Dependence, in strict pharmacological terms, is a state that develops during chronic drug treatment in which drug cessation elicits an abstinence reaction (withdrawal).
Dependence can be associated associated with a whole range of psychoactive drugs or chemicals (eg caffeine, alcohol, opioid, cannabis or stimulant dependence). As awareness of problematic drug use grew, the definition of dependence changed to include addiction and abuse. Various definitions of dependence evolved with DSM-4, ICD-10, WHO and leading authors describeing it as a cluster of behavioural, cognitive and physiological phenomena that may develop after repeated substance use. Now people link dependence with ‘addiction’ when in fact dependence can be a normal body response to a substance. Whilst drug dependence can be part of addiction, is not the same thing.
To reduce confusion, the new DSM-5 (2013) criteria has replaced drug dependence with DSM-5 SUD measured on a continuum from mild to severe. Refer to Appendix A.3 Misuse, non-medical use and abuse.
Note: There are legal implications involving the term dependence (eg restrictions around prescribing to drug dependent persons). Characteristics of person who is drug dependent include having a history of substance misuse and being identified as a ‘doctor shopper’ or ‘prescription shopper’.23 (Refer to Appendix A.4 Drug-seeking behaviour).
Note: In DSM-5, substance dependence and substance abuse have been combined into a single category of substance use disorders (SUDs) (specific to each substance). Each SUD is divided into mild, moderate and severe subtypes, with the number of criteria present determining the severity.