this is an emotionally charged topic and people are often not very precise with terminology when discussing it. so I can understand why you would be confused just from reading a couple articles and comment sections.
> This distinction seems rooted in mind-body dualism, further driving my skepticism.
this does not really make sense though, and opioid withdrawal is a good example to demonstrate why. people who abruptly stop consuming opioids usually get symptoms that are similar to a bad cold or flu. it's not just "in their head"; they literally have snot pouring out of their nose and sweat uncontrollably for days. this is typically what people mean by "physiological addiction". sometimes it is also called "dependence" to distinguish long-term pain management patients from addicts. btw, most common recreational drugs cause some degree of withdrawal, but it's often not significant enough to notice.
in the short term, drug with significant withdrawal symptoms are especially difficult to stop consuming for any length of time. but it doesn't take that long for the body to return to homeostasis. a couple weeks is typical, but it might take up to a year in extreme cases.
the learning (ie, what you might call "psychological addiction") never quite goes away though. this is why addicts must be extremely cautious, if not abstain entirely, for the rest of their lives.
I appreciate your example (and level-headedness, btw), but what are we to make of:
1. The fact that these behaviors are learned precisely in response to physiological changes (be it avoidance of withdrawal or chasing the high)
2. The fact that all the supposedly non-physically-addictive drugs like cannabis have well-documented withdrawal symptoms, like sleep dysfunction, that are very much physiological.
If your point is that the physiological withdrawal from heroin is worse than cannabis, then I don’t disagree. I just disagree with the premise that anything can be meaningfully addictive without having a measurable physiological effect. This includes things like gambling, in which the physiological effects are well-documented.
So I’m not so sure that the two forms of addiction can be so well separated. It seems to me that physiology is the mediator of behavior, here, which points back to the very definition of addiction.
I’m left to wonder why people insist on the relevance of this distinction. I don’t believe it’s only to make the point that cannabis is less bad than heroin, as nobody is seriously debating that. I instead get a strong whiff of semantic games.
severe withdrawal complicates the early stages of recovery and probably makes a relapse more impactful (just what I've observed; I'm not a doctor). but in general I agree, the distinction does not matter much within the context of addiction. detoxing is not the hardest part of recovery for most addicts. the hard part is usually "what to do instead" for the next n decades.
there is a useful distinction to be made between what I would call "addiction" and "dependence" though. this is why I included the example of PM patients in my initial comment. just like addicts, these people build tolerance and would experience severe withdrawal if their supply were abruptly cut off. the difference is that these people are (mostly, pill mills are a thing) not chasing a high for its own sake. their lives are actually improved by consuming opioids, and they would be just fine with an equally effective substitute.
to be clear, I am not implying PM patients are morally superior to opioid addicts in some way. the distinction is that addiction is intrinsically damaging to a person's quality of life. dependence is merely a tradeoff that may or may not be worth it.
>the hard part is usually "what to do instead" for the next n decades.
Agreed. And (as you've no-doubt guessed by now), I would argue that this second, harder phase of recovery has very little to do with addiction per se, in both it s mechanisms and coping strategies.
>there is a useful distinction to be made between what I would call "addiction" and "dependence" though.
I'd have to think about this a bit more, but even though I agree the distinction is practically useful for treatment, it's once again a distinction of degree rather than kind. In both cases, there is a physiological habituation to a substance that causes unpleasant withdrawal symptoms. Something analogous to the pleasure-seeking behavior of bona fide addicts is still there, I think, when you consider that drug-dependent people will consume a substance to "feel normal".
>dependence is merely a tradeoff that may or may not be worth it.
I'd quibble about merely, since the worm can turn mighty quick, and people are generally pretty bad at knowing how deep in the hole they are. But I take your general point.
> I'd have to think about this a bit more, but even though I agree the distinction is practically useful for treatment, it's once again a distinction of degree rather than kind. In both cases, there is a physiological habituation to a substance that causes unpleasant withdrawal symptoms. Something analogous to the pleasure-seeking behavior of bona fide addicts is still there, I think, when you consider that drug-dependent people will consume a substance to "feel normal".
I've mostly agreed with you up until here, but having known both heroin addicts and a few PM patients, I don't agree with this at all. while there is a significant minority of PM patients that are addicts in disguise, I genuinely don't believe most of them enjoy taking their prescription. at least in theory, the PM patient works with their doctor to find a dose that adequately manages their chronic pain while minimizing impairment and other unpleasant side effects like nausea and constipation. the addict seeks the highest dose they can get away with (not arousing suspicion of employer/family, being able to afford it, etc.). the intention behind the use is very different.
more generally, my working definition of addiction is something like this: a) inability or extreme difficulty in regulating b) an activity or use of a substance that c) negatively impacts one's health, interpersonal relationships, or other meaningful goals. the PM patient clearly satisfies b). but I would argue they don't satisfy a) if they are able to stick to what they've agreed with their doctor and haven't specifically chosen that doctor for being a total pushover. they don't satisfy c) at all: the drug is what allows them to participate in something like an ordinary life. in extreme cases, it is what allows them to exist at all.
btw, I could also have chosen SSRIs as my example for dependence. I think the PM example is better for teasing apart addiction vs dependence, since there is a bit of overlap in reality. but SSRIs are interesting because they do not demonstrate the same tolerance building effect as other psychoactive drugs, nor are they (commonly) used recreationally. nevertheless, people do report fairly nasty withdrawal symptoms from abrupt cessation of SSRIs. you can google "ssri brain zaps" if you're curious.
tl;dr: addiction and dependence can look similar from the outside. one simple heuristic for distinguishing them is how the person behaves after acute withdrawal subsides. the addict will always feel the temptation to go back, and resisting that temptation is usually a lifelong struggle. the person who was merely dependent will stop and never look back if they find an alternate solution to their problem.
> This distinction seems rooted in mind-body dualism, further driving my skepticism.
this does not really make sense though, and opioid withdrawal is a good example to demonstrate why. people who abruptly stop consuming opioids usually get symptoms that are similar to a bad cold or flu. it's not just "in their head"; they literally have snot pouring out of their nose and sweat uncontrollably for days. this is typically what people mean by "physiological addiction". sometimes it is also called "dependence" to distinguish long-term pain management patients from addicts. btw, most common recreational drugs cause some degree of withdrawal, but it's often not significant enough to notice.
in the short term, drug with significant withdrawal symptoms are especially difficult to stop consuming for any length of time. but it doesn't take that long for the body to return to homeostasis. a couple weeks is typical, but it might take up to a year in extreme cases.
the learning (ie, what you might call "psychological addiction") never quite goes away though. this is why addicts must be extremely cautious, if not abstain entirely, for the rest of their lives.