Are You Addicted?

I'm sure if you're reading this and you actually are an addict your answer to the above question is almost certainly an adamant NO! That's sort of the irony of addiction, in the beginning we're in the pre-contemplation stage; that is, we're in denial that we actually have an addiction.

Doesn't matter what the addiction is, the basic premise is that you're letting it get the better of your life. You could be addicted to Facebook, sex, ice cream, cannabis, heroin, riding ponies..., amphetamines, or alcohol. The addictions we struggle with on a daily basis have so overtaken us that we've barely developed the ability to keep the urges bottled away. I guess that's the point of it isn't it? They're not called addictions for nothing.

Even though I joke a little about the nature of some addictions (who do you know that's addicted in the clinical sense to riding ponies?) for some it's no joking matter. Families have been torn apart because of some addictions. Some have been murdered. Others have lost their 'sanity' (but then again, who's 'sane' these days?). The consequences spread far beyond the simple taking of a substance. There're entire macro-level repercussions to some addictions (think of the numerous legislations put forth to tackle the 'problem' of addiction).

Today I'm going to focus on illicit (e.g. amphetamines, heroin, etc.) and licit (alcohol, caffeine, nicotine, etc.) substances for the most part. That's because I'm a little familiar with the latter given some experience working in the drug and alcohol field, and delivering psychoeducational substance use and abuse sessions to clients that would satisfy the diagnostic criterion for Substance-Use Disorder.

Where to start? It seems like quite a task, but I don't think we can begin without defining our terms.  The DSM-5 discusses substance use disorder through the use of required criterion. However, before we get to the discussion of DSM-5 diagnosis there are a few other terms that I think we should look into. These terms are as follows:

1. Substance use: where a person uses a substance sporadically (e.g. every now and then at a party), but it's not causing any significant problems in their life and functioning

2. Substance misuse: where a pattern is beginning to be observed in a person's substance use. This pattern has proved to cause some observable harm to the person using, and the people around them (e.g. the person might become more violent or aggressive when on the substance, thereby leading to behaviours and verbalisations that often get them into trouble)

3. Substance abuse: this is similar to substance misuse, however it's got a lot more negative repercussions and effects. When a person abuses a substance he or she has established a pattern of use that's proved to cause significant psychological, physiological, social, occupational, and interpersonal distress.

4. Substance dependence: similar to substance abuse, however the user has built up a tolerance to the substance of choice so that more and more is needed to achieve the same effects as before. Also, withdrawal effects or symptoms are evident when the person attempts to stop using the substance. These effects are many and varied, and are specific to the substance of choice. In the treatment of substance-use disorder, withdrawal effects are taken into consideration when rearing a user off of the chosen substance as some of these symptoms can get so intense so as to cause death.

Now you might see the above described in various ways, but when I'm speaking with my clients I find the above formulations helpful to use given their straightforward applications.

Now to the DSM-5 and substance-use disorder (after all, that's what this series is about anyway!).

In order to be diagnosed with substance-use disorder, a person must present with the following symptoms, or satisfy the following criteria:

1. Person's use has persisted and usage increased for longer than intended

2. Person must've had multiple unsuccessful attempts to cut down or quit the substance

3. Person spend significant time obtaining the substance, using, and recovering from its effects

4. Intense cravings must be present when without the substance for a period of time (this craving activates specific areas of the brain)

5. Failure to fulfil major obligations and activities such as work, school, or home

6. Continues using substance despite its negative effects and the appearance of problems caused by its use

7. Social, occupational, or recreational activities reduced or given up because of substance use

8. Continued use even when it's hazardous

9. Continued use even though person understands it's detrimental to mental and physical health. Problems are continually being exacerbated by use

10. Higher dosages needed to get the same effect as before

11. Withdrawal effects evident

A person must satisfy at least two of the above criteria in order to be considered for diagnosis of substance-use disorder. Substances are also specified, and each substance carries with it differing specification for a diagnosis.

If you're using a substance in an excessive manner, you're not only putting your own mental and physical health in jeopardy, but also the mental and physical health of those that are around you. If you are struggling with using any substances at this moment, please consult your GP in order to qualify for a mental health plan and/or advice on how to minimise your usage, and eventually become abstinent.

Images retrieved from:

http://images.idiva.com/media/content/2012/Sep/choose_the_right_general_pr.jpg

http://www.facesofchildabuse.org/images/substance%20abuse%20pic.jpg

http://my-rehab.com/wp-content/uploads/2014/02/drug-abuse.jpg

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