regardless of the type of symptoms they display. Thus, anyone who experiences withdrawal symptoms will display some level of psychological dependence. 

There is no reason to believe that relapse rates are lower when the person is considered to be psychologically dependent on a substance as opposed to having more physically based withdrawal symptoms.


Sources

(February 2016). Dualism. Stanford Encyclopedia of Philosophy. Retrieved December 2018 from https://plato.stanford.edu/entries/dualism/

(2013). Introduction to Psychology. Cengage Learning. from

(2011). Concepts of Chemical Dependency. Cengage Learning. from

(2013). The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association. from

(2014). The ASAM Principles of Addiction Medicine. Lippincott Williams & Wilkins. from

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