The distinction between what is a “medication” and what is a “drug” is largely a social construct. The distinction between what is drug dependence and what is drug addiction is based in science. What is often overlooked is the potential for any person who is using an addictive substance as prescribed to become an addict.

The line between dependence and addiction is easy to cross.

  • Dependence is an inevitability of sustained and repeated use of a drug. Anyone who is prescribed opiates, benzodiazepines, or stimulant medications will, in a short period of time, experience a series of adjustments in which their body and mind come to rely on the substance being present.
  • Moving from dependence to addiction is more than simply requiring the drugs in one’s system. The key aspect of addiction is that using the drug causes additional problems in one’s life and the drug gradually becomes the focus/most important thing in a person’s life.

Addiction can be triggered in dozens of different ways.

  • For many, their pain continued after their doctors discontinued prescriptions and attaining the pills illegally was sought. 
  • For others, supplementing the amount prescribed becomes the catalyst. 
  • For still others, the emotional experience of the drug is incredibly enticing even in the absence of physical pain and/or emotional distress.

Nobody intends to become addicted. It’s a Hell that we find ourselves in.

We tend to think of opiates when looking at the line between dependence and addiction but it happens with plenty of other medications as well. For years, doctors prescribed “mother’s little helper” (Valium). Today, they are more likely to hand out Xanax, Klonopin, and Ativan. These drugs are highly addictive and easily abused. They are very dangerous when combined with alcohol (potentially lethal) and withdrawing rapidly from these medications is incredibly hazardous to one’s health.

For decades now, we’ve been prescribing Adderall, Ritalin, Concerta and more recently, Vyvanse for Attention Deficit Disorder. Each of these medications is a stimulant and like opiates and benzodiazepines they are a “controlled substance”, meaning that their possession, distribution, and prescription are monitored by the Drug Enforcement Agency (DEA). We’ve known for many years that these drugs are widely abused and often wrongly prescribed. They’re widely sought after because these drugs make one feel more alert, energized, and in some cases, euphoric.

Misdiagnosis is a common cause of crossing from dependence to addiction. The untold story of ADD (we no longer call it ADHD) is that the symptoms of this disorder are also symptoms of a wide spectrum of anxiety disorders. When we don’t ask the right questions; we diagnose the wrong condition and we inadvertently set people on a course to live their lives at 100mph.

The dependent person crosses many lines to become addicted. We most often do so without any awareness or intention. The subconscious mind rules these choices. At the same time, the person living in addiction will establish new lines (parameters around their use) that provide a false sense of security. These are assurances to ourselves that there are things we will not allow (injection, harder drugs, having drug use interfere with work or family). The best example of this is the high functioning alcoholic who will not allow themselves to drink before 5pm.

The lines keep moving. We make exceptions. We become increasingly adept at rationalizing and justifying our choices. Progressively, the disease of addiction dictates out choices. We find ourselves increasingly fearful and avoidant of ourselves and what our lives have become. 

Ultimately, every addict finds themselves in a pit of shame and fear. We face judgment and consequences with our prescribing physicians/clinicians and other authorities in our lives. We face stigma from countless sources. Pride and stoicism are further obstacles to getting the help needed. 

As a society, we must reconsider how we judge addiction and recognize that under the right circumstances, none of us are immune.