Tolerance, Dependence & Addiction

Tolerance and dependence are closely associated with addiction, but they are not synonymous terms. Each of these terms describe something different about how alcohol and drugs can affect a person's body and brain.

An early symptom of increasing addiction is tolerance, which occurs when a person no longer responds to a drug in the way they initially did. This means that the person who is becoming addicted has to use larger and larger doses in order to get the effect they are looking for. When the substance is alcohol, these are people who are often said to be able to "handle their liquor." The situation is similar with addiction to most other substances, and because the person believes that s/he can handle it, the addiction may be difficult to recognize.

While many other diseases present with immediate impairment, addiction can appear, to the person who is becoming addicted, as a benefit.

All the while, however, both physical and psychological dependence is growing, the end result being no longer simply a desire to use, but a need to use, and a need to use increasing quantities of the substance that the person is addicted to in order to achieve the same effect.

Increased quantities damage the liver and alter the chemistry of the brain, and eventually tolerance begins to decrease.

With dependence, when the person stops using a substance, their body goes through withdrawal, which is a group of physical and mental symptoms that can range from mild to life-threatening. When the addiction is to caffeine, the withdrawal symptoms may be merely annoying, but the person who is withdrawing from alcohol or opioids is likely to experience severe withdrawal symptoms, which may even be life-threatening.

Someone who takes a presc
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ription medication every day for a long period of time may become dependent upon the medication, and experience the need to keep taking the medication even when there is no longer a therapeutic need for it.

Prescription medications, legally prescribed, are the path to addiction for many people. With many prescription medications, particularly opioids, the patient is taken off of it gradually to avoid or lessen the effects of withdrawal. Someone who is dependent on a drug is not necessarily addicted.

Although tolerance, dependence, and addiction can all result from using drugs or alcohol repeatedly, addiction is a disease. When a person keeps using alcohol or another substance and can't stop, even when there are negative consequences, they have become addicted, which may also be known as a severe substance use disorder.

Addiction comes on gradually, allowing the person to adjust to the illness so that they can continue to function, although they are addicted. Unaware that s/he is adapting to the disease, there is a tendency for the person to deny his or her addiction, sometimes for years. Denial of the disease might be considered part of the disease.

The early stage of addiction is characterized by growing tolerance and dependence, but there are not very many observable problems.

The middle stage brings a progressive loss of control, but the problems are often not attributed to use. Family and friends might notice the problems, but they are likely to attribute the behavior to irresponsibility, unaware that the addicted person is not choosing the problem behaviors. Because it is part of the disease, the addicted person cannot simply choose to drink or use responsibly, at least not through willpower alone.

Marked deterioration occurs during the chronic stage, and these may occur in the physical, psychological, behavioral, social, and spiritual realms. The brain, liver, heart, and digestive system may be damaged during the chronic stage.

Behavioral swings occur as the person drinks or uses a drug to feel better, but is unable to sustain these good feelings. In the quest for the original high, the addicted person's life becomes progressively drug centered. People and activities who interfere with drinking or drug use are set aside, as the person's focus is on getting ready to use, using, and recovering from using. While using, they will do things that they wouldn't do sober. While sober, they structure their lives to protect their using. This may include breaking promises, lying, and isolation. Drinking or drug seeking behavior becomes a lifestyle.