Differentially define the terms tolerance, dependence, withdrawal, addiction, and abuse and their relationships relative to alcohol use.

A. Tolerance means that with continued use, more and more of a substance (like alcohol) is needed to achieve the same effect.
1. Drugs with high potential for tolerance can be dangerous as people keep taking more.
2. Alcohol generally has a moderate potential for tolerance; however, its effects vary among individuals.
a. Some people develop tolerance within a week of daily moderate drinking; others only develop it after extended periods of heavy drinking.
B. Dependence means that a body’s cells have a drug (like alcohol) so incorporated into their functioning that “normal” functioning requires the drug.
1. In dependence, stopping (i.e. withdrawing) the drug causes withdrawal symptoms.
a. Withdrawal symptoms signify that the body is adjusting to functioning without the substance.
b. Symptoms are generally the obverse of the drug effects.
c. Since alcohol is mainly a depressant, alcohol withdrawal symptoms include irritability, restlessness, and agitation.
d. Withdrawal symptoms are very unpleasant from many drugs; those from alcohol are among the worst. Cardiovascular effects can be life-threatening. Other symptoms include tremors, usually the first to emerge; and in the severely addicted, delirium tremens, including disorientation, hallucinations, and sometimes convulsions.
e. Withdrawal typically lasts from two days to a week.
f. Physical risks are serious enough to warrant special alcohol treatment facilities.
C. Tolerance and dependence are independent of one another.
1. They may occur together, or either one may occur without the other.
2. Using alcohol or other drugs will not inevitably cause tolerance or dependence.
D. Addiction is sometimes defined as the combination of dependence and withdrawal.
1. While definitions vary, compulsive use and craving for the substance are included in all definitions.
2. Experts differentiate dependence vs. addiction by compulsive behavior and the damage it does to users’ lives.
a. Loss of control of use
b. Compulsive seeking and use regardless of consequences
3. Some experts also distinguish addiction vs. alcohol/drug abuse.
a. In this definition, somebody who is not dependent or addicted engages in alcohol/drug abuse if the use is harmful and excessive.
E. Tolerance, dependence, addiction, and abuse are all separate and all included among the properties of alcohol.
F. The “psychological” dependence or addiction some people refer to is not the same as dependence on alcohol or similar drugs, which has major physiological aspects.
1. Psychological dependence involves habituation to the behaviors of use.
2. A controversy about the validity of this concept is that if a substance/drug does not underlie the behaviors, psychological dependence is not clearly analogous to physiological dependence.