🔒 Addiction (dependence)
A compulsive need. The person has cravings, needs more of the substance over time (tolerance) and feels unwell when they stop (withdrawal). Their life starts to revolve around the substance.
Addiction » Characteristics of Addiction
What you'll learn this session
Study time: 30 minutes
AQA spec: 3.2.4.6
- What addiction (dependence) is, and the signs of cravings, tolerance and withdrawal
- How substance misuse (abuse) is different from addiction
- How the ICD is used to diagnose addiction as dependence syndrome
- The three features doctors look for, and how to apply them to a short case
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Unlock This CourseAddiction or just using a substance?
Many people use substances such as alcohol, nicotine or caffeine. Most of them are not addicted. Psychologists separate two ideas that sound alike but are not the same. You need to know the difference for the exam.
Key terms:
- Addiction (dependence): a compulsive need to keep taking a substance. The person feels they cannot manage without it.
- Substance misuse (abuse): using a substance in a harmful or risky way. The person may not be dependent on it.
- Craving: a very strong urge to take the substance.
- Tolerance: the body gets used to the substance, so the person needs more and more to get the same effect.
- Withdrawal: unpleasant physical or mental symptoms when the person stops taking the substance or cuts down.
- Dependence syndrome: the ICD name for addiction. It is a group of features that go together.
Two different things
⚠️ Substance misuse (abuse)
Using a substance in a harmful or risky way, such as drinking far too much in one night. The risk or harm is the key point. There may be no dependence at all.
Quick way to remember
Addiction = a compulsive need (cravings, tolerance, withdrawal). Misuse = harmful or risky use. A person can misuse a substance without being addicted, and addiction usually involves misuse as well.
How is addiction diagnosed?
Addiction cannot be spotted from a blood test alone. Doctors look at a person's behaviour and feelings. As with depression, they use the International Classification of Diseases (ICD), the list of illnesses and symptoms you met in Characteristics of Clinical Depression. In the ICD, addiction is called dependence syndrome.
The ICD tells the doctor which features to look for. The specification asks you to know three:
💥 Strong desire
A strong desire to use the substance, even though it is causing harmful consequences, such as health problems, money trouble or damaged friendships.
🎮 Difficulty controlling use
The person finds it hard to control how much they take, when they start or when they stop. They may try to cut down and fail.
🥇 Higher priority
The substance is given a higher priority than other activities or obligations, such as hobbies, school, work or family.
A doctor looks for several of these features together. One feature on its own is not enough to say someone is dependent. This links to the earlier ideas too: cravings are the strong desire, and tolerance and withdrawal are signs that the body has become dependent.
Worked example: a case to diagnose
Jake is 17. He used to play football and go to college every day. Over the last year he has started drinking alcohol alone most evenings. He says he wants to cut down because his mum is worried and he keeps missing college, but every time he tries he ends up drinking again. He now skips training because he would rather be drinking. When he did not drink for two days he felt shaky and sick, and he gets strong cravings by mid-afternoon.
Reasoning:
- Strong desire despite harm: he has strong cravings even though it is causing problems at college and with his family.
- Difficulty controlling use: he tries to cut down and cannot.
- Higher priority: he skips football and college because of drinking.
- The shaky, sick feelings when he stopped are withdrawal.
He shows all three ICD features, so a doctor would diagnose dependence syndrome (addiction), not just misuse.
Misuse without addiction
Compare: Priya
Priya is 16. At a party she drank far more than she should and had to go to hospital. She had never drunk much before and has not had a drink since. She has no cravings, does not need more to get the effect and loses nothing from her normal life.
This is substance misuse: a harmful and risky way to use alcohol. It is not addiction, because there is no compulsive need, no loss of control and no sign that alcohol has become a priority.
Common mistakes
Common mistakes
- Saying misuse and addiction mean the same thing. Misuse is harmful or risky use. Addiction is a compulsive need with cravings, tolerance and withdrawal.
- Forgetting that misuse can happen without any dependence.
- Listing the ICD features without linking them to the case. In a case question, quote the details from the person's behaviour.
- Writing only "they like it a lot" for strong desire. The ICD feature is a strong desire to use the substance despite harmful consequences.
- Mixing up tolerance (needing more) and withdrawal (feeling ill when stopping).
Exam-style question
Sam has used a drug for two years. He gets strong cravings, he cannot stop even though he has lost his job, and he now spends his free time only on the drug and has dropped his friends and hobbies.
(a) Explain one difference between addiction and substance misuse. [2 marks]
(b) Using the ICD, identify two features of dependence syndrome that Sam shows. Refer to Sam in each answer. [4 marks]
Model answer
(a) Addiction is a compulsive need to use a substance, with cravings, tolerance and withdrawal (1), whereas substance misuse is using a substance in a harmful or risky way, which may not involve dependence (1).
(b) Any two from: a strong desire to use the substance despite harmful consequences: Sam gets strong cravings and keeps using even though he has lost his job (1 + 1). Difficulty controlling use: Sam cannot stop using the drug (1 + 1). A higher priority given to the substance than other activities: Sam spends his free time only on the drug and has dropped his friends and hobbies (1 + 1).
Exam tip
In part (b), each feature earns one mark and the link to Sam earns the second. Name the ICD feature first, then copy the evidence from the case.