Addiction vs Dependence

I know with the latest Oxycontin crap hitting the fan, people are throwing around the word “addiction” like its going out of style. Let me clarify a few points here.
Addiction is NOT the same as Dependence. People associate withdrawal symptoms with addiction. Fact of the matter is, it appears with both. Example:

  • Patient is on a beta-blocker for years and years. You take away the beta-blocker and guess what, they patient goes through withdrawals (higher heart rate, higher blood pressure, etc).
  • Patient is on Fentanyl patches for chronic pain. You take away the patch, and bingo, withdrawals.
  • Patient is on avandia and you take it away because you’re dumb and think its going to suddenly kill the patient. Guess what, withdrawals (higher blood sugar).
    Withdrawals is the body’s natural response to a sudden change in receptor block/activation. If I dump 500mg of atenolol into someone, they are going to have (among other things) a very abrupt reaction. Because I am not withholding medication, its not really withdrawals, but it illustrates the same principle.
    Now lets look at Addiction. The basic difference between the two is mostly psychological. Why are they taking it? Are they taking it for a euphoric effect or are they taking it so they can live a decent quality of life with a broken back/cancer pain/whatever.

  • A person who is addicted will snort oxycontin illegally, and do illegal things to obtain more oxycontin so they can get the same high. If you buy your oxycontin on the street to snort/crush/inject (ie: take it how it was NOT supposed to be taken) you are an addict.
  • A person who is dependant on oxycontin takes it as prescribed and lives a normal quality of life. They will bitch and moan if the drug is discontinued, but will generally work with you to move to a different agent.
    Now the line gets blurred by patients who are on narcs for legit reasons, but their pain is uncontrolled, so they take it upon themselves to go and doctor/pharmacy shop to obtain more to control their pain. Even if it resorts to doing illegal things.
    Nothing fries my wires more than having some doctor refuse to prescribe oxycontin or fentanyl to a chronic pain patient because they are afraid they will be “addicted”. Sure, and giving them 200 Vicodin ES/month (wtf?) and blowing out their liver is the correct way to go. Theres a reason why these things are C2 narcotics. They have very abrupt and euphoric effects and guess what… THEY ARE REALLY REALLY GOOD FOR CHRONIC PAIN! Of course trying to explain this to a doctor is about as useful as a debating with a turd. They just get all pissy and hang up (so much for “patient care”). Then you have the patient ask the question “Will I become addicted to these?” The answer is “If you are dosed correctly, you will become dependent on them to live a normal quality of life. Its like insulin or any other medication.”
    Sometimes it just amazes me as to how much fear doctors put in patients that is 100% unwarranted and unneeded. Maybe it’s just a CYA move, but it ends up doing tons more harm than good. So there you have it. Be it right or wrong (in your opinion) thats my take on Addiction vs Dependence.

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  • 32 Comments

    1. knitalot3 says:

      Thanks for the insight.
      I have a sympathy for pharmacists. They really get stuck between the rock and hard spot sometimes.

    2. eddie armstrong says:

      use-what it was intended for…
      misuse-not necessarily what it was intended for…
      abuse-just for the f’ing hell of it…
      don’t know toooo many people using blood sugar med the last way, but do know of many using the other products that way,
      AND, it don’t matter how you use those, use ‘em too much and you ARE dependent!!! aka–addicted!
      IMHO

    3. Susan says:

      I’ve come here from time to time reading your blog. I never posted a comment here before.
      I suffer from severe osteoarthritis from an auto accident of 30 yrs ago.
      There are days that the pain is mostly managable just with two buffered aspirin in the morning, but I do have some very bad days when I can hardly stand on my arthritic ankle, knee and hip.
      I mainly take aspirin to keep the inflammation at a minimum.
      About a year ago I had asked my doctor for Oxycontin, just to be out of pain one or two days a week.
      He flat out said no!
      I had shoulder surgery last February (shoulder was worn out from many years of crutch usage) and he gave me Oxycontin for after the surgery. I took them as prescribed, the lowest dose of 20 mg.
      I took them for two days and was amazingly pain free. On the 3 day after the surgery I took the prescribed dose after 12 hrs from the last one .. and oh my – apparently the intense pain from the surgery was NOT in need of Oxycontin and I had to keep lying down to help with the “woo headedness”. What an awful feeling.
      I have no idea why the addicts would want to feel this way, I couldn’t imagine what it would feel like if I had taken it like they do, snorting or such.
      I do wish they’d make an Oxycontin, less then 20 mg to help manage pain.
      I take an occaisional Percodan to help with pain but would never take them on a daily basis, as for some reason I suffer from mild headaches the day after.
      I can see why my OS said no to Oxycontin, I had no idea how strong they really are.
      I’ve tried the Celebrex and they did not help to relieve my arthritis pain, and best to not take something that will need you to have liver testing!
      Later this year I hope to have an ankle and knee replacement. First tho, my shoulder has to be “crutch ready”.
      Wish me luck!
      and thanks to your blog, I so appreciate my pharmacist, and have even sent thank you notes for special ordering medications for me.
      :)
      susan

    4. My problem is that the patients won’t take their pain meds. Today I had a little old lady with chronic pain tell me she hadn’t taken her Lortab in 3 weeks because she was “afraid of becoming addicted”. A lot of my elderly patients believe this, and I have to do a lot of teaching in order to convince them that they can take their pain meds properly and not get “addicted”. I have no idea why they get this idea into their heads. Maybe it’s their generation or something. I hate to see them hurt so much.

      • Les says:

        You are not too bright. Doctors mistreat pain all the time and infact alot of people end up in the ER and get treated like narcotic junkies when in reality they really are in pain so what happens then… Do you think that when A doctor refuses to give a patient pain medicene in the ER that the patient all the sudden feels better and just goes home? NO WAY! They go to the next ER and yes they are seeking pain medicene because they are in pain and the only way they can handle it is when they get some relief from Pain meds. People with real pain are forced to hospital bounce like junkies on the street and then getting treated like the junkies do and have doctors tell you that you are Withdrawling from the pain meds and need to go to rehab. It’s not just older people who are afraid to become addicted, It’s anyone who is in pain and has to have pain meds to not hurt so bad. I’m here to tell you that anyone who takes pain meds for any reason even as prescribed by doctors Will become dependent on the meds. That is why some people are smart that have a chronic pain problem not to take the pain meds as prescribed but to only take it as needed. The patient will always start taking the meds more and more as time goes by because the tolerance builds up to where they need more and more pain meds for pain control. It’s sad that people with pain get treated so badly by ER doctors in general but it goes deeper than that because Alot of docs are scared to give out pain meds because they fear losing their jobs. I’ll me the first one to stand up and say the FDA sucks bad.

    5. RxDr says:

      OK Angry,
      We can agree that there are many different connotations of the word ‘addiction’. A simple google search brings up more than 20 wildly varying definitions. Some even specify that addiction has to be just with pain drugs or drugs in general when everyone knows that it can be with just about anything….(like this blogging thing maybe?) ;-) I always try to steer my patients away from using that word when I’m talking about treating chronic pain. As you noted, that negative connotation can really put a dent in appropriate pain management. I always steer them towards the word dependance and tolerance versus misuse/abuse.
      Hey, here’s a topic for your next article…. Big Pharma forcing patent law down our throats and keeping the cost of treatment in the stratosphere…. I’m thinking particularly of the drug ‘PLAVIX’…but also OXYCONTIN…. Both briefly had generics available that would have brought the price down considerably (Plavix is about $4.00/tablet in acquisition cost for our hospital). But both ‘parent’ companies sued over patent infringment (or similar patent crap) and forced the generics back off the market! I’m not sure when Plavix generic will be available again, but I think Oxycontin generic isn’t coming out again until 2009 or 2010?). That’s such a load of crap! Those companies had plenty of exlusivity to recoup their R&D, which is quite the joke now-a-days anyway (how many TRULY NEW drugs are there coming down the pipeline?)…not many…just rehashes and release form changes….no originality…Not many NMEs….(new molecular entities).

      • Patsi H says:

        Hello RxDr… i know this was a very long time ago, but i have just seen it now, so i apologize for the long overdue “reply”. i am a spine & neck chronic pain patient, i have DDD along with 2 multi-level disc/spinal injury issues. In approximately 2001 my spinal surgeon & my spinal specialist jointly decided to hold off multiple major surgeries as long as humanly possible (or at least until i can no longer walk) and started me on long term timed release meds + pt. Because i am still quite active (and am determined to be so until i can no longer do it) pain patches (fentanyl) which seemed to work fairly well, were decided against and i was put on Oxycontin with bt meds as needed. For quite a long while i was given a generic and it was fine, no issues. All of the sudden, poof, no more generics and along with that, poof, one issue after another with insurance payments every month to pay for my meds. Some months it is days of fighting to get my refills, because of the “costs”. This was NEVER an issue before i was forced to purchase the brand name. We were told it would be only a couple years and the brand company would have to allow the generics again, that, was many years ago, it is now 2013 and still brand only. So, the BIG PHARMA peeps are still at it and i can not find any date (nor can either of my docs) that generics my be available again…. i was told by Ins. & my pharmacy the $$ difference is almost triple between the two. This infuriates me for many reasons, but i think the main one? WE pay for almost 100% of R&D PERIOD, by we i mean US the US taxpayer. I’d bet, if more of us REALLY KNEW how the system ran, WE would NOT put up with this… But, as i talk with people, both everyday peeps and Docs, almost all of them, pro or no, do not know how R&D for our drugs works, let alone that we that pay the R&D costs ALSO pay the highest $$ for THOSE SAME drugs… It is GREAT to know there are Docs & Pharmacists out there that DO know! Thanks for being a good Doc with knowledge that also seems to use it and give a damn!

    6. JAXFIVE says:

      You are absolutely correct! The difference between addiction and dependence is the psychological aspect–the drug seeking behavior. My Grandmother was absolutely dependent upon Oxycontin for her Stage 4 colo-rectal cancer (cancer that eventually took her life)!! However, thanks to Oxycontin she was able to function on a daily basis and live, in little or no pain-until the end.
      Oxycontin is a fabulous medication!!
      Crushing/snorting/injecting is not what a dependent patient does, it is was an addict does! Junkies and crapass ambulance chasing attorneys have produced the “stigma” of taking a medication such as oxycontin.

    7. A cable-TV documentary on marijuana, “In Pot We Trust,” succinctly illustrates the difference between dependency and addiction. The medical case for dronabinol is well-established, but the weed is still demonized, and people such as the stuttering cerebral palsy patient in the film must get their medication from drug dealers instead of legitimate sources. I still don’t see why this drug isn’t available legally in better legitimate drug delivery systems. It has genuine applications as a medication. Sure, people become dependent on it, but I am dependent upon atenolol, hydrochlorothiazide, and Prevacid.

    8. Hope says:

      I think the key to all this is, normal people do not score drugs on the street. Sort of like alcoholics; normal people do not store gin in the toilet tank so no one will know what they are doing. Addicts basically become a host for a drug to live through, and have no real lives or choices of their own. Chronic pain people have a life because of the drug. And they would give anything to not have to use it.
      I’m sorry people get addicted to shit. But it’s not really my problem. My problem is making sure the chronic pain people get what they need to keep going to work, or taking their cancer treatment, or whatever.

    9. Chadwick says:

      Once again, I love you. Great article. Most people have no idea whatsoever what addiction really is, and most will define it with withdrawal. I just took two courses in drug addiction with a wonderful professor (Dr. Michael A. Bozarth, some of you may actually know him, well known in the field of drug addiction). We were taught that withdrawal is neither sufficient nor necessary for addiction, and I completely agree.
      I had a patient once tell me that his wife “needs to stay on hydrocodone because she’s addicted”. Last I checked, you need to be on hydrocodone because you’re in pain, not because you’re addicted.
      Better yet, it has been over two months since she last had it filled, and it was for a 30 day supply. That’s addiction? Give me a break. People don’t have a clue what addiction really is.
      It’s just as bad as “I get a headache if I FORGET to have my coffee in the morning, so I’m addicted.” An addict wouldn’t forget.
      Try, “I mugged a guy and stole his gold watch to trade it for a bag of blow.” That there may be addiction…

    10. Carver says:

      I am glad to see your post. I have recently started reading med blogs, initially for the humor, but it is an addictive habit (reading med blogs). I have had chronic pain which began a few months after recovering from a groin lymph node dissection for stage III metastatic melanoma. I have read up on pain management issues because the last think I need is an addiction. I have tried to do everything right, not drink alcohol, etc. but often when the issue of pain management comes up, I hear one more story about someone who became addicted to pain meds. What they don’t usually say initially is that the person was drinking a lot while taking the meds but when I ask that’s often the case.
      My pain doc has never discussed alcohol with me although the pharmacy labels warn against it. It was my medical oncologist who became concerned about my liver and made a change, sending the report to my pain doc. Sometimes I feel like my pain doc’s primary concern isn’t so much treating me but is making sure I have the lowest possible dose of pain meds (which on the face of it suits me if it weren’t for the liver and tylenol issue).
      Much of what your post said is what I’ve read in articles about how if pain meds are only used to treat pain and not for other reasons, the person may have a physical dependence but not an addiction. In my case I know I don’t have an addiction because when changes are made in other meds I initially don’t need the stronger pain meds. The problem is once I’ve adjusted to neurontin boosts it’s not as affective and in order to work I do need other meds. I have an okay relationship with my pain doc but I don’t think he’s as concerned about my liver as he’s concerned about other things.
      Anyway, thanks for you thoughtful piece. Carver

    11. Raven says:

      Sometimes your posts are so harsh I’m afraid of my own pharmacist for weeks, but you always speak the truth. (I LOVE that you call doctors and yell at them for prescribing an inappropriate pain med!)
      Uncontrolled chronic pain can look an awful lot like addiction. Many people with real pain end up in the ED because they can’t get relief from their PCP, and they are often treated like drug-seekers, when they are only seeking relief. There is an attitude that people–or maybe only certain people–should just learn to live with a certain level of pain. That somehow wanting to be out of pain is a weakness in the patient’s character.
      If there are meds that can take the pain to near-zero without diminishing quality of life, why not let a patient be pain-free?
      ~Raven

    12. emead says:

      I have to totally agree with you on this subject. Two years ago, my sister had metastatic breast cancer with no less than 9 different bone metastases sites. She would cry in pain just walking from the bed to the bathroom. She was so afraid of becoming “addicted” to narcotic pain medications that she refused them and tried to alleviate her pain with tylenol and advil. Being a pharmacist myself, I tried to talk to her and her oncologist about narcotic pain medications at length. After 3 months of nightly phone calls from my sister, I convinced her to follow her oncologist suggestion to use a home health morphine “patient controlled administration? pump for her pain. Two weeks later, she passed away. I am often haunted by the knowledge that she did not have to suffer in pain as much or as long as she did just because she was afraid of becoming ?addicted? to narcotic pain medications when she had a terminal illness.

    13. DrRx says:

      One comment….
      I agree there are different connotations to the word addiction (the DSMIV is probably the best to go with and that does support your comments). In explaining Oxycontin and fentanyl (I’m assuming you’re talking about patches and not lollipops or injection), I wouldn’t use the term ‘abrupt euphoric’ effects, because neither of them release right away. Fentanyl patches, in particular, can take 12 hours or longer to have their initial effect….
      I often wonder what would happen if Coffee (caffeine) were to become the C-II substance that it probably should have been from the get-go? If you had to get a script for coffee, could you imagine the lengths people would go to get a cup from you? They’d probably bum rush the place at some point! I just think our society has a hypocritical approach to addiction (by sanctioning some and outlawing others….)

    14. fred says:

      yes.. I always remind myself of the differance between addiction and dependance when I encounter some of our favorite customers…
      It’s hard to step back and think that when someone is on Hycodan syrup for the past 2 years… and never misses a refill every 12 days.

    15. sharon jones says:

      As a physician I can tell you that prescribing decisions are made to CYA all the time. Early in my career I was sued by a 96 year old woman’s family for prescribing prn morphine while she was in the hospital. Someone at the coroner told her that the dose of morphine given three days earlier contributed to her death, not her age, aspiration pneumonia, or underlying coronary disease. So after a few actual lawsuits, and reports to medical board for any untoward event, hardly anyone gets anything that could be possibly addicting albeit helpful. Had another doc in the area sued for elder abuse, higher potential monetary award than plain malpractice, for prescribing a terminally ill hospitalized patient morphine in the hospital. These things take their toll, and many of us have to work many more years before we retire, so no we don’t go out on a limb for too many patients. Jeve

    16. Chadwick says:

      I see a few people commenting in this post and the other post about addiction being withdrawal or dependence. Think about this:
      Some diabetics (type I or course) are dependent on insulin, but would you really say that they’re addicted to their insulin?
      People with thyroid problems are dependent on their thyroid medication, but are they really addicted to it? Many of them forget to take them at times.
      SSRI’s have withdrawal symptoms when you stop taking them, but have you ever heard of someone being addicted to SSRI’s? Most people, when they go off them, hate the withdrawal so much that they will never use them again.
      A lot of inhalors such as albuterol have withdrawal (and while there are some people who abuse them…just like every other drug) but you generally don’t see everyone addicted to albuterol.
      Keep in mind that just because one person seems “addicted” to something, it doesn’t necessarily mean that the substance is addictive. When a large percentage of its users are addicted… then you know it’s addictive. Often times when this happens, it’s the person in and of themselves and not the actual drug
      i.e. someone who is so obsessed with getting to sleep at night (which the obsession actually makes insomnia worse due to stress) being “addicted to ambien”.
      I could rant for hours… I’ll stop

    17. DrRx says:

      To Susan…
      This goes back a number of days, but if you are reading the comments by now, good for you…
      There IS a 10 mg dose of Oxycontin. So there is definitely a LOWER dose you should have been started on. 20 mg twice daily is a lot for an opiate ‘naive’ person…

    18. Gravelpit says:

      I agree, only I feel the same way about sleeping disorders…sleep disorders are a chronic problem…take away the medication and the problem comes back…just something to think about
      Gravelpit

    19. Susan says:

      thank you DrRX for your reply to my post.
      [There IS a 10 mg dose of Oxycontin. So there is definitely a LOWER dose you should have been started on. 20 mg twice daily is a lot for an opiate 'naive' person...]
      When I have my replacement surgeries (hopefully before the end of the year) I will ask for the lower 10 mg dosage. It was great to have NO PAIN while I was recovering from shoulder surgery.
      I do take an occasional Percodan after my physical therapy sessions, but mostly ICE packs can help with pain and swelling.
      I’ve had 4 surgeries to my ankle and 1 on my knee, next step is replacements.
      It is nice to know that I have a stash of oxy’s, since I have so many left, should I fall and suffer intense pain.
      I’m not a klutz, I just fall alot because of weak worn out arthritic joints.
      I am so looking forward to walking pain free, cane free, and having an ankle with range of motion.
      Thanks Angry Pharmacist for this blog .. I have learned so much.
      especially this – the life of a pharmacist is not an easy one.
      You should see a massage therapist to get all that angst worked out, not to mention all that time on your feet.
      Sure helps me ALOT!
      blessings,
      susan

    20. Mrhunnybun says:

      They make an Oxycontin 10mg and a 5mg in the UK. Do you not have that in the US?

    21. Suzy says:

      I have osteoarthritis because of a severe leg break five years ago. My docs will only prescribe me Vicodin 10/500 up to 8 a day. I have tried other OTC things and once had percocet, but even the Vicodin doesn’t work. When I was in the hospital getting surgery for the break, after the surgery they’d give me shots of demerol for pain. That was the only time since my leg break that I’ve been without pain.
      Why won’t doctors prescribe stuff that ACTUALLY takes away pain rather than mountains of vicodin that make you feel slow and cranky all the time?
      In a perfect world (with my leg break), I’d be able to go get a shot of demerol when I have huge flares of pain and that’s it. Now that I’ve been on Vicodin for years, it feels like it will be impossible to get off.
      I think it’s the DOCTOR’S fault for being afraid to treat us the right way—they make US into Addicts and Dependants by not prescribing medicine correctly. Ugggh.

    22. Luckie says:

      I am dependent upon my anxiety meds. They have greatly increased my quality of life. I have an understanding doctor, one who knows that lying in bed feeling panicky and making numerous, expensive ER trips is not living fully. I thank god for the medicine i have in my life. It has made an amazing difference to me, and hopefuly more doctors will avoid this almost “stigma” of prescribing someone something that is greatly needed.

    23. Iain says:

      I was involved in a motorcycle wreck June 23/07. Broken spine, 16 ribs (flail chest) 2 breaks of left femur, broken shoulder…
      I have been on Oxycontin since the accident and it seems to be virtually impossible to find information on how to gradually reduce one’s use of the drug; that is, an orderly withdrawl. It seems that everyone is convinced that I am an addict, despite the fact that I am asking how to stop using the drug. I don’t need much help, but I would like some…

    24. dolly says:

      i’ve had chronic pain for over 20 years with no real help medically. i was diagnosed with endo and most recently lupus. when i asked the doctor for
      pain meds his nurse asked why?, she was borderline
      angry at my request. i’m still baffled by the
      healthcare systems treatment of people who are truly suffering. i’m surely not living with this
      daily pain, i’m existing.

    25. gene says:

      i have severe back pain ever since a car accident , the doc prescribed percocet 2 times but now all of a sudden hes saying thats it . no more percocet ,, that is so wrong , im tempted to photocopy the script and fill it twice ,,,,,but i dont wanna get arrested ,,, i wish i was good friends with a pharmacist ,, maybe he would fill the copy

    26. Sharon says:

      It is SO great to see someone in the medical field (allied health, medical, pharmacy) state the difference etween addiction, dependance and tolerance.

      I suffer from Chronic Pain (I have Reflex Sympathetic Dystrophy) and have had it for more than 16 yrs in my leg and 14 yrs in my arm (my arm is by far the worst).

      Without my pain meds (and yes I am on serious narcotics and serious dosages (MsContin 60mg in the morning and 90mg at night every day and I have Anamorph (the faster acting variety) 30mg for breakthrough pain. i have been VERY VERY lucky in that my Dr (GP/PCP) is happy to prescribe the med’s for me as she KNOWS I am in this pain she has seen it (the laws etc are a bit different here in Australia).

      I have had all the Oh – you will get/ are addicted etc but I try to take every opportunity to explain the difference and often use the example of diabetics and there insulin as a corrolation.

      We are victimied becasue the medication we need to have any quality of life happens to be a pain med.

      But still I suffer the stigma of having to take pain medications to live some sembelence of a normal life (sure my pain isn’t removed by my med’s but it is lessened enough so that I can have some kind of quality of life.

      The other thing I hate is people who call these medicaitons drugs and sure they are technically drugs but the connotation is often that of illegal drugs when talking pain med’s I ALWAYS refer to them as medications. I have enough stigma from needing these medicaitons without calling them drugs.

      The other thing we have to deal with is if we are injured in an accident or have an extreme pain flare and go to the ER for help they often look at what you already take and say they can’t give you anything else to help with your added/ acute pain becasue you are already on heavy medications. This is SO WRONG. I wouldn’t be there if my pain med’s were holding my added pain would I.

      I am very careful with my pain medications and only take them as prescribed, I keep them in a safe and shred the boxes so that they cannot be seen in my bins (a friends house was broken into when they saw her pain medicaiton used boxes/ bottles in her bin and they stole all of her medications (even her birth control pill).

    27. NOYB says:

      I love this blog and love this site. Been trying to hit this message home to many recently but seems like so many have thick skulls. I try to explain that just because someone becomes, say, tolerant to pain medications that does not mean they are now an “addict for life” (considering it was used for pain, too). Then, you have people who will shoot IV mayo because they “like the feeling”. Yeah, I think I would dub them an addict (and someone in need of psychological help). Does that mean that mayo now needs to be a Schedule II? Anyway, thanks.

    28. Home Care Nurse says:

      Starting out a reply “You’re not too bright” was totally uncalled for, “Les”.

      The “Road Nurse” has a valid point. Often elderly people don’t take the prescribed med that is needed after surgery, then they don’t want to move, and their recovery from surgery is compromised. You can’t get addicted from a few days of post-surgery meds.

      Let’s keep our comments more civil, please.

    29. crazymess says:

      This has been an interesting blog to read. But I would like to clarify a few things about addiction and dependence, since I live with an addict.
      An addict will take a medication any way they can to get their high. There is no set way for an addict to take a drug. However they can get high.
      And there is a close relationship between dependence and addiction. People who have been on a medication for a long period of time become dependent. If you remove that drug, they will have withdrawals. Some have built up such a tolerance to the medication that they have become addicted to it. Those are the ones who run out of their prescription medication and show up at the ER complaining of severe pain. They will not always be forthcoming about their prescription medication in order to receive what they need. Now how does that NOT make them an addict or are they still just dependent?? Lying is a trait addicts have and use with great success.
      There truly is a fine line between addiction and dependence. The only distinguishing factor between them is the patient’s willingness remove themselves from the medication. Dependent patients are more cooperative, though still have some issue, with removing or changing the medication. An addict will not accept a change to their high. Unless that change provides more than the first medication.
      Oh, and not all addicts are junkie, robbers, who steal whatever they can to get whatever they need (alcoholics are addicts as well). Sometimes, they are normal adults working alongside all of us. They go to work, pay their bills, everything ‘normal’ people do. The difference between them and everyone else is their addiction.

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