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Psychopathological syndromes
Psychological dependence
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Psychological dependence

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Not to be confused with Addiction.
Addiction and dependence glossary
  • addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Psychological dependence is a cognitive disorder that involves emotional–motivational withdrawal symptoms—e.g. anxiety and anhedonia—upon cessation of prolonged drug abuse or certain repetitive behaviors. It develops through frequent exposure to a psychoactive substance or behavior, though behavioral dependence is less talked about. The specific mechanism involves a neuronal counter-adaptation, which could be mediated through changes in neurotransmitter activity or altered receptor expression.Environmental enrichment and physical activity can attenuate withdrawal symptoms. Psychological dependence is not to be confused with physical dependence, which induces physical withdrawal symptoms upon discontinuation of use. However, they are not mutually exclusive.

Symptoms

Symptoms of psychological dependence include:

Development

Psychological dependence is caused by consistent and frequent exposure to a drug or behavioural activity. It is often associated with effects of drug use, but it can also be caused by behavioural activity e.g. pornography.

The mechanism that generates dependence involves a neuronal counter-adaptation, which is localized to areas of the brain responsible for a drug's positive reinforcement. This adaptation occurs as a change in neurotransmitter activity or in receptor expression.

Change in neurotransmitter activity

Studies have shown that in rats experiencing ethanol withdrawal, stimulant withdrawal or opioid withdrawal, the nucleus accumbens shows lower levels of serotonin and dopamine than controls. These decreases are associated with depression and anxiety.

In anatomically distinct areas of the rat brain, withdrawal is linked to lower levels of GABA and neuropeptide Y as well as higher levels of dynorphin, corticotropin-releasing factor, and norepinephrine; these fluctuations can contribute to psychological dependence.

Altered receptor expression

Changes in receptor expression have also been linked to various symptoms of drug withdrawal. For example, in a study of rats undergoing nicotine withdrawal there has been observed a down regulation of α6β2*n-icotinic acetylcholine receptors in the mesostriatal dopaminergic pathways.

Methods for reducing dependence

A study examined how rats experienced morphine withdrawal in different surroundings. The rats were either placed in a standard environment (SE) or in an enriched environment (EE). The study concluded that EE reduced depression and anxiety withdrawal symptoms.

Another study tested whether swimming exercises affected the intensity of perceivable psychological symptoms in rodents during morphine withdrawal. It concluded that the anxious and depressive states of the withdrawal were reduced in rats from the exercise group.

Distinction between psychological and physical dependence

Table 1: List of different drugs and which type of dependence they induce
Physical dependence Psychological dependence
Alcohols Stimulants
Opioids Hallucinogens
Benzodiazepines Cannabis products
Barbiturates Inhalants
SSRIs

The major differences between psychological dependence and physical dependence are the symptoms they cause. While symptoms of psychological dependence relate to emotional and motivational impairment, physical dependence entails somatic symptoms e.g. increased heart rate, sweating, tremor. The type of dependence experienced after chronic use varies between different substances (see table 1).

Although psychological dependence and physical dependence are distinct entities, they should not be characterized as mutually exclusive. Empirical studies have shown that cravings, which are traditionally associated with psychological dependence, involve a physiological element.

See also


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