Difference between Physical and Psychological Addiction

If you are relatively new to the art and science of substance misuse treatment, it is only a matter of time until you discover the dichotomy between physical and psychological addictions.

When I first began working in the field of substance misuse, I was told that the distinction between the two lies in the withdrawal symptoms when an addiction is brought to a sudden halt. The withdrawal process for drugs such as alcohol and heroin precipitate physical withdrawal symptoms such as hallucinations, the 'shakes', and nausea. Therefore an addiction attached to these drugs should be considered 'physical'. I was also told that withdrawing from drugs such as cocaine, amphetamine or ketamine precipitates only psychological withdrawal symptoms, and so addictions to these drugs should be considered a psychological addiction.

Whilst the above may be true, it is a rather simplistic definition of the distinction between physical and psychological addiction. In this post we aim to dive into the science between these two broad types of addiction. By the time you have completed reading this post you will gain a good understanding of these important concepts.

What is a physical addiction?

A physical addiction signifies chemical changes in the body due to the consumption of drugs or alcohol. A physical addiction is when cells in the body have been altered during exposure to drugs or alcohol so these cells cannot function correctly without further exposure to drugs or alcohol.

The retardation in cell functionality gives rise to physical withdrawal symptoms when drugs or alcohol are withdrawn. The user thus returns or 'relapses' to drug or alcohol use in order to ease these painful withdrawal symptoms. In order to beat addiction, the user must go through a process known as 'detoxification'. During detoxification at a drug or alcohol detox clinic, prescription medications may be offered to clients in order to ease an otherwise painful withdrawal process.

Examples of painful withdrawal symptoms include diarrhea, the 'shakes' and abdominal pain.

Example of substances causing a physical addiction include:

  • Opiates such as methadone and heroin
  • Benzodiazepines
  • Alcohol
  • Barbiturates
  • Nicotine

What is a psychological addiction?

Unlike a physical addiction, a psychological addiction does not bring on physical withdrawal symptoms once the drug is withdrawn. Here the user experiences a 'compulsion' or 'perceived need' to use the drug or to engage certain behaviours.

Example psychological withdrawal symptoms include insomnia, cravings, irritability fatigue, depression and eating troubles.

A psychological addiction relates to an alteration of the user's belief system. For instance a cocaine user may believe he or she will not enjoy a Saturday night out on the town without using cocaine. However, if he or she is unable to obtain cocaine, physical withdrawal symptoms described above will not be experienced.

This is not to say psychological addiction is not as serious as a physical addiction. Many psychological addictions lead to serious physical and mental health problems. Users become 'all-consumed' on their addiction to the expense of their health, career and relationships with others. Psychological addiction may lead to self-harm and even suicide.

Similarities between physical and psychological addiction

Above we have focused on how physical and psychological addictions differ. Now we focus on how they are similar to one another.

One key element both types of addiction have in common relate to their effects on the brain. This is because both types of addiction tend to affect the brain's reward system known as dopamine. Over time the body builds up a resistance to dopamine meaning more of the substance is needed in order to feel normal.

Another similarities between psychological and physical addiction is how both types of addiction is treated. Physical addiction requires a supervised detox whilst a psychological addiction does not. However this is where the distinction ends. Following detoxification, the mental causes of physical addiction are treated in exactly the same manner as psychological addiction i.e., cognitive behavioural therapy, psychotherapy and holistic therapies, education, nutrition and relapse prevention.