Psychological vs. Physical: Different Forms of Addiction
If you’ve ever scoured the internet looking up information on marijuana, you’ve likely seen several contradicting viewpoints on whether or not the drug is addictive. Those who swear the drug is not addictive compare it to drugs like heroin and nicotine that have a physiological withdrawal syndrome, while those that swear it isn’t addictive leave out that role that psychological dependence plays in making even innocuous behaviors addictive. Somewhere in the middle of this lies the painful truth that just about anything can become addictive when considered in the right light, and that includes marijuana, alcohol, eating, and sex, alongside drugs such as heroin and cocaine. What separates marijuana and eating from heroin and nicotine is the type of addiction that’s being treated.
In the case of some drugs or behaviors, the key factors that create the compulsion are psychological and understood more broadly in terms of psychological dependence. Far from being innocuous, or “all in your head”, psychological addiction is the major pitfall for most of those who come to rehab. Long after the physiological withdrawal symptoms from the drug have been treated and overcome, a lingering sense of dissatisfaction, anxiety, or an inability to experience joy has been left behind.
For so many of those who have fallen victim to drug abuse, they make it successfully through kicking the physical addiction, only to find themselves using again, and then having to go through the excruciating experience of withdrawal once more. This is because in many cases the psychological dependence is more difficult to overcome that the physical dependence is, and what few ideologues on either side of the marijuana debate are likely to tell you, is that for most addicts who come into rehab for treatment, they are likely to be battling both kinds of addiction simultaneously.
While treatments generally focus on managing the symptoms of physical addiction, the key to making the commitment to sobriety stick is overcoming the psychological addiction. In the process, treatment professionals end up needing to address the psychological reinforcement and conditioning that led to the problem in the first place. For the vast majority of people who come into rehab clinics, the escapist tendency toward drug abuse was a means of temporarily staving off emotional or psychological discomfort. In psychological terms this is known as negative reinforcement. The physical aspect of addiction is identified with positive reinforcement.
The difference is important, though they both work on the same general psychological mechanism. Positive reinforcement is caused by the drug hijacking and the pleasure and reward centers of the brain. Negative reinforcement is what’s left behind when the drug is taken away, or no longer satisfies the craving to the degree it once did. Negative reinforcement has the power to compel and results in the compulsive nature of addicts.
Ideally, the psychological dependence can be managed the same way the physical dependence can be. In practice it’s far less effective. Relapses occur often, which is why having a psychological and social support system there is so pivotal for those directly coming out of rehab. Social supports create a new kind of conditioning that creates a new foundation for reward. While the psychological dependence on reward may never be completely gone it can (and should) be rewired toward more positive and less self-destructive behaviors.