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Forgive my ignorance, but I’ve never been clear on the distinction between “psychologically addictive” and “physiologically addictive”. Surely anything that pro

Forgive my ignorance, but I’ve never been clear on the distinction between “psychologically addictive” and “physiologically addictive”. Surely anything that produces a measurable dependency and withdrawal is just addictive? This distinction seems rooted in mind-body dualism, further driving my skepticism.

Sahbak 3y ago
You can and will die if you quit cold turkey from certain drugs. That is the difference.
- lbourdages 3y ago
  Like alcohol. Heroin, however, will not kill you, but I doubt anyone argues that it is not addictive.
- arp242 3y ago
  I don't think anyone has ever died because they stopped smoking tobacco. Is tobacco not "physically addictive"? If it's not, this only underscores the point that physically/psychologically addictive distinction is not all that useful. And if it is, that only underscores your explanation isn't a very good explanation of the differences.
  - deleted 3y ago
    [deleted]
- omginternets 3y ago
  I don’t think that is the difference, since a fair few drugs we universally agree are addictive don’t do that.
  - shrimpx 3y ago
    It's not that you will die but your body will react adversely. Like with alcohol if you quit cold turkey you can get tremors and seizures. Even with caffeine you get brain fog and hardcore headaches. Basically with hard chemical dependence there will be some kind of adverse body reaction. With marijuana that doesn't exist or is so vanishingly small that you don't feel anything.
    - omginternets 3y ago
      Which is it? Is it absent or “small”? I believe it is rather established that cannabis has withdrawal symptoms in the form of sleep and mood impairments. That would qualify cannabis as physiologically addictive, as indeed would be any drug with physical withdrawal symptoms. Granted, they may be lesser than other drugs, but they are still there.
    - nulld3v 3y ago
      > With marijuana that doesn't exist or is so vanishingly small that you don't feel anything. What? For many, many users this is just completely not true. Insomnia, headaches, nausea, irritability are all common symptoms of weed withdrawal.
      - shrimpx 3y ago
        Ok there are symptoms but my understanding is for many people they're negligible. Also I'd be interested to see the symptoms related to actual chemical dependency on marijuana-specific chemicals, versus generic withdrawal symptoms from denial of expected dopamine release, which you could get by changing how you game, work out, have sex, eat, whatever.
mughinn 3y ago
While I'm not an expert, it's probable some things directly cause addiction by modifying something in your brain, while others don't do it directly with the chemicals but by other means The divide is probably clearer with non-drug addictions, like gambling. Gambling isn't some drug that modifies chemicals in your brain and makes you addicted, and yet some people are addicted to gambling. It's possible some drugs function like gambling, where they don't actually modify chemicals in your brain to make you addicted, but you can get addicted anyways, psychologically
- omginternets 3y ago
  What other possibility is there besides “modifying something in the brain”, especially for something psychological in nature?
  - lfmunoz4 3y ago
    [dead]
Frummy 3y ago
My interpretation is that physiologically addictive means actual physical changes, such as some receptor becoming downregulated and to feel something again you take the drug again. Whereas psychologically addictive could mean you need something for the identity you have or to cope with life experiences. For example I am physically addicted to nicotine but psychologically addicted to caffeine, I would describe it, since I get an actual craving for nicotine whereas caffeine well I like doing a lot of work and fitting into capitalism but I go weeks or months without thinking about it there's no mechanism in my body which tells me to take an energy drink although some people have it that way
- omginternets 3y ago
  Receptor modulation happens when you play video games, too, but I doubt anyone would claim they are “physiologically addictive”. Again, this whole distinction is predicated on the idea that something can affect behavior without affecting the brain. I struggle to see how that is even possible.
  - Frummy 3y ago
    All roads lead to rome right. But the brain doesn't have to be the first busstop. One avenue is via the gut, bacteria screaming for unhealthy food. Or just the old ghrelin, hunger hormone. But on a more analytical approach, I just don't agree with your premise. There's a stark difference between the brains lowlevel mechanics such as serotonin receptor downregulation all the way to buying the brand in the supermarket that reminds you of your childhood. What I mean is it's not a mind-body dualism problem, rather, it's a scale problem. Does the mechanism that drives you to behave consist of individual molecules or cells, or unfathomably complex dynamic patterns of neurons firing across every region of your brain that constitute almost a religious reminder of who you are and what you desire. What I'm saying is is it the hardware or the software. That's physiological vs psychological. But if you wish you can turn any topic in the world into metaphysical philosophy, I just think we have a lot of textbooks in any hospital university library already on these topics that don't bring philosophy into it.
    - 3y ago
function_seven 3y ago
Yes. This distinction drives me up a wall. The way I see it, all addictive substances are psychologically addictive[0]. Some are also physically addictive. Addiction, by definition, is a psychological phenomenon. For recreational drugs, it's the only thing that keeps you using even when the net effect is harmful to your life. It's really annoying to see people say things like, "It's only psychologically addictive" as if that's somehow less perilous than the alternative, or easier to overcome if you want to stop. Most alcoholics have a hard time quitting not just because of the DTs (not that I'm dismissing those!), but because it's bloody hard to break that habit! The yearning for a drink is incredibly strong, long after you've detoxed. The physical withdrawal from alcohol can be managed over just a few days. The psychological withdrawal from it is typically a long-term journey with plenty of opportunities for relapse. Same with heroin. Kicking it is no fun, that's for sure. But once you've done your 30 days or whatever, the physical part is over. The real challenge is just beginning. [0] Okay, I supposed there are addictions that are purely physical. Some blood pressure medications, for example. I ignore these, because "addiction" is probably not the right term for them. "Dependence" better suits therapies that you really do need to continue, or taper when it's time to stop.
- omginternets 3y ago
  I still don’t understand the distinction between “physical” and “psychological”, especially when the thing being manipulated by the drug is the central nervous system. Surely psychological phenomena are also physical ones, insofar as they are seated in the brain and the rest of the body? Do you have an example of a pure case of “psychological addiction”? The only thing I can think of is the social aspect of consuming the drug. But then, I can think of a great number of activities that, when removed, cause “withdrawal” in the form of longing for the social interaction, none of which fit the common-sense definition of “addiction”. So I’m left to conclude that this distinction is a false one. For the purposes of things we generally consider to be drugs, the only possible kind of addiction physiological.
thefz 3y ago
> Forgive my ignorance, but I’ve never been clear on the distinction between “psychologically addictive” and “physiologically addictive”. Quit cigs/caffeine and you'll be irritable and nothing much else... maybe constipated for the first days? Quit heroin and you will likely stop to function, your brain needs it. Same as alcohol, real alcoholics don't stop cold turkey or they will likely die, their body needs it. As the substances have replaced their natural counterparts which the body has forgot how to make.
- omginternets 3y ago
  The constipation is exactly physiological withdrawal symptoms, though… as are the sweats, sleep issues and tremors. I’m struck by how you and others point to physiological symptoms when arguing that the withdrawal is purely psychological.
leetcrew 3y ago
this is an emotionally charged topic and people are often not very precise with terminology when discussing it. so I can understand why you would be confused just from reading a couple articles and comment sections. > This distinction seems rooted in mind-body dualism, further driving my skepticism. this does not really make sense though, and opioid withdrawal is a good example to demonstrate why. people who abruptly stop consuming opioids usually get symptoms that are similar to a bad cold or flu. it's not just "in their head"; they literally have snot pouring out of their nose and sweat uncontrollably for days. this is typically what people mean by "physiological addiction". sometimes it is also called "dependence" to distinguish long-term pain management patients from addicts. btw, most common recreational drugs cause some degree of withdrawal, but it's often not significant enough to notice. in the short term, drug with significant withdrawal symptoms are especially difficult to stop consuming for any length of time. but it doesn't take that long for the body to return to homeostasis. a couple weeks is typical, but it might take up to a year in extreme cases. the learning (ie, what you might call "psychological addiction") never quite goes away though. this is why addicts must be extremely cautious, if not abstain entirely, for the rest of their lives.
- omginternets 3y ago
  I appreciate your example (and level-headedness, btw), but what are we to make of: 1. The fact that these behaviors are learned precisely in response to physiological changes (be it avoidance of withdrawal or chasing the high) 2. The fact that all the supposedly non-physically-addictive drugs like cannabis have well-documented withdrawal symptoms, like sleep dysfunction, that are very much physiological. If your point is that the physiological withdrawal from heroin is worse than cannabis, then I don’t disagree. I just disagree with the premise that anything can be meaningfully addictive without having a measurable physiological effect. This includes things like gambling, in which the physiological effects are well-documented. So I’m not so sure that the two forms of addiction can be so well separated. It seems to me that physiology is the mediator of behavior, here, which points back to the very definition of addiction. I’m left to wonder why people insist on the relevance of this distinction. I don’t believe it’s only to make the point that cannabis is less bad than heroin, as nobody is seriously debating that. I instead get a strong whiff of semantic games.
whimsicalism 3y ago
You're totally right and it's funny even the comments agreeing with you don't get your point. Humans love to categorize, you can't blame us for making them up most of the time. And the mind-body dualism is still very much here to stay, culturally.
- omginternets 3y ago
  Thank you. It’s always destabilizing when so many people simultaneously miss what I thought to be a clearly-stated point.
jmdeon 3y ago
I'm with you here. I think talking about both is important but its a false dichotomy. I would classify "psychologically addictive" as something that makes a little voice in my head go "do that thing again" and is mainly driven by the speed at which an action(drug or not) receives a physiological response in my body. If I take a hit of a weed vape I feel it so fast that my psychological addiction gets triggered more easily. Whereas when I eat a weed edible the response takes so long that the little voice in my head doesn't say, "eat another one". Unless I eat one every day then that little voice becomes stronger over time. I can do either of those things one time and only experience the acute withdrawal. I would classify "physical addiction" as a habit where cessation causes a lengthy (not acute) withdrawal period, caused by some type of brain changes like receptor degrowth because of over-agonization or whatever. I think we qualify ones that have worse withdrawal as more physically addictive. As some have already pointed out, alcohol withdrawal can make you dead and opiate withdrawal can make you wish you were, so we consider these very physically addictive. THC withdrawals exist, but they are so minor when compared to death or opiate-withdrawal hell that we consider it not very physically addictive. An extreme example: Someone could spike my coffee with opiates every day for a year without me knowing, slowly increasing the dose so I'm not too messed up. I would be physically addicted but have no psychological addiction.
- omginternets 3y ago
  That’s fair. I cringe at the linguistic abuse that is “physiological vs psychological”, if that’s how we’re defining things, but I guess that’s “just” semantics. [0] To reiterate an important point you make: if we’re going with those definitions, then the only difference between the two is one of quantity. In both cases, physiological effects of the drug are driving the addiction, mediated by behaviors that emerge in response to changes in physiology. So again, the qualitative difference is only the one that emerges from a vast difference in quantity. I’d also insist that we recognize some of the very-physiological withdrawal symptoms experienced by at least some cannabis users, e.g. sleep disruption… [0] Part of my reason for asking this question initially is because I’m convinced this is not mere semantics, but rather a linguistic game that people play to argue that cannabis has zero meaningful addictive potential. I find that to be disingenuous. P.S.: I hope it’s obvious to everyone that I’m not bashing cannabis use in general. Hell, I appreciate the occasional joint.
photochemsyn 3y ago
It's an overused distinction - but certain drugs when used over long periods of time result in such large biochemical changes to the human body that if they are suddenly withdrawn, the person may experience various medical emergency situations that require hospitalization (delirium tremens with alcohol, seizures with benzodiazepines, dehydration due to vomiting and diarrhea with opiates). These extreme physical effects are seen at the upper end of abuse limits, and the majority of people who legitimately suffer from addiction don't need round-the-clock medical care if they quit - and even those who do can generally avoid such problems if they go through a tapering-off process over the period of about a month.
SCAQTony 3y ago
I should have been more clear: Physical addiction is when sickness, pain or impairment demands that you get your fix or possibly die. Example: "...benzodiazepines can kill you. This type of withdrawal can cause seizures, which increase your risk of life-threatening harm. It can also cause psychosis, which alters your perception of reality." When an individual, who has chronically misused alcohol, suddenly stops or drastically reduces, they can experience a combination of withdrawal symptoms—both physical and emotional—that can range from mild to severe, and in rare cases, can be life-threatening." https://americanaddictioncenters.org/withdrawal-timelines-treatments/risk-of-death https://americanaddictioncenters.org/withdrawal-timelines-tr... Psychological addiction: "...Psychological dependence on drugs or alcohol is the emotional, motivational, and mental addictive qualities that come with substance abuse. ..." https://footprintstorecovery.com/blog/psychological-dependence/ https://footprintstorecovery.com/blog/psychological-dependen...

Sahbak 3y ago

You can and will die if you quit cold turkey from certain drugs. That is the difference.

lbourdages 3y ago
Like alcohol. Heroin, however, will not kill you, but I doubt anyone argues that it is not addictive.
arp242 3y ago
I don't think anyone has ever died because they stopped smoking tobacco. Is tobacco not "physically addictive"? If it's not, this only underscores the point that physically/psychologically addictive distinction is not all that useful. And if it is, that only underscores your explanation isn't a very good explanation of the differences.
- deleted 3y ago
  [deleted]
omginternets 3y ago
I don’t think that is the difference, since a fair few drugs we universally agree are addictive don’t do that.
- shrimpx 3y ago
  It's not that you will die but your body will react adversely. Like with alcohol if you quit cold turkey you can get tremors and seizures. Even with caffeine you get brain fog and hardcore headaches. Basically with hard chemical dependence there will be some kind of adverse body reaction. With marijuana that doesn't exist or is so vanishingly small that you don't feel anything.
  - omginternets 3y ago
    Which is it? Is it absent or “small”? I believe it is rather established that cannabis has withdrawal symptoms in the form of sleep and mood impairments. That would qualify cannabis as physiologically addictive, as indeed would be any drug with physical withdrawal symptoms. Granted, they may be lesser than other drugs, but they are still there.
  - nulld3v 3y ago
    > With marijuana that doesn't exist or is so vanishingly small that you don't feel anything. What? For many, many users this is just completely not true. Insomnia, headaches, nausea, irritability are all common symptoms of weed withdrawal.
    - shrimpx 3y ago
      Ok there are symptoms but my understanding is for many people they're negligible. Also I'd be interested to see the symptoms related to actual chemical dependency on marijuana-specific chemicals, versus generic withdrawal symptoms from denial of expected dopamine release, which you could get by changing how you game, work out, have sex, eat, whatever.

mughinn 3y ago

While I'm not an expert, it's probable some things directly cause addiction by modifying something in your brain, while others don't do it directly with the chemicals but by other means The divide is probably clearer with non-drug addictions, like gambling. Gambling isn't some drug that modifies chemicals in your brain and makes you addicted, and yet some people are addicted to gambling. It's possible some drugs function like gambling, where they don't actually modify chemicals in your brain to make you addicted, but you can get addicted anyways, psychologically

omginternets 3y ago
What other possibility is there besides “modifying something in the brain”, especially for something psychological in nature?
- lfmunoz4 3y ago
  [dead]

Frummy 3y ago

My interpretation is that physiologically addictive means actual physical changes, such as some receptor becoming downregulated and to feel something again you take the drug again. Whereas psychologically addictive could mean you need something for the identity you have or to cope with life experiences. For example I am physically addicted to nicotine but psychologically addicted to caffeine, I would describe it, since I get an actual craving for nicotine whereas caffeine well I like doing a lot of work and fitting into capitalism but I go weeks or months without thinking about it there's no mechanism in my body which tells me to take an energy drink although some people have it that way

omginternets 3y ago
Receptor modulation happens when you play video games, too, but I doubt anyone would claim they are “physiologically addictive”. Again, this whole distinction is predicated on the idea that something can affect behavior without affecting the brain. I struggle to see how that is even possible.
- Frummy 3y ago
  All roads lead to rome right. But the brain doesn't have to be the first busstop. One avenue is via the gut, bacteria screaming for unhealthy food. Or just the old ghrelin, hunger hormone. But on a more analytical approach, I just don't agree with your premise. There's a stark difference between the brains lowlevel mechanics such as serotonin receptor downregulation all the way to buying the brand in the supermarket that reminds you of your childhood. What I mean is it's not a mind-body dualism problem, rather, it's a scale problem. Does the mechanism that drives you to behave consist of individual molecules or cells, or unfathomably complex dynamic patterns of neurons firing across every region of your brain that constitute almost a religious reminder of who you are and what you desire. What I'm saying is is it the hardware or the software. That's physiological vs psychological. But if you wish you can turn any topic in the world into metaphysical philosophy, I just think we have a lot of textbooks in any hospital university library already on these topics that don't bring philosophy into it.
  - 3y ago

function_seven 3y ago

Yes. This distinction drives me up a wall. The way I see it, all addictive substances are psychologically addictive[0]. Some are also physically addictive. Addiction, by definition, is a psychological phenomenon. For recreational drugs, it's the only thing that keeps you using even when the net effect is harmful to your life. It's really annoying to see people say things like, "It's only psychologically addictive" as if that's somehow less perilous than the alternative, or easier to overcome if you want to stop. Most alcoholics have a hard time quitting not just because of the DTs (not that I'm dismissing those!), but because it's bloody hard to break that habit! The yearning for a drink is incredibly strong, long after you've detoxed. The physical withdrawal from alcohol can be managed over just a few days. The psychological withdrawal from it is typically a long-term journey with plenty of opportunities for relapse. Same with heroin. Kicking it is no fun, that's for sure. But once you've done your 30 days or whatever, the physical part is over. The real challenge is just beginning. [0] Okay, I supposed there are addictions that are purely physical. Some blood pressure medications, for example. I ignore these, because "addiction" is probably not the right term for them. "Dependence" better suits therapies that you really do need to continue, or taper when it's time to stop.

omginternets 3y ago
I still don’t understand the distinction between “physical” and “psychological”, especially when the thing being manipulated by the drug is the central nervous system. Surely psychological phenomena are also physical ones, insofar as they are seated in the brain and the rest of the body? Do you have an example of a pure case of “psychological addiction”? The only thing I can think of is the social aspect of consuming the drug. But then, I can think of a great number of activities that, when removed, cause “withdrawal” in the form of longing for the social interaction, none of which fit the common-sense definition of “addiction”. So I’m left to conclude that this distinction is a false one. For the purposes of things we generally consider to be drugs, the only possible kind of addiction physiological.

thefz 3y ago

> Forgive my ignorance, but I’ve never been clear on the distinction between “psychologically addictive” and “physiologically addictive”. Quit cigs/caffeine and you'll be irritable and nothing much else... maybe constipated for the first days? Quit heroin and you will likely stop to function, your brain needs it. Same as alcohol, real alcoholics don't stop cold turkey or they will likely die, their body needs it. As the substances have replaced their natural counterparts which the body has forgot how to make.

omginternets 3y ago
The constipation is exactly physiological withdrawal symptoms, though… as are the sweats, sleep issues and tremors. I’m struck by how you and others point to physiological symptoms when arguing that the withdrawal is purely psychological.

leetcrew 3y ago

this is an emotionally charged topic and people are often not very precise with terminology when discussing it. so I can understand why you would be confused just from reading a couple articles and comment sections. > This distinction seems rooted in mind-body dualism, further driving my skepticism. this does not really make sense though, and opioid withdrawal is a good example to demonstrate why. people who abruptly stop consuming opioids usually get symptoms that are similar to a bad cold or flu. it's not just "in their head"; they literally have snot pouring out of their nose and sweat uncontrollably for days. this is typically what people mean by "physiological addiction". sometimes it is also called "dependence" to distinguish long-term pain management patients from addicts. btw, most common recreational drugs cause some degree of withdrawal, but it's often not significant enough to notice. in the short term, drug with significant withdrawal symptoms are especially difficult to stop consuming for any length of time. but it doesn't take that long for the body to return to homeostasis. a couple weeks is typical, but it might take up to a year in extreme cases. the learning (ie, what you might call "psychological addiction") never quite goes away though. this is why addicts must be extremely cautious, if not abstain entirely, for the rest of their lives.

omginternets 3y ago
I appreciate your example (and level-headedness, btw), but what are we to make of: 1. The fact that these behaviors are learned precisely in response to physiological changes (be it avoidance of withdrawal or chasing the high) 2. The fact that all the supposedly non-physically-addictive drugs like cannabis have well-documented withdrawal symptoms, like sleep dysfunction, that are very much physiological. If your point is that the physiological withdrawal from heroin is worse than cannabis, then I don’t disagree. I just disagree with the premise that anything can be meaningfully addictive without having a measurable physiological effect. This includes things like gambling, in which the physiological effects are well-documented. So I’m not so sure that the two forms of addiction can be so well separated. It seems to me that physiology is the mediator of behavior, here, which points back to the very definition of addiction. I’m left to wonder why people insist on the relevance of this distinction. I don’t believe it’s only to make the point that cannabis is less bad than heroin, as nobody is seriously debating that. I instead get a strong whiff of semantic games.

whimsicalism 3y ago

You're totally right and it's funny even the comments agreeing with you don't get your point. Humans love to categorize, you can't blame us for making them up most of the time. And the mind-body dualism is still very much here to stay, culturally.

omginternets 3y ago
Thank you. It’s always destabilizing when so many people simultaneously miss what I thought to be a clearly-stated point.

jmdeon 3y ago

I'm with you here. I think talking about both is important but its a false dichotomy. I would classify "psychologically addictive" as something that makes a little voice in my head go "do that thing again" and is mainly driven by the speed at which an action(drug or not) receives a physiological response in my body. If I take a hit of a weed vape I feel it so fast that my psychological addiction gets triggered more easily. Whereas when I eat a weed edible the response takes so long that the little voice in my head doesn't say, "eat another one". Unless I eat one every day then that little voice becomes stronger over time. I can do either of those things one time and only experience the acute withdrawal. I would classify "physical addiction" as a habit where cessation causes a lengthy (not acute) withdrawal period, caused by some type of brain changes like receptor degrowth because of over-agonization or whatever. I think we qualify ones that have worse withdrawal as more physically addictive. As some have already pointed out, alcohol withdrawal can make you dead and opiate withdrawal can make you wish you were, so we consider these very physically addictive. THC withdrawals exist, but they are so minor when compared to death or opiate-withdrawal hell that we consider it not very physically addictive. An extreme example: Someone could spike my coffee with opiates every day for a year without me knowing, slowly increasing the dose so I'm not too messed up. I would be physically addicted but have no psychological addiction.

omginternets 3y ago
That’s fair. I cringe at the linguistic abuse that is “physiological vs psychological”, if that’s how we’re defining things, but I guess that’s “just” semantics. [0] To reiterate an important point you make: if we’re going with those definitions, then the only difference between the two is one of quantity. In both cases, physiological effects of the drug are driving the addiction, mediated by behaviors that emerge in response to changes in physiology. So again, the qualitative difference is only the one that emerges from a vast difference in quantity. I’d also insist that we recognize some of the very-physiological withdrawal symptoms experienced by at least some cannabis users, e.g. sleep disruption… [0] Part of my reason for asking this question initially is because I’m convinced this is not mere semantics, but rather a linguistic game that people play to argue that cannabis has zero meaningful addictive potential. I find that to be disingenuous. P.S.: I hope it’s obvious to everyone that I’m not bashing cannabis use in general. Hell, I appreciate the occasional joint.

photochemsyn 3y ago

It's an overused distinction - but certain drugs when used over long periods of time result in such large biochemical changes to the human body that if they are suddenly withdrawn, the person may experience various medical emergency situations that require hospitalization (delirium tremens with alcohol, seizures with benzodiazepines, dehydration due to vomiting and diarrhea with opiates). These extreme physical effects are seen at the upper end of abuse limits, and the majority of people who legitimately suffer from addiction don't need round-the-clock medical care if they quit - and even those who do can generally avoid such problems if they go through a tapering-off process over the period of about a month.

SCAQTony 3y ago

I should have been more clear: Physical addiction is when sickness, pain or impairment demands that you get your fix or possibly die. Example: "...benzodiazepines can kill you. This type of withdrawal can cause seizures, which increase your risk of life-threatening harm. It can also cause psychosis, which alters your perception of reality." When an individual, who has chronically misused alcohol, suddenly stops or drastically reduces, they can experience a combination of withdrawal symptoms—both physical and emotional—that can range from mild to severe, and in rare cases, can be life-threatening." https://americanaddictioncenters.org/withdrawal-timelines-treatments/risk-of-death https://americanaddictioncenters.org/withdrawal-timelines-tr... Psychological addiction: "...Psychological dependence on drugs or alcohol is the emotional, motivational, and mental addictive qualities that come with substance abuse. ..." https://footprintstorecovery.com/blog/psychological-dependence/ https://footprintstorecovery.com/blog/psychological-dependen...