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Dependence, Tolerance and Addiction Explained

Needing a medicine, noticing that it works differently, or feeling unwell after a missed dose can be frightening. These experiences deserve a careful conversation. The terms below describe different things and help you explain what has happened.

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What the Words Mean

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TermPlain meaningWhat it does not tell you by itself
Physical dependenceThe body has adapted to a substance. Reducing or stopping it can cause withdrawal symptoms.Dependence alone does not establish addiction. It can develop while a medicine is taken as prescribed.
ToleranceThe same amount produces less of a particular effect over time.It is not an instruction to increase a dose. A change in symptoms may have other causes.
AddictionCompulsive substance use that continues despite harmful consequences. Problems controlling use and its effects on life matter.A missed dose, tolerance or withdrawal alone is not a complete assessment.

Sources: [1]

Sources: [2]

Fictional example: someone takes a prescribed benzodiazepine as directed and develops symptoms after missing it. Physical dependence is one possibility to discuss; the example alone cannot establish addiction. The useful next step is a medication review, not a self-directed dose change.

Sources: [1] [2]

Prepare for a Medication Review

What you take and what has changed
Medicine/substance, dose as prescribed, actual use, timing, symptoms and when they occur. Bring the container or medication list.
What is affecting your life
For example: running out early, missed responsibilities, pain or anxiety returning, side effects, or fear about stopping.
Your question for the clinician
For example: What might explain this change, and what is the safest next step?

Help With the Next Conversation

Sources

  1. NIDA: Principles of Drug Addiction Treatment, Third Edition
  2. FDA: Benzodiazepine Boxed Warning and Safe Use

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