Tolerance vs Dependence vs Addiction: What Is the Difference?

Tolerance, dependence and addiction are often used as if they mean the same thing. They do not, and the difference matters for treatment.

Tolerance

With repeated use, the brain adapts, and the same amount has less effect. Receptors become less responsive and the brain adjusts its own chemistry to compensate.

Physical dependence

The body has adapted so much that stopping suddenly causes withdrawal. Dependence can happen with many medicines taken exactly as prescribed, including some for blood pressure, anxiety and pain. Dependence alone is not addiction.

Addiction

Addiction, or substance use disorder, is compulsive use despite harm: cravings, loss of control and continuing even as health, work or relationships suffer. It involves changes in the brain's reward, motivation and self-control systems.

Why it matters

• Someone dependent on a prescribed medicine that is helping may not need to stop it at all; any change is planned with the prescriber and done gradually, never stopped suddenly
• Someone with addiction needs more than a taper: treatment for cravings, counseling and support
• Tolerance falls quickly after stopping, which is why a return to former amounts can cause overdose

Help at Hope Addiction Medicine

Our team combines medication with counseling and behavioral therapies, in person at our West Ashley office in Charleston and by telehealth when appropriate. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment or call our office.

This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If someone may be overdosing, call 911 and give naloxone if you have it.