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15290316 tn?1447023108

Difference Between Addiction and Dependency

What do you personally think it is? I've had nine years on chronic pain education telling me that it's okay to be physically dependent on your presription narcotics, and that most patients on long term opiods are not addicted to them.
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Avatar universal
To me there is a difference in addiction and dependence. If one is addicted to something, they can stop it. If a person has a disease, or some other kind of condition that the doctors cannot fix other than for them to take pain meds. in order for one to be able to have some quality of life, then of course anyone would choose to take a pain medicine. That's not addiction, in my opinion, that's trying to enjoy life and not suffer.
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Avatar universal
Here's my 2 cents:

Physical dependence will occur in the human body with a number of drugs--some not even narcotic---if the cessation produces a withdrawal syndrome.  I've heard it called "habituation" by doctors, and it is a normal function of our biology.

Addiction, however, is a compulsion...to repeat the same behavior over and over even though the user KNOWS the outcome is negative, harmful, etc.

I think physical dependency can cross over to addiction very, very easily.  In AA they talk about "the invisible line."  When someone who is a heavy drinker (the "I can quit any time I want" type) chooses to imbibe, they never know the day, hour, minute or second that they are crossing the line to addiction.  

It's a very good question...wish more folks had responded with their opinions...
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Avatar universal
I have a great example at home. I'm a addict no doubt about it I have lied stolen cheated bribed to get my fix. My hubby who has had major surgery's has had to use pain meds. Hubby Has Never done any of these things to obtain them. When I quit he quit with me He was taking 1 a day. while I was taking 20 25 a day I went thru cravings I mean gut wrenching cravings where I was looking all over for a speck of a piece of anything he was feeling a lil emotional.. He never looked back If he needs a pain med he will take one, It is far and few between.. I can not do that. It would need to be consistent our I would go insane with desire for more meds.. It is all in our Brains our emotions.. He had a dependency I have a addiction.. He keeps them locked up and carries the key at all times To Guard against Me. That is the difference.. lesa
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Avatar universal
I am "dependent", but not addicted. I was on Norco 10/325 for over a year until my back surgery and foot surgeries were done and healed. Now I am on Tylenol #3 for residual pain as I rehab both back and foot simultaneously. I take ibuprofen during the day and try to get by with 2-3 Tylenol #3. Also have some pretty serious arthritis in my back now, and hands. I can go a couple of days with nothing, some days, I'm taking 3. My "old dr" always said that there was no need to live life in chronic pain. I miss her! My new(ish) dr is giving me a lot of grief about even being on ibuprofen. I need a new doc, for sure. ALL drs are unwilling to write scrips anymore for anything. It's the new laws....so all of us who legitimately need something for pain now feel like criminals. Never seen a chronic pain dr, they say I don't qualify. I wish you the best. Llife is too short to be lived in pain and misery.
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3197167 tn?1348968606
This is a question that has come up a lot on this forum.  Lots of good threads to read if you put "Addiction vs. Dependency" in the search box at the top.  
People that are NOT addicted do not run out early and do not take more than prescribed (self-medicate).  We can start OFF taking them as prescribed...and then cross a line....an almost invisible line due to a change in our brain chemistry.  My husband is like Lesa's......he can have a major surgery....take his pain meds AS PRESCRIBED or not even take many at all....and then go thru some minor discomfort when he gets off of them.  He doesn't take them longer than a week or 10 days.  But there are people like me that took them for an extended period of time awaiting insurance and surgery....and I crossed over the line.
  
Tuckmore is the community leader in the Pain Mgmt Forum...and she wrote an EXCELLENT journal on this very topic back in 2009.  It will definitely bless and inform anyone that takes the time to read it and addresses your question perfectly!  Here's the link to her journal:

http://www.medhelp.org/user_journals/show/138942/Addiction-VS-Dependency

If you're interested in an EXCELLENT video by a Dr. who is a recovering addict, funny man, devoted to teaching about addiction that spent some time in Leavenworth Federal Prison....let me know and I'll shoot ya the link.  It's LONG....so most people don't wanna watch it~
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Avatar universal
Chig- No, if you're addicted to something you can't "just stop it". If you've been truly addicted to a drug, you would understand this. Its almost like when people who don't understand depression tell depressed people to "just snap out of it". Ridiculous BS.
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7163794 tn?1457366813
COMMUNITY LEADER
This is a topic that comes up alot on this forum....and sometimes I find it hard to see the difference in "addiction" and dependence.  I, myself, am an addict and I let my disease of addiction run my life for many years.  I am now a bit over 19 months clean, and am very grateful for what I am and where I am.

Here's my trouble with the two.....I know many addicts that "claim" that their pain is so unbearable, that can't be without the pills.  As addicts with a disease we are soooo totally capable of lying to ourselves about our pain levels.  And before I get a bunch of ugly posts.....please know I am NOT talking about ALL pain management patients....but let's be honest.....we all know how to play the pain management game!  Are their people that are truly in pain and need the medicine to live a somewhat normal life, YES!!!!!  Is it hard to see the blurred line between the 2......YES!!!!!!
Addicts are physically addicted as well......but there's also something in us that is willing to put everything to the side to keep using....no matter what the cost, no matter who it hurts????  No matter how far down we go??  It's the disease of addiction......MY OPINION.....so no one get there panties in a wad please!
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Avatar universal
Moyte- I like your answer the best!!!

Did anyone ask this question to the OP: why do you ask?
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15290316 tn?1447023108
Thanks everyone for the info. The post from the chronic pain forum was awesome. I'll try to give everyone my story and see what you think.

I am 35 years old and have multiple chronic health issues. At 19, I was diagnosed with endometriosis. It wreaked havoc on my abdominal organs over the years and has permanently scarred my intestines, colon, liver and kidneys. Three years ago, I began throwing up daily. Since then, the vomiting has increased to about four times a day.

From ages 19-26, I used non-narcotic pain medications. Lots of them. It was before the days of liver damage warnings that are now common knowledge. As a result of extreme prolonged use of NSAIDs, my liver was further damaged. When I was 26, I had surgery to remove scar tissue from my organs. The surgery was botched and I immediately went from working full-time to being disabled.

That's where the pain clinic enters my life nine years ago. At first, they tried non-narcotic methods to get me pain relief. When those failed, I signed a contract for opiods. I tried all different kinds, but Oxycontin emerged as the one that got me back to work. That, and I don't vomit blood when I take them. I've been on them ever since. The dose has increased since the beginning, but I've been on the same dose for the past several years.

I've detoxed a handful of times over the years, but it was always for medical reasons and was with knowledge of the pain clinic.


Have I been the perfectly compliant patient with my daily doses? not always. I might take an extra one if I throw up the first one in the morning. I may take an extra one on days where I physical activity is necessary, and then I have to taper down at the end of the month. I told the doctor this (in an attempt to get my dosage upped a few years ago), but they convinced me that was a bad idea. Instead, they told me what I was doing was okay, but that I had to get in lock down mode other days to make up for the extras.

I've had some really bad days in those last few days of the month, and I always hate myself for it. With that said, I've never doctor shopped, forged scripts, or took other meds not belonging to me.

This month, I was a dumb arse. I was in Florida for two weeks. Somewhere between the hotel, the rental car, and my house, I misplaced my cosmetic case containing 21 of my Oxys. It was awful. I am no fool. I know that I'll look like a total drugseeker to call my doc and tell him what I did. So I put on my big girl pants and did as much of a taper as I could with the supply I didn't lose, and then went into a horrible (almost) CT WD.

So I'm really struggling with it now. My script can be picked up in a couple days if I want it.

I've harbored a lot of guilt about being on Oxy, but I can live somewhat of a normal life because of it. No one except my husband knows I'm on them because I'm afraid to tell anyone. People judge. I hate it. I also hate feeling like these pills are in charge of my life (as in quality of life).

I'm on day 9 of detox, but my pain is out of control right now. I just don't know if I'm ready to throw out that pain relief. What do you guys think?
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Avatar universal
I am definitely someone that crossed the line from dependence to addiction.  I went from taking codeine as I needed it to using it as a preventative.  I had so much to do in a day and I couldn't let a migraine slow me down, SO......"nip it in the bud".  That's hard for me to admit.  

I told myself that as long as I didn't exceed the recommended daily dosage (and I didn't) that it'd be fine.  A lot of rationalising and ritualising went into my addiction (and I have to think of myself as an addict).  So I see a clear line of where my dependence on meds to relieve migraines crossed over into a daily addiction.

I think rationalising, bending the truth, rotating pharmacies, those are all clear signs that it's out of control.  Do I still have a chronic illness? Yes, but I need to find a way to manage it differently.
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Avatar universal
Sorry puppies, you must have been writing your post at the same time I was and now my post looks weird!  

I think you have a dilemma because of your particular health issues.  Are you able to manage without the meds when detoxed?  Are you detoxing with the help of a doctor and will they then re-evaluate your medical needs from there?
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Avatar universal
Hi there- I'll answer your question. First, did you report your purse stolen at the time? Did you call your doctor and let him know? Do they do urine testing at your clinic?

Reporting the crime is necessary for a lot of reasons...Anyway, if all of that is as it should be then, yes, you should get you're next prescription.
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Avatar universal
I guess I was "dependent, not addicted."  I took 10/325 Norco for about 7 years total.    I never ran out....never abused my prescription.    I was prescribed 240 a month, there at the end.    Just because I didn't abuse my prescription, did not mean that I didn't go thru withdrawals when I quit.    I quit CT the first time and was off for about 18 mo. and then had knee surgery and PT and went back on them for about a year.   Longer than I should have stayed on them, but I dreaded the withdrawals.    I tapered the second time.

I did not have any trouble tapering....or sticking to my schedule, which was a very slow taper.    I still had some withdrawals with the taper.....mostly lethargy and depression.    I never took the full amount prescribed.   Hate to say this....I sold about 100 a month to one guy who paid me $5 each.

I haven't had very much trouble wanting to take them any more.   I would never go back on them unless I had a serious, perhaps terminal illness where I had to do it.  I am healthy for my age, and I can't see taking a chance and messing that up with any prescription med.     But, I have never used any drugs to any extent except smoked a little home grown pot over 30 years ago.    I don't even drink unless you count one margarita here or there.    I never drink more than one.....afraid I'd get stopped for a DUI.   So, my "addictions" are not geared towards drugs or alcohol.
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15290316 tn?1447023108
They didn't get stolen. I misplaced them when packing up two weeks worth of crap when we returned from vacation.

I do get drug tested, but I'm not due for one for a couple months. Doctors hear these kinds of excuses all the time, so I didn't tell the pain clinic what happened. I never want to give them a reason not to trust me.
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Avatar universal
Okay. I apologize. I mixed you up with someone else. It happens. But in reading back through your comments, it seems you consider yourself an addict. So maybe I was hasty with my earlier comment.

In this thread you said that sometimes you might take an extra ONE on bad days and then run short for a FEW days at the end of the month. Two days ago you said you took up to 300mg per day and were without the last 10 days of the month. Kind of like now....

I'm only trying to point out how we try to fool ourselves into thinking we're just fine when we're not.  I can't tell you or anyone else that they're an addict. It's not my call. Only you know what you're doing and obviously you're looking at that now.

I believe you have pain. Most of us here have pain daily.  Keep examining your behavior and use of the pills and then decide how much you really need them.  All the best-
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15290316 tn?1447023108
I appreciate your insight Vicki. As you can see, I go back and forth hating myself for the Oxy. I should clarify that this is the first time I've ever run out of meds completely because of my carelessness. Usually, I can taper down at the end of the month for all those extras I took.
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Avatar universal
The back and forth and rationalization and "downplaying" the situation is typical. Don't kid yourself though, you're in a tough spot.

Go back and read your original thread. There isn't any judgement (shouldn't be) in this forum so be honest and let us know how we can help.
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3197167 tn?1348968606
Being a chronic pain person myself....I recognize the "inner argument" that's going on in your head.  Eventually, something just clicks....it is different for each of us.  You may have to test the waters again.  If you still think you can "control" your usage....then you aren't an addict.  But, like Vicki said, it is a decision you will come to on your own.  I just remember your very first post....and this is what you said:

"I've spent most months running short on meds early, taking as much as 300mg a day just to avoid that sick feeling in between doses. Then, I would spend the last ten days of every month in partial withdrawals tapering while I waited for my next scripts. I definitely have a problem."

You'll figure this out in your head....and we'll be here to support you...always♥
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Avatar universal
Hi Puppies:

I feel for you.  First off, I had severe endometriosis as well, 30 years ago.  The pain I suffered was awful, and eventually, I had to undergo major surgery to remove a very large endometrioma (they call them "chocolate cysts") from my left ovary...along with 1/2 the ovary too.  

Nowadays they would have done the procedure laparoscopically, but back in 1985, they cut a long horizontal incision almost form hip bone to hip bone.

I was never put on pain meds prior to the surgery, because every doctor I went to couldn't find a cause for the pain, so I was dismissed.  This was way back when HMO's were all the rage.  I went from one specialist to the next, every department, and finally the 2nd GI doctor I saw told me I needed psychiatric help for the pain I was "making up to seek attention." GRRR!

Finally, when the tumor grew so large I couldn't lift my leg, it was seen on an ultrasound (another new machine back then.) and i had surgery.

Anyhow...long story short, I WAS put on pain meds after the surgery, because I still had endometriosis.  The surgeon said my fallopian tubes looked like someone had sprinkled paprika all over them (blood cells.)  I didn't like the meds; they made me nauseous, and I got married soonafter and pregnant, which made the endo pain stop.

Fast forward:  20 years later, I develop severe and chronic back pain and chest pain.   I was always going to the ER thinking I was having a heart attack, and then being discharged 12 hours later being told, NOPE I didn't, but no other explanation.

My doctor finally diagnosed me with costochondritis (the chest pain) brought on by too much driving & typing on a computer (I am in sales) AND also made worse by playing piano (I have played all my life. I gave my piano away, and haven't played in years.)  The back problems were a different story:  one doctor said i had fibromyalgia, another said I had degenerative disk disease, still another said a pinched nerve.  

Sigh.  I just needed to be able to work, and couldn't afford to take time to have surgery.  And so I started my 8 year journey with opiates.  At first, Vicoprofen (I refused Vicodin, because I didn't want to be taking acetaminphen daily) but my stomach became a mess due to the NSAIDS...so I was switched to pure oxycodone.  

I started at 10 mgs a day, then 20, 30, 40.  I stopped at 40.  My doctor wanted to up the dosage when I would get breakthrough pain, but I refused.  He also wanted me to try a Fentanyl patch, which I also refused.    I would play all kinds of games with myself...wean myself down to 20 mgs a day, then take the 40 to get pain relief.

BUT.  Something happened over the years, something changed.  I began to notice that while YES, the oxycodone took my physical pain away, it ALSO removed my emotional pain.    And I had a boatload of the latter.  I'm an abuse survivor...despite 20 years of therapy, there are some scars that will never be fully healed, only managed.  

I had a toolbox full of tips, tricks, exercises, distractions, etc that i had learned in multiple programs on how to deal with flashbacks and panic attacks that I suffered because of being abused.  

When I was on the oxy, I didn't need any of them...because I didn't GET flashbacks or panic attacks.  I was blissfully numb.  

This happened so slowly, so subtly, that I first I hardly noticed.  But the years went by, and I began to rely on the pills for emotional pain relief JUST as much as physical pain.  And then the scale tipped, and I was using them JUST to feel "good" and "normal."  

I began to overuse them, take several at one, and I'd be constantly running out at the end of the month.

Was I physically dependent?  Yes, of course.  Was I emotionally addicted?  Absolutely.  

Life is hard off opiates.   I'm one week shy of 10 months, and I think I'm still recovering; last night I got ZERO sleep, despite taking trazodone, doing breathing exercises, drinking herbal tea, etc.

For me, there is no way I couldn't be addicted to something that promised my childhood never happened.   I know that is a weird sentence, but it applies for me.   Now I'm back to where I used to be...I have panic attacks and flashbacks...sometimes I'll recognize a smell that sends me reeling or a song will come on the radio that I HAVE to turn off.      I do whatever I have to do to deal with life on life's terms.    Meetings, forums, you name it.

Addiction is like a thief in the night...you never see it coming, and no one ever thinks they will become one.  

Thanks for letting me tell my story; sorry I hijacked your thread with so many words!

Hugs,
-Robin
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