If there were an award for the most addictive drug, heroin would be a clear frontrunner. Heroin profoundly impacts the brain’s reward pathways. The illicit opioid is capable of bringing about addiction on the first try, and users report that it imparts a pleasurable sensation.

How pleasurable?

One user explained in a 2018 New York Times report that being on heroin was “like being hugged by Jesus.”

A 2007 study ranked heroin as the most addictive drug because of its ability to spike dopamine levels, the brain’s “feel-good” chemical, by up to 200 percent in experimental animals, stated this CNN article.

Heroin’s unparalleled ability to hijack the brain makes it a case study on how central a role psychological dependence plays in imparting addiction.

The same case can be made with opioids in general, which have been responsible for a drug epidemic that has spanned generations and hooked 2.5 million people in the process, according to the National Institute on Drug Abuse (NIDA). For context, that number exceeds the individual populations of cities like Houston, Philadelphia, Phoenix, and Dallas — the fourth, fifth, sixth, and ninth largest U.S. cities by population, respectively, according to Ballotpedia.

There are surefire signs that signify psychological dependence. Chief among them are drug cravings and withdrawal symptoms. Read on to learn more about psychological dependence and its signs.

What is Psychological Dependence?

Psychological dependence or addiction cannot be separated from the physical effects of substance abuse because they occur together.

To understand drug and alcohol addiction, one must be able to fathom how dependence plays a role in that outcome. NIDA defines dependence as a state where the body feels normal only in the presence of the drug. Once that substance is removed, the body will experience physical disturbances known as withdrawal symptoms.

The symptoms that manifest are physical at first. People who go through opioid withdrawal, for example, will exhibit physical flu-like symptoms like muscle aches, runny nose, sweating, abdominal cramping, diarrhea, nausea, and vomiting. However, opioids can produce lingering withdrawal symptoms that are psychological in nature, like severe depression, suicidal thoughts, anxiety, panic attacks, and insomnia.

With heroin, notes TheNew York Times, a user in withdrawal might have “crippling pain, vomiting, insomnia, spasms, hot and cold flashes, goosebumps, congestion, and tears. All this on top of debilitating anxiety and depression. You might feel like you’re having the worst flu of your life, or like a demon is crawling out of your skin.”

That same report notes that heroin addiction is so compelling that trying to get that next fix will cause you to do things you’d never imagine doing.

“Sell your body. Abandon your child. Steal from your mother. You might lose your job. Lose your home.

Lose your loved ones…You’re now addicted to opioids, and you no longer take the drug to get high but to escape feeling low. The brain has adopted a new form of compulsion that can reassert itself even after years of sobriety,” notes the Times.

Like heroin, a primary psychological symptom common with all addictive drugs are cravings, which is described as the strong desire or urge to use a substance. However, to truly understand the nature of addiction, psychological dependence, and the symptoms it produces is merely a facet. It often co-exists with the physical disturbances one experiences during withdrawal and addiction.

In essence, psychological dependence is just one side of the addiction coin. States Adi Jaffe in a Psychology Today post, it is best to look at addiction as “both a psychological addiction AND a physical addiction that are inextricably [linked] through our psyche’s presence in the brain, a physical part of the body.”

The Psychological Signs of a Substance Use Disorder

In fact, the American Psychiatric Association (APA) outlines criteria that comprise a substance use disorder (SUD) in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  There are 10 or 11 diagnostic criteria, depending on the substance, that has to occur in a 12-month period that characterizes a SUD, the clinical term for substance addiction.

People who meet two or three of those criteria are said to have a “mild” disorder. Those with four or five are said to have a “moderate” one. When someone exhibits six or more of those symptoms, the SUD is considered “severe.”

The following DSM-5 criteria are used to determine whether someone has a SUD. Those criteria, which have been posted on NIDA’s website, are as follows:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance, occurs.
  5. Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
  6. Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  8. Use of the substance is recurrent in situations in which it is physically hazardous.
  9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
    2. A markedly diminished effect with continued use of the same amount of the substance.
  11. Withdrawal, as manifested by either of the following:
    1. The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
    2. The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.

It’s worth noting that several of these criteria are psychological in nature. However, there are other signs to watch for that indicate psychological dependence, and they are unique to the specific drug that is being abused.

Drugs of Abuse and Psychological Signs

Many popular drugs of abuse have psychological signs of dependence. According to a handout by the Substance Abuse and Mental Health Services Administration (SAMHSA), the following drugs have associated effects that are psychological in nature.


The short-term psychological effects of alcohol include impaired judgment and altered perceptions. Memory loss and loss of appetite are long-term effects of heavy alcohol use.


The psychological effects of this stimulant are anxiety, paranoia, violent behavior, insomnia, irritability, decreased appetite, and confusion.


The psychological risks of this illicit stimulant are violent, erratic, or paranoid behavior, hallucinations, and experiencing a sensation of imaginary insects crawling over the skin. Depression, anxiety, confusion, and loss of interest in food or sex are more symptoms. Another psychological risk associated with cocaine is “cocaine psychosis,” which is when a user loses touch with reality and has a loss of interest in friends, family, hobbies, and other activities.


Common psychological effects from drugs like LSD (lysergic acid diethylamide), PCP (phencyclidine), mescaline, peyote, or mushrooms (psilocybin) include depression, anxiety, paranoia, suspicious thoughts, violent behavior, flashbacks, a sense of estrangement/distance, behaviors that mimic schizophrenia, and catatonic syndrome.


Paranoia, psychological dependence, hallucinations, sleepiness, short-term memory impairment, diminished inhibitions, and the diminished ability to experience sexual pleasure are the psychological effects of marijuana.

Do you see any of the above symptoms in yourself or a loved one? If so, professional addiction treatment can be a viable solution. Why? Because the services it offers are designed to address the psychological underpinnings of addiction as well.

How Professional Treatment Can Help You

A reputable professional treatment program offers services (or links to services) that treat the entire person, not just the actual addiction.

The first step in a professional rehab program is medical detox. During this process, the addictive substance is removed from the body, and withdrawal symptoms are treated and alleviated. But rehabilitation does not end there.

The psychological and emotional components of addiction are fervently addressed through a suite of comprehensive services provided through residential and outpatient treatment. A residential treatment program is for clients with severe addictions, as it allows for a comprehensive, full-time treatment protocol.

The therapeutic services that are offered at this level include:

  • Behavioral therapy
  • Family therapy
  • Group therapy
  • Motivational interviewing (MI)
  • Mindfulness
  • Life skills training

Outpatient programs can serve as the next step after the completion of a residential program, or it can be an option in and of itself for people with milder addictions. Outpatient services offer comprehensive, evidence-based services as well, but on a part-time basis.

Once treatment is completed, relapse prevention can offer ongoing support by connecting clients to a recovery community like 12 Steps. As the name suggests, such a community can serve as a hedge against drug or alcohol relapse.

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