Mangement of Dependence and Withdrawal
Dependence
The issues of dependence and withdrawal have come up repeatedly through the previous articles we published. They are a primary concern of any taker of psycho-active medication. Some outline of current thinking on these issues therefore seems called for.
It has been traditional to distinguish between physical dependence and psychological dependence. Physical dependence is the state that produces withdrawal syndromes – of which the classic instances are alcohol induced delirium tremens and opiate-induced cold turkey. This is assumed to be physical because withdrawal syndromes are usually intensely physical states with shakes, palpitations, sweating and sometimes even convulsions and death. Some have argued that many individuals are trapped into continuing use of drugs out of a terror at the prospect of withdrawal.
Psychological dependence in contrast has often been thought to be purely a psychological thing that does not involve anything physical in the brain. The symptoms are the craving for a substance that leads addicted individuals to start taking it again, often after they have gone through the physical horrors of withdrawal. Such agonies would have scared any reasonable person off taking the drug again, it is assumed, which testifies to the reality of psychological dependence.
Recent discoveries are leading to a revision of these ideas. It is now thought that there are two distinct types of physical dependence, one of which produces withdrawal syndromes and the other cravings. In addition there are a range of psychological factors that may lead someone to continue abusing psychoactive substances.
