Understanding Dependence and its Treatment

Dependence on mood-altering substances is a phenomenon that is rarely understood and often mistreated. There are two kinds of dependence – physical and psychological dependence.

Physical aspect

Physical dependence manifests in withdrawal symptoms such as tremors, delirium, hallucinations and aggression when the drug is “withdrawn” from the body. Physical dependence is essentially the body’s tissues reacting to the loss of substance from the body – a substance in the presence of which they had got used to functioning.

Psychological aspect

Psychological dependence is less obvious to the observer yet the more complex of the two. It is defined as “a relatively extreme, pathological state in which obtaining, taking, and recovering from a drug represents a loss of behavioral control over drug taking which occurs at the expense of most other activities and despite adverse consequences” (Altman et al).

Psychological dependence is characterized by an emotional dependence on the drug, as well as subtle and progressive changes in the individual’s personality and value systems. The individual reaches a point where he can neither function without the drug, nor imagine an enjoyable life without it. He begins to use the drug as a coping mechanism to the relative exclusion of all other natural coping systems. His moods and feelings of self-worth depend solely on the presence or absence of the chemical. This is emotional dependence.

The link between personality and emotions has long been established. Hence when we observe that an addict’s emotions and belief systems have become distorted, we find it leads back to certain personality changes which have either been brought about or exacerbated by continued abuse of mood-altering substances. Addicts often share similar personality traits – self-centeredness, low self worth, a magnified ego, grandiosity, dishonesty, high self-will and so on.


Denial is a major characteristic of psychological dependence. It is a distorted belief system. Denial, one of the hallmarks of the disease of addiction simply means that everyone around the addict can see the problem, but he himself is blinded to it. Denial is a primitive psychological defense mechanism, which serves to protect the individual from unpleasant realities – in this case, the reality of addiction. It is this denial that serves to perpetuate the vicious cycle of addiction and the seeming apathy of addicts to the havoc they wreak to themselves and to those around them.

Addiction treatment

Thus it is imperative that treatment for substance dependence addresses these various interlocked and interacting facets of dependence – neither is detox sufficient by itself, nor is counseling useful without a thorough physical assessment. Finally, recognition of the individual as a unique personality with an incurable yet treatable disease is a truth, which would serve many an addiction counselor in their objective to reach out to the dependent individual.

Raisa Luther

Therapist, Hope Trust