Dependence Is Not Addiction

It’s no secret I’m a fan of tramadol. Hell, it’s the name of my site. Those little white pills saved my life. So it should be no surprise that I’m all for prescription pain medication when it’s used appropriately.

And it should be no surprise that one of my pet peeves is the fear-mongering that runs rampant and unchecked in the medical community that stops professionals from prescribing pain meds to treat chronic pain assertively.

What’s behind this insane aversion to the pills? I think there are a couple of things at work here. One is that somehow, we’ve abdicated responsibility for medical decisions to law enforcement officials. That’s messed up.

Another is this ineffective, wasteful “war on drugs” with its screwball insistence on locking up as criminals those who merely use, alongside the devils that push the crappy stuff on them. It’s swept up legitimate uses of pain medication along with the highly-publicized legitimate cases of prescription pain med addiction and the street-drug abusers.

And finally, I think there’s a fundamental misunderstanding that fuels this mess: too many folks are confusing dependence and addiction. Need proof? Here’s a page on drug dependence from the University of Maryland Medical Center — and look at the very first sentence:

Definition of Drug dependence:

Drug addiction, or dependence, is the compulsive use of a substance, despite its negative or dangerous effects.

Right there, in the very first sentence. A medical university gets it wrong. Now, true, in the next few paragraphs, it hedges the bet a bit:

However, a physical dependence on a substance (needing the drug to function) is not always part of the definition of addiction. Some drugs (for example, certain blood pressure medications) do not cause addiction but they can cause physical dependence. Other drugs cause addiction without leading to physical dependence. Cocaine is an example.

But it’s too late. The damage has been done. The first sentence makes it clear — “drug dependence = drug addiction.” The subsequent qualifications are too little, too late.

What’s the Difference Between Dependence and Addiction?

So what exactly is the difference between being dependent on a drug and being addicted to it?

  • Dependence is a normal physical condition, while addiction is an abnormal psychological condition.
  • Dependence simply means your body has grown “used” to the drug; addiction means you psychologically crave it, usually in higher and higher doses.
  • Dependence does not in and of itself interfere with your daily functions and life; addiction devastates.

We, as the fibromyalgia and chronic pain community, simply must do a better job of educating the world about this distinction. We need to speak out when our friends get it wrong. We need to write to editors of newspapers whose journalists get it wrong. We need to — yes! — correct our own doctors if need be.

The reluctance to speak up is completely understandable. None of us wants to be labelled an addict or drug-seeking (the medical profession’s cute little label for anyone whose pain they don’t quite understand — basically, a less emotionally charged way of calling someone an addict).

There’s so much stigma in this society against pain medication that when we speak up for any aspect of it as a treatment option, we’re automatically aware that somewhere, in some file, there’s a giant red asterisk being placed beside our names.

But we have to get over that if things are to change. The actual risk of addiction has been proven to be quite low, and when no conservative measures are working, why on earth should we be required to hurt like hell — often becoming nonfunctioning and disabled in the process, thereby putting an unnecessary drain on government resources — when we don’t have to be?

I do believe that lifestyle changes can hold chronic pain at bay in many instances — but not all. Why should we be forced to hurt like hell while we make those changes? All because some people don’t understand that dependence does not mean addiction.

I realize others may disagree with me strongly. If you’ve ever had a family member addicted to any substance, as I have, you may well be experiencing a strong emotional reaction to what I’m writing here. That’s fine.

Please understand: I’m not saying addiction to legal prescription pain medication does not exist. I’m saying it’s not a foregone conclusion, and it’s not a sufficient reason for chronic pain patients being forced to rely on ineffective conservative treatments, when there are legitimate medications that make them feel better and give them their lives back — which is exactly what tramadol did for me.

8 thoughts on “Dependence Is Not Addiction

  1. Lisa

    help…yes, I wrote the word “help” in lowercase to indicate how “small” my own voice has become in trying to find reliable, caring, and more importantly, trusting medical care for my chronic pain and other fibromyalgia symptoms. Since my diagnosing physician relocated earlier this year, (along with 2 others over the past 3 years), I am left with the additional, (and seemingly ridiculous), battle of having to convince my new doctor that my uncontrolled pain is a reality, a truth, an actual debility. There's more to this story. I frightened myself into the “addiction” trap over a year ago, and get this, removed myself from pain management because I was so concerned, (maybe even paranoid), about addiction. I put myself through the tortures of withdrawal because I didn't understand the difference between addiction and physical dependence. I had, in fact, grown tolerant to the narcotic pain relievers I was prescribed and was mortified at the possibility of having to take higher doses. I felt it was time to hit the reset button, and when I did…(though I haven't actually seen the red flag in my chart), control of my pain by my doctors became obviously overshadowed by the addiction stigma. There's so much more to my story, but I am tired, disgusted, in pain – (even with pregabalin and tramadol) – and ready to remove the word “doctor” from my vocabulary, altogether. But mostly, I'm angry with myself for the illogical, unreasonable thinking that got me to this place. I have few options left.
    I intend to read everything on your site as it appears to bypass the usual fibro hype I've seen on other “medical” sites, and because it actually makes sense. Thanks, L.

    1. sherriesisk

      Lisa – Thank you so much for commenting and the kind words. You are so brave to tell your story so honestly. I wish more of us would speak up about our experiences with the medical profession and prescription pain medication.

      Please don't give up. There are alternatives out there – I'm not a doctor, so I won't advise you which to try or stay away from. You're obviously a self-aware and highly intelligent person, and seem to be well on your way to true empowerment as a patient.

      Now that you know the difference, explore (A) different doctors and (B) different treatments. I don't know of ANY single treatment plan – including prescription pain meds – that will “fix” us all. Almost every fibromite I've ever met who achieved some semblance of normalcy again did so as the result of a comprehensive approach, including dietary changes, exercise (within limits), meditation, conservative care measures (like heating pads and massage therapy), and medication where appropriate.

      I hope you find more information of use on this site. Please write back and let me know how you're doing from time to time.

  2. Marcy

    THANK you SO MUCH for saying this! I am constantly posting this on my fibromyalgia page on facebook. The media isn’t doing us any favors lately—that’s for sure!

    1. Annie Post author

      I am SO sorry it took me so long to approve your comment – I never got the email notification of it! My apologies. You won’t have any trouble in the future commenting here, if I’ve done this correctly. Thanks for your kind words! Keep fighting!


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