Physical dependence

Physical dependence is a physical condition caused by chronic use of a tolerance forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms. A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal.

This may occur as physical dependence, psychological dependence or both.

Physical dependence can develop from low-dose therapeutic use of certain medications such as benzodiazepines, opioids, antiepileptics and antidepressants, as well as the recreational misuse of drugs such as alcohol, opioids, and benzodiazepines.

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

alcohol (alcoholic beverage) (cf. alcohol dependence, alcohol withdrawal, delirium tremens)

Alcohol dependence is a previous psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol (also known formally as ethanol).

All µ-opioids with any (even slight) agonist effect, such as (partial list) morphine, heroin, codeine, oxycodone, buprenorphine, nalbuphine, methadone, and fentanyl, but not agonists specific to non-µ opioid receptors, such as salvinorin A (a k-opioid agonist), nor opioid antagonists or inverse agonists, such as naltrexone (a universal opioid inverse agonist)

As with other opiate-based pain killers, chronic use of codeine can cause physical dependence.

alcohol (alcoholic beverage) (cf. alcohol dependence, alcohol withdrawal, delirium tremens)

Long-term use can lead to alcohol abuse, cancer, physical dependence, and alcoholism.

benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) (see benzodiazepine dependence and benzodiazepine withdrawal syndrome)

It is necessary to distinguish between addiction and drug abuse of benzodiazepines and normal physical dependence on benzodiazepines.

benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) (see benzodiazepine dependence and benzodiazepine withdrawal syndrome) Protracted withdrawal syndrome is noted to be most often caused by benzodiazepines. A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms.

Long-term use is controversial because of concerns about decreasing effectiveness, physical dependence, withdrawal, and an increased risk of dementia.

benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) (see benzodiazepine dependence and benzodiazepine withdrawal syndrome)

Physical dependence and psychological dependence may also occur.

benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) (see benzodiazepine dependence and benzodiazepine withdrawal syndrome)

Chronic exposure to benzodiazepines causes neural adaptations that counteract the drug's effects, leading to tolerance and dependence.

Abrupt withdrawal from other drugs, such as opioids can cause an extremely painful withdrawal that is very rarely fatal in patients of general good health and with medical treatment, but is more often fatal in patients with weakened cardiovascular systems; toxicity is generally caused by the often-extreme increases in heart rate and blood pressure (which can be treated with clonidine), or due to arrhythmia due to electrolyte imbalance caused by the inability to eat, and constant diarrhea and vomiting (which can be treated with loperamide and ondansetron respectively) associated with acute opioid withdrawal, especially in longer-acting substances where the diarrhea and emesis can continue unabated for weeks, although life-threatening complications are extremely rare, and nearly non-existent with proper medical management.

Loperamide has been shown to cause a mild physical dependence during preclinical studies, specifically in mice, rats, and rhesus monkeys.

nicotine (tobacco) (cf. nicotine withdrawal)

Nicotine dependence involves tolerance, sensitization, physical dependence, and psychological dependence.

nonbenzodiazepine hypnotics (z-drugs) such as zopiclone and zolpidem.

When drug tolerance and physical dependence to zolpidem develop, treatment usually entails a gradual dose reduction over a period of months to minimize withdrawal symptoms, which can resemble those seen during benzodiazepine withdrawal.

All µ-opioids with any (even slight) agonist effect, such as (partial list) morphine, heroin, codeine, oxycodone, buprenorphine, nalbuphine, methadone, and fentanyl, but not agonists specific to non-µ opioid receptors, such as salvinorin A (a k-opioid agonist), nor opioid antagonists or inverse agonists, such as naltrexone (a universal opioid inverse agonist)

Physical dependence and withdrawal from buprenorphine itself remain important issues since buprenorphine is a long-acting opioid.

benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) (see benzodiazepine dependence and benzodiazepine withdrawal syndrome)

Alprazolam and other benzodiazepines may also cause the development of physical dependence, tolerance, and benzodiazepine withdrawal symptoms during rapid dose reduction or cessation of therapy after long-term treatment.

nonbenzodiazepine hypnotics (z-drugs) such as zopiclone and zolpidem.

They are safer than the older barbiturates especially in overdosage and they may, when compared to the benzodiazepines, have less of a tendency to induce physical dependence and addiction, although these issues can still become a problem.

gabapentin (Neurontin) and pregabalin (Lyrica), calcium channel modifiers that affect GABA

Following abrupt or rapid discontinuation of pregabalin, some people reported symptoms suggestive of physical dependence.

alcohol (alcoholic beverage) (cf. alcohol dependence, alcohol withdrawal, delirium tremens) A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms.

Alcohol withdrawal may occur in those who are alcohol dependent.

These can include caffeine, stimulants, steroidal drugs and antiparkinsonian drugs.

Mild physical dependence and withdrawal symptoms may occur upon abstinence, with greater than 100 mg caffeine per day, although these symptoms last no longer than a day.

Substance dependence

The withdrawal state may include physical-somatic symptoms (physical dependence), emotional-motivational symptoms (psychological dependence), or both.

A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal.

Regular use of these substances can cause a person to become dependent on its effects in order to fall asleep.

clomethiazole

Long term and frequent use of chlomethiazole can cause tolerance and physical dependence.

nicotine (tobacco) (cf. nicotine withdrawal)

The onset of this opposing force and the fact that the brain becomes used to and dependent on nicotine to function normally is known as physical dependence.

commonly prescribed antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (cf. SSRI/SNRI withdrawal syndrome)

As such, some researchers advocate the term withdrawal over discontinuation, to communicate the similar physiological dependence and negative outcomes.

Addiction

Past editions have used physical dependence and the associated withdrawal syndrome to identify an addictive state.

Discontinuation syndrome

Physical dependence