Physical addictions describe the body and brain’s dependence on a drug, while psychological addiction refers to an emotional dependence a person forms to a drug. Many people assume that the physical addiction to a drug is stronger than the psychological addiction, but this is not true. Research on relapse and remission indicates that the psychological aspects of addiction are what are most likely to determine whether a person relapses or achieves long term sobriety.

Physical Addiction vs Psychological Addiction

Physical addictions can definitely make quitting certain drugs very difficult. Opioid drugs like heroin, stimulants like cocaine, and even nicotine are some of the most physically addictive drugs. When a person is physically addicted to a drug, they will experience physically painful or uncomfortable symptoms of withdrawal when the drug is no longer in their system.

Because drugs metabolize at different speeds, the withdrawal symptoms may come a few hours or a few days after the last dose.

The experience of physical withdrawal symptoms is what differentiates physical addiction from psychological addictions. A person who is physically addicted to a drug can experience unpleasant withdrawals like muscle pain, nausea, diarrhea, cramps, hot and cold flashes, and flu-like symptoms for days or even a week after they stop using.

The period of physical withdrawal from a drug is often called the acute phase of withdrawal.

Psychological addiction describes the mental and emotional aspects of addiction. A person who gets high begins to associate the drug with pleasure, happiness, or relaxation. These positive emotional associations with the drug are incredibly powerful reinforcements and make a person much more likely to seek out the drugs more often and in higher doses.

People who are already stressed out, anxious or depressed are even more likely to find drugs psychologically rewarding, as they may temporarily seem to “correct” their emotional imbalances.

The positive emotional association that a person develops to drugs or alcohol can be so strong that many people begin to feel as though they cannot be normal or functional without the drug. These beliefs may even be reinforced when a person misses a dose or tries to take a break or cut down and begins to experience physical or psychological withdrawal symptoms.

The emotional dependence the person has formed with the drug can continue even after any acute physical withdrawals have passed.

Virtually all people who are physically addicted to an illicit drug are also psychologically addicted. In fact, what we describe as physical addiction can and does routinely happen to other people who are prescribed more benign medications like steroids or anti-depressants.

When a person who has regularly taken these medications suddenly stops or misses a dose, they may experience some of the same symptoms experienced by those who quit hard drugs like heroin or cocaine.

A person who has become physically addicted to an un-intoxicating medication is not recommended to enter into addiction treatment because a physical addiction alone does not drive compulsive drug use.

Because their medication was not getting them high, it is not activating the same “reward pathways” in the brain and they have no incentive to take higher or more frequent doses.

Illicit drugs and alcohol, on the other hand, do light up the reward pathways in the brain, causing the release of brain chemicals like dopamine, serotonin, and GABA which cause feelings of pleasure, happiness, euphoria, and relaxation.

Physical Withdrawals and Relapse

Decades worth of research has helped us to better understand addiction and what drives it. Being physically addicted to a drug definitely creates additional discomfort in the early stages of recovery and can increase the risk for relapse during the acute withdrawal phase.

But this only accounts for a small percentage of people who relapse, especially because so many treatment options now exist to facilitate early recovery and ease symptoms of withdrawal.

Many relapses occur either after a person has come out of acute withdrawal or after they have taken a medication that prevents or greatly reduces physical withdrawals.

If physical addiction alone explained compulsive drug use, this would not be the case. As an example, heroin withdrawal is often believed to be one of the most painful withdrawals, causing chills and hot flashes, diarrhea, nausea, sweating, insomnia and anxiety and depression. The physical withdrawal symptoms for heroin are so unpleasant that many people addicted to heroin or other opioids will continue using even after they no longer can get high from the drug, just to avoid these symptoms (1).

Today, there are novel medications which can help heroin users bypass the physical withdrawal phase almost entirely. By taking a substitution medication like methadone or suboxone, a person can seamlessly come off of heroin without withdrawals (1).

If physical addiction was the primary barrier, these medications should have near perfect rates of success, but they do not. Research indicates that only about half of the people who receive these treatments have remained sober at an 18 month follow up (3).

Because these medications prevent withdrawals, we know that the 50% of people who began using again did not do so because of the physical aspect of their addiction.

3 Common Causes of Relapse

Research conducted on relapse rates and risks have helped us better understand what specific factors lead to relapse, and interestingly, all are psychological in nature. Consistently, the most common precursor to relapse is the experience of stress. People who have relapsed almost always cite stress and difficult emotions as a main contributing factor to relapse (2, 4, 5). Because people who have been addicted to drugs or alcohol relied on these substances to cope, stress, sadness, anxiety or frustration are often major triggers.

In most cases, people who relapse during a stressful situation also describe neglecting specific routines, activities, and supports which helped them get sober and stay sober in the past. These might include things like attending 12 step meetings, contacting their sponsor, attending counseling, or using other coping skills.

Neglecting these support systems, skills and routines that have helped them cope more effectively in the past further increases the risk of relapse during a stressful or difficult time (2, 4). Because stress and life challenges are inevitable, maintaining these recovery skills and routines is important in guarding against relapse.

Another consistent factor linked to relapse is the level of self-efficacy, or confidence in one’s ability to remain sober, a person has developed (2, 4). Self-efficacy is developed over time, as a person in recovery begins to rely less on avoidance tactics to remain clean and sober and instead uses learned skills.

When a person in recovery has had success in being exposed to triggers, temptations and opportunities to relapse but has not done so, they are better equipped to deal with cravings.

Steps to Overcome Psychological Addiction

A different skillset is needed to address the underlying psychological aspects of addiction. While the physical withdrawals will pass in time and can be reduced or eliminated with medication, the psychological dependence on a drug can continue indefinitely.

Addressing these underlying psychological aspects of addiction seems to be an essential part of achieving long-term remission from an addiction.

Some of the methods to overcome psychological addiction include (2, 4, 5):

  • Seeking formal treatment to address underlying mental health issues like anxiety, depression, or PTSD, and also to help learn effective methods of coping. Treatment can include inpatient rehab or detox, counseling, medication, group therapy, or any combination of these.
  • Maintaining strong relationships with friends, family, and other supports like 12 step sponsors and peers, as well as professional supports like a counselor or psychiatrist. Strong intact support systems greatly reduce the risk of relapse.
  • Building self-efficacy in your recovery by working to use effective coping skills to manage stress and difficult emotions, and also to use impulse control skills to resist temptations to relapse as opposed to relying solely on avoidance tactics.
  • Developing new routines which may include social interaction, enjoyable leisure activities, and any other activities that benefit you physical and mental wellbeing or help you manage stress.
  • Practicing self-compassion by being kinder in the way you talk to yourself and treat yourself, forgiving yourself for past mistakes, and working to practice more effective and consistent self-care.
  • Building emotional intelligence by becoming more aware and in touch with your emotions, learning to accept them and using them as tools to learn and grow as opposed to avoiding or repressing them.
  • Starting a meditation routine to help you develop more mental strength and learn to unhook from unhelpful thoughts, urges and stories that can lead to relapse.
  • Focusing on your future by developing and working towards important personal and professional goals will keep you positive, motivated, and focused on the future, as well as providing a sense of control, purpose and direction.
  • Being proactive about solving problems or addressing sources of toxic stress in your life to prevent them from becoming bigger issues, as opposed to trying to avoid them, escape or distract yourself.
  • Contributing your time, energy and talents to causes that you care about or activities that allow you to help other people or effect positive change in another person’s life or the larger community.

While the focus of early recovery is often on overcoming the physical and acute withdrawals, the psychological aspects of addiction should not be neglected, especially because these are more likely to lead to relapse.

Building and maintaining a life that is fulfilling and focused on your relationship, goals and values will provide protection, minimizing the psychological pull of drugs. Strengthening your ability to cope with stress, difficult emotions, and urges will ensure that even if you do feel this pull, you will be equipped with the skills needed to resist it and remain strong – and sober.

Sources:

  1. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization
  2. Rates and predictors of relapse after natural and treated remission from alcohol use disorders.
  3. Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”.
  4. Relapse prevention
  5. Sinha, R. (2001). How Does Stress Increase the Risk of Drug Abuse and Relapse? Psychopharmacology, 158, 343-359.

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