It’s all in the words

By Alan Koenigsberg, M.D.

What is the difference between addiction and dependence? Between a hypothesis and a theory? Between lightning and a lightning bug?

While the difference between the last two may seem obvious, a small, three-letter word makes all the difference in the world, between an amazing, brilliant, potentially life-threatening natural phenomenon and a harmless, attractive bug.

This is also true in the world of science and more specifically, medicine. In this article, I’m going to continue to write about medical topics and in this case, strength training, but I’m also going to start including word definitions scattered throughout to help people better understand medical terminology.

In the field of physics, a theory is a proven hypothesis. In other words, a scientist makes observations about natural phenomena and forms an idea of what may be causing it. That’s a hypothesis. That hypothesis is then rigorously tested and if no exceptions occur over time, a general consensus may form that this hypothesis is true and valid and it becomes a theory. Hence, the theory of relativity or the theory of evolution.

In common parlance, however, a “theory” is a hunch or guess.

In similar fashion, when I, as a physician, discuss the term “dependence,” I am referring to a physiological condition which is common when taking a medication for a prolonged period. If the medication is stopped abruptly, the person may experience a discontinuation syndrome or withdrawal symptoms. This is NOT a sign of addiction but rather, dependence.

Addiction, however, is a truly different condition. The person uses a substance, which could be a prescription medication, and develops tolerance, meaning they need higher and higher doses to get whatever positive reactions from this drug, they develop cravings, their behavior deteriorates, they are in denial about not being able to stop using the drug and they continue to use in spite of this severe dysfunctional behavior.

This is clearly different than dependence, in which the person is often doing just fine, as in taking an antidepressant medication. They do not crave the medicine, they are not dysfunctional, they usually do not become tolerant to the medicine and yet they may experience withdrawals if stopping the medicine abruptly.

The reason this is such an important distinction is that I regularly hear questions from people who are reticent to begin certain medications because they fear “becoming dependent” on the medicine. 

They may certainly become dependent on the medicine to be well yet will not become addicted, but they don’t know or understand the difference or perhaps have been told there is no difference.

Think of this: People are dependent on their eyeglasses: if they take them off, the world is blurry. Do they crave wearing their glasses? Do they ask for increasing prescriptions? Are they dysfunctional when wearing the glasses?

Many people are indeed dependent on various medications these days: medicines for multiple sclerosis, epilepsy, high blood pressure, chronic migraines, bipolar disorder, low thyroid and so on.

What did people do in generations past? They suffered miserably from these conditions.

I’ll plan to discuss strength training in older years next week, work toward helping discuss living a healthy life as we muddle through the summer months and into the fall and wish everyone a happy and healthy New Year.

Regardless of age and physical condition, we can all do something to work toward being healthy and strong and live our later years to the best of our ability. My goal is for people to learn how to play out the hand we were dealt as best we can.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at

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