Talk:Physical dependence

Opinions as Facts
Hey, I don't write in very often, but I noticed the first picture on this article and was disturbed. It's a graph representing drug researcher's opinion on the harmful effects of various drugs. Are we then supposed to take these opinions based on arbitrary judgments as to what harm is as gospel? I just think it's poor representation that will, to all but the most careful readers, look like some kind of actual scientific study. Wikipedia is a scholarly institution, and we should treat it as such.

Chemical, physical dependence
How is physical dependence distinct from chemical dependence? The article for chemical dependence doesn't sound very encyclopedic, and this one isn't very specific. Turly-burly 06:47, 20 June 2006 (UTC)
 * Just noticed that chemical dependence is at chemical dependency. These articles should either be merged with a redirect OR should be given parallel names.  Any preferences?

Increasing tolerance automatically part of physical dependence?
I'm not sure that increasing tolerance is necessarily part of physical dependence. I think a person -can- be physically dependent on a drug (and will suffer physical withdrawl if it is suddenly stopped), without being caught in the vicious circle of increased tolerance leading to increasing dosage resulting in further tolerance. - Pacula 17:10, 31 October 2006 (UTC)

This article is extremely poor.
Amphetamines? I have yet to find a good reference on physical dependence and I’m tempted to remove it. They are EXTREMELY physiologically addictive in a large segment of the population but I don’t think they belong in this article. I have yet to find one good reference on a scale even approaching narcotics, barbs, benzos, or even alcohol.

The general understanding of addiction (of all types) is framed largely by prohibitionists and is extremely complex and widespread. People laugh about internet, (Wikipedia?), video game, food or even caffeine addictions but where exactly should we draw the line? Wikipedia articles should be factual in nature and not represent government propaganda or even popular opinion. The fact that a substance or behavior is accepted or legal should have no bearing on the true nature of the issue. The sunscreen article is a good example of an article which adds balance against popular perception.71.92.107.39 (talk) 09:05, 1 March 2008 (UTC)


 * From the caffeine article:
 * In large amounts, and especially over extended periods of time, caffeine can lead to a condition known as caffeinism. Caffeinism usually combines caffeine dependency with a wide range of unpleasant physical and mental conditions including nervousness, irritability, anxiety, tremulousness, muscle twitching (hyperreflexia), insomnia, headaches, respiratory alkalosis and heart palpitations.
 * With "dependency" linking to this page. Is that a mistake?  Or should caffeine be mentioned somewhere in this article? 96.237.166.25 (talk) 23:48, 28 March 2008 (UTC)

I am finding conflicting sources. According to the Center for Substance Abuse Research at the University of Maryland, methamphetamine IS indeed physically addictive. Dartmouth and University of Oregon also say amphetamines are physically addictive.Yonskii (talk) 01:42, 18 September 2010 (UTC)


 * Where are the conflicting sources? This article seriously bothers me in its current form.  I'm pretty sure meth is very chemically addictive; that's why I came to this article, but I only found un-cited claims.  Those university articles don't seem to conflict to me... There must be a clear definition of chemical withdrawal and a list of substances that exhibit it, right?? --Grant M (talk) 19:49, 4 April 2011 (UTC)


 * I also find a lot of this questionable. For instance, I know someone who has taken Neurontin and carbazepine for epilepsy, but never was fiending because of a missed dose.  And anabolic steroids may be cause psychological dependence (arguably) but there is no physical dependence.


 * And the table on the upper right seems rather misleading as it's not about risks on an individual level, and thus it's easy to miss the context. Alcohol looks like the worst of the worst, but most people drink socially and only a fraction are driving drunk or pickling their livers.  But hard drugs such as meth, cocaine, and heroin cause such profound changes in brain chemistry that they don't lend themselves to moderate use.  The only reason these rank lower is because there are more alcoholics than hard drug users by raw numbers. Afalbrig (talk) 10:06, 5 June 2014 (UTC)

Special Case
I've researched a few cases where patients claimed to only take the prescribed dose of opioids (i.e., Vicodin, Lortab) and had withdrawal symptoms after discontinuing the drug. (No immediate citation available.) What we must remember is that every human body is different, and just because a doctor thinks that 7.5 mg of hydrocodone may benefit a patient more than it may harm them, we can't necessarily assume that the prescribed dose is the best. Doctors usually prescribe these types of medications based on body-weight and/or severity of the case, not on the patient's history of physical tolerance to the drug. Quite often, pain medications, namely, opioids, find their way into emergency care and are used "on-the-spot" based on the severity of the pain or suffering that is being treated (i.e., symptomatic treatment). Many other factors that cannot usually be measured, such as drug tolerance (or initial INtolerance), and patient-drug history, NEED to be considered in prescribing these dependence-inducing drugs, but they often CANNOT be considered in "on-the-spot" situations. Therefore, some patients may be initially prescribed an excessively high dose of a medication that could normally be assumed to be an "abusive" dose which could induce tolerance and later dependance. Now, the question is, in this case, is that person "physically" dependent, or is he/she "chemically" dependent? Is it a sudden reversal of an adaptive response that triggers withdrawal, or could we simply attribute the withdrawal to a reverse in "excess" dosing? If the person had taken half the amount that he/she had been taking all along, could the withdrawal have been mitigated or even eliminated? "Physical dependence," to me, implies an adaptive response with or without abuse (i.e., the antidepressant case), whereas "chemical dependance" implies that abuse has occurred and the individual has developed excessive tolerance to the drug, and thus needs more and more of the drug to inadvertently obtain less and less effects.

Poor distinction
Cut:
 * Physical dependence is distinguished from addiction. While addiction tends to describe psychological and behavioral attributes, physical dependence is defined primarily using physical and biological concepts.

What's the difference between dependence and addiction? Is it a matter of degree, or what? These 2 sentences are not adequate reference material.

Sounds like an assertion that "addiction is psychological" (it's all in your head) and a denial that anything can be "physically addictive". Indeed, the physical addiction page redirected me here. --Uncle Ed 16:25, 31 January 2007 (UTC)


 * The term "addiction" is used to mean different things by different people, even professionals. This ambiguity is responsible for all sorts of confusion.  Physical dependence on the other hand, does have a specific meaning that people agree upon.  Mental health professionals and researchers often refer to things such as "internet addiction" and compare them to "substance addiction."  In the former case, addiction is used to mean "behavioral compulsion" and in the latter case it is used to mean "physical dependence."  Such sloppy use of terminology gives the impression that compulsive behavior and physical dependence are the same thing, when in fact, they are very different.  Whenever possible, a more specific term than "addiction" should be used (i.e. "compulsive internet use" or "opiate dependence").  --Elplatt 00:25, 1 February 2007 (UTC)


 * So you're saying that compulsive behavior and physical dependence are distinct, well understood concepts, while the meaning "addiction" of addiction varies with the user of the term? --Uncle Ed 14:33, 1 February 2007 (UTC)


 * Correct. There is some useful info about this on the addiction page.

Difference from Addiction
Physical dependence is a symptom of some addictions. The fact is this is an attempted to separate the dirty street addict who uses heroin from the well to do mothers of 2 who uses Oxycontin from a doctor with some uses of the word. The effort to make people who despise addicts but are ones themselves feel better that in some way they only have a physical need and otherwise they do not use for the same reason people who are black poor or city folk do. Physical dependence does not mean there is no psychological need for drugs. Physical dependence and the withdrawal from such dependence is very, very psychological the head aches the sleeplessness certainly causes psychological effects. The idea that with psychoactive drugs the physical dependence can be separated from the psychological effect is just well umm OK stupid. Maybe use heroin for a few year withdraw then go to rehab and get clean and try not to relapse when you can go down street that is a drive threw open air drug market. I think there is something about using and not and understanding such things and I know everyone will say no it is science not experience or feelings it is try it!!!! N. Riley Friday November 18 2007 10:54PM

I enjoyed a particular reference to NSAID addiction. Commonly cited “accepted” societal addictions such as nicotine or caffeine are usually not debated. This particular reference however describes “massive” NSAID addiction which is not commonly known. Such drugs show no physical addiction or “rewarding” brain pathways but are in fact considered highly “abused”. Such use is the compulsion out of habit (hate to use the cliché) but not for pleasurable effects. Suppose one has a headache and takes as aspirin. The headache is persistent even after the aspirin is metabolized so another is consumed. Eventually this becomes a compulsion out of “fear” that the headache will return after the drug wears off or perhaps to avoid a rebound headache. Acetaminophen (or paracetamol for our overseas friends) is highly toxic and arguably taken in excessive amounts. There is in fact a difference between physical and physiological addiction although I wouldn’t debate the use of physical addiction as a cover in order to avoid the guilt or even to avoid addressing a physiological addition. 71.92.107.39 (talk) 08:46, 1 March 2008 (UTC)


 * This section needs to be written on the whole, as it does not make a difference on a) How it developed? b) How is the person's medical conditions at the moment? The text should make it clear that there are several different definitions of the term in the scientific world. The substance of the text is, for example, not true at all, compared with DSM-IVDala11a (talk) 07:46, 21 May 2008 (UTC)

I think that important points have been made here. It is possible because the word physical is used that people especially lay people may interpret that to mean physical symptoms on withdrawal of the drug. I have enhanced some of the wording in the article so that people will understand that both psychological and physical symptoms can be the result of physical dependence during a withdrawal syndrome. To be quite honest though addiction is almost always a mixture of both physical as well as psychological dependence but differs from drug to drug and person to person, eg crack cocaine being extremely psychologically addictive and benzodiazepines being very physically dependence producing. An alcoholic and heroin addict after months or years of chronic use continue on abusing their substance not just because they can't stop getting intoxicated but also because they need to fend off withdrawal symptoms. However, the medical definition of physical dependence is the withdrawal symptoms which appear during reduction or cessation of a substance due to physiological adaptions in the CNS or body. You can actually get rebound or withdrawal effects from even stopping nasal deconjestants and proton pump inhibitors, rebound acid production, rebound stuffiness but those symptoms are mild compared to say alcohol or benzodiazepine withdrawal. I think that the question of whether someone is chronically taking a substance primarily due to psychological reasons seperate from the physical dependence or -- whether they are taking it mainly due to craving the high or intoxicating effects or is literally psychologically dependent to it because they feel or think that they need it. I have just done some edits. Let me know if there are any oppositions to my edits and also feel free to make some edits yourselves and to post suggestions and opinions on the talk page. I do think that it is important that this article gets at least the basics of physical dependence accurate as a lot of wiki articles will link to this page.-- Literature geek |  T@1k?  19:50, 22 December 2008 (UTC)

By the way the addiction versus dependence debate always comes up in drug and alcohol settings and also amongst patients who are physically dependent on prescribed drugs and nobody can ever agree completely. Many view addiction as both physical and psychological whereas others view it as entirely behaviourally with physical dependence being a seperate but natural consequence of addiction. Alas I see the debate is coming up on wikipedia. I am kind of neutral on it but anyway that argument is for the addiction article not the physical dependence article. I think that we should just stick to defining and explaining physical dependence in the article, remove or correct any inaccuracies and acknowledge that it can occur from frequent or chronic prescribed therapeutic use of drugs as well as from frequent or chronic drug or alcohol misuse.-- Literature geek |  T@1k?  19:59, 22 December 2008 (UTC)

I disagree with the "difference from addiction" section: addiction is not simply the psychological dependence, it can be made up of both physical and psychological dependencies. Most sources I have read do not consider a drug to be "addictive" if it does not have a component of physical dependence; purely psychological dependence can emerge from almost any drug.

Furthermore, the title and location of this section is untidy and seems to have just been thrown in as an afterthought. This section should be renamed and adjusted to include this, or at the very least to present this as an alternative opinion since it is the subject of debate. --Giftiger wunsch (talk) 14:46, 3 February 2009 (UTC)

Well the section you are disputing is uncited, so at present there is nothing to stop you from deleting it. :=) Unreferenced data can be challenged and deleted without debate.-- Literature geek |  T@1k?  17:54, 3 February 2009 (UTC)

Treatment
The sentence:

Treatment usually requires the initiation and then tapering of a medication that has a similar action in the brain but a longer half-life.

is incorrect, besides being uncited. The most common drug for which withdrawl is treated is alcohol and, at present, only rarely is alcohol used during medically-supervised withdrawl.Desoto10 (talk) 21:53, 11 April 2008 (UTC)

Disputing the inclusion of whole classes in the list
Anticonvulsants, antipsychotics, and antidepressants have been wholesale declared to be causing physical dependence, which is generally unproven (except for benzos, which are included in the list separately anyway). Xasodfuih (talk) 01:06, 22 December 2008 (UTC)

Some references have been added. There are still some issues:


 * SSRI: most (if not all) publications on SSRIs avoid using "depedence", but wiki article on SSRI says "physical dependence is a reality".
 * anticonvulsants: these actually produce tolerance (at least for epilepsy, dunno about bipolar and other uses), so with the definition added today, which says tolerance == physical dependence, they should be listed as well. Xasodfuih (talk) 05:49, 22 December 2008 (UTC)


 * SNRI and SSRIs cause withdrawal on discontinuation. But effexor is also know to cause addiction.  Check out:  As is Tianeptine: --Doc James (talk) 13:35, 22 December 2008 (UTC)

Antipsychotics, anticonvulsants, antidepressants, beta blockers etc etc can cause acute rebound/discontinuation/withdrawal syndromes of varying degrees if discontinued abruptly though. I think that it is worth acknowledging that they don't technically in the medical definition induce physical dependence but can induce discontinuation/withdrawal responses if discontinued abruptly or over-rapidly. So I think that they are worth including on this page as a side note as they are such commonly utilised drugs as this page is largely about withdrawal reactions (albeit from physical dependence). I think that there is justification for a brief mention as a side note of discontinuation/withdrawal reactions.-- Literature geek |  T@1k?  20:19, 22 December 2008 (UTC)


 * I would agree with literature's approach.--Doc James (talk) 21:34, 22 December 2008 (UTC)

I did a little more tweaking and some additions, dunno if I made it worse or better, I think better. I am tired need to go sleep and to prepare for Christmas tomorrow. The page is still on my watch list. Have a good Christmas.-- Literature geek |  T@1k?  01:48, 24 December 2008 (UTC)

The Distinction from Addiction is not spurious
There are many classes of drug that induce physical dependency and/or discontinuation syndromes that are not suitable for use as recreational drugs. Most medications intended to regulate basic bodily functions cause a discontinuation syndrome if discontinued incorrectly, whether they are meant to regulate mood or blood pressure, but few people would argue that someone taking blood pressure medication as prescribed was an addict. Perhaps more references to less-controversial drug categories would help make the distinction clearer? Nightsmaiden (talk) 10:51, 30 July 2010 (UTC)

Caffeine
I've just moved caffeine from the list of drugs that cause physical dependence to the following section on rebound effects. While the article cited in support of having caffeine in the list does use the term "physical dependence" in the title, it's clear from the abstract that the withdrawal symptoms being described are inconsistent with the definition of physical dependence earlier in the article, but are instead the more minor symptoms described in the section on rebound effects.Jbening (talk) 14:23, 18 September 2010 (UTC)

External links modified
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Neuroadaption should not redirect to this page
Neuroadaption currently redirects to physical dependence. However, they are very distinct concepts. The former is a neurological mechanism which can explain the latter. I got here by following a link from the page about kindling. I was expecting a very different article when I clicked that link. Specifically, I was expecting an article which explained in detail how neurons adapted to their environmental conditions. Instead, I was redirected to a page about symptoms and treatment of the resulting clinical condition. What I expected and what I got were two completely different things at completely different levels of abstraction: neurological/neuroscientific and clinical, respectively. Matheus Afonso Martins Moreira (talk) 19:34, 2 June 2016 (UTC)