By Dr. Edward Selby, PhD
I’m not addicted… am I?
It might seem like such a simple question: to know whether you or someone you care about is addicted to alcohol or drugs or not. But if this is such an easy question, why is it so hard for some to admit or acknowledge addiction? Part of the issue lies in addiction tendencies to deny or minimize addictive behavior, but the other primary reason this can be a difficult question to answer is that most people are unaware of what “addiction” actually is. In some cases, addictive behavior is clear, especially when alcohol or drugs are used in dangerous ways that could result in serious harm to themselves or others. But in other cases, people can have addiction without actually realizing it!
“Addiction” is a term that generally refers to a large number of problems surrounding the use of a substance. Substance use disorder is a set of behavioral patterns characterized by 11 different symptoms considered over the last 12 months. The 11 symptoms that cut across alcohol and drug categories are described in detail below for further reference. If an individual endorses at least two symptoms over that time window, then they are designated as having a substance use disorder. Clinicians can also specify if the disorder is mild (2-3 symptoms present), moderate (4-5 symptoms present), or severe (6 or more symptoms present). So back to the original question of knowing if you or another person is “addicted,” the matter really boils down to endorsing at least two of the substance use disorder criteria.
Substance Use Disorder Symptom Categories
The 11 substance use disorder criteria specified cover a lot of ground in characterizing a problematic relationship with a substance but can generally be divided into the following groups: 1) psychosocial impairment, 2) behavioral impairment, and 3) tolerance and withdrawal symptoms. The first symptom category, psychosocial impairment, means that the use of alcohol or drugs is impairing an individual’s ability to think, make decisions, and is causing strife between the substance user and others, such as family, friends, or work/school colleagues. The psychosocial problems arising from substance use are among the most frequent reasons for people seeking treatment (Ghouchani et al., 2016) and can lead to major consequences if a substance use disorder isn’t addressed, such as loss of employment or strained relationships.
The second category of symptoms involves problematic behavioral patterns. These symptoms can range from using a substance more frequently or for longer periods than intended to dangerous behavior, such as using a substance in situations that are physically hazardous to do so, such as while driving. As a substance use disorder increases in severity, most addicted individuals find themselves increasing behavior connected to substance use (including spending more time focused on obtaining the substance). Simultaneously, as addiction gets worse, people disengage from healthy behaviors such as maintaining relationships and fulfilling major responsibilities, such as work obligations.
The third and final category of addiction symptoms pertains to physiological and biological changes that arise from using a substance excessively. All substances, from alcohol to heroin, are foreign substances to the body, which is why they to the initial active effects of a drug (e.g., euphoria, high). Because alcohol and drugs are foreign substances, however, repeated use of a substance leads to physiological changes in the body that can be subtle at first and severe with heavy substance use. Tolerance refers to an individual’s diminished response to the use of a substance over time and can manifest in the individual needing to use higher doses of the substance to obtain the desired effects of the substance. Tolerance is part of our body’s way of trying to protect us from foreign substances and it’s usually helpful and adaptive to dealing with toxins in our environment, but in the case of substance use, it can lead to progressively escalating substance use behavior.
Withdrawal symptoms are related to tolerance and arise from the same physiological roots of the body’s reaction to a foreign substance. However, the difference is that as an individual develops an addiction, the body begins to operate while accounting for the presence of the drug. The body anticipates, so to speak, that a certain level of the substance will be in the body every day. If this isn’t the case, for reasons such as lacking access to the substance, the individual’s body will go into withdrawal and respond in physiologically problematic ways. In the case of heroin use, if a dose is missed the individual is likely to experience nausea, abdominal pain, sweating, shaking, muscle spasms, and agitation. Withdrawal symptoms can start even after just a few uses of an extremely addictive drug like methamphetamine (Petit et al., 2012).
You should now have a basic understanding of what is generally meant by the term “addiction.” If you or someone you know is experiencing two or more of the symptoms discussed (and listed below), then a diagnosis of substance use disorder may be appropriate. Further, depending on how many symptoms are endorsed and how much impairment someone is experiencing, substance use disorders can range from mild to severe. It is important not to minimize or disregard any of these symptoms, and even if someone is using alcohol or drugs in a way that may seem mild, continued use is likely to increase the severity of the addiction. The sooner an individual seeks treatment, the better their prognosis will be. Depending on addiction severity, BeWell inpatient or outpatient services may be essential in starting the road to recovery. Don’t wait until addictive behavior gets worse, seek treatment now!
Basic DSM-5 Substance Use Disorder Criteria
- The substance is used in larger amounts or over a longer period than originally intended.
- The individual experiences a persistent desire for the substance or is unsuccessful when attempting to reduce use of the substance.
- The individual spends substantial time in activities necessary to obtain or use the substance or to recover from its effects.
- Craving for the substance leads to strong desire or urges to use the substance.
- Using the substance repeatedly results in difficulty fulling responsibilities at work, school, or home.
- The individual continues to use the substance despite having persistent or recurrent social or interpersonal problems due to using the substance.
- The individual gives up or reduces social, occupational, or recreational activities in favor of using the substance.
- The substance is used in dangerous or physically hazardous situations (e.g., using while driving, operating heavy machinery, etc.)
- The individual uses the substance despite knowing that the substance is causing or exacerbating other physical or mental health problems (e.g., smoking despite a chronic breathing illness)
- Tolerance is exhibited by the individual by either a need to use more of the substance to achieve the desired effect or the individual experiences decreased effect of the substance with repeated use.
- Withdrawal is exhibited by the individual, as characterized by the specific symptoms of withdrawal from the substance or the individual takes more of the substance to relieve or avoid withdrawal symptoms.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA.
- Ghouchani, H. T., Niknam, S., Aminshokravi, F., & Hojjat, S. K. (2016). Factors related to addiction treatment motivations; validity and reliability of an instrument. Journal of research in health sciences, 16(3), 147.
- Petit, A., Karila, L., Chalmin, F., & Lejoyeux, M. (2012). Methamphetamine addiction: a review of the literature. Journal of Addiction Research & Therapy S, 1, 1-6.
Dr. Edward Selby is a licensed psychologist and an Associate Professor of Psychology in the Rutgers University Department of Psychology. Dr. Selby specializes in the research and treatment of suicidal and self-injurious behavior, personality disorders, and eating disorders, with a particular focus on emotion regulation and harmful behaviors like binge eating, substance use, and self-injury. Dr. Selby has published extensively in these areas, with over 100 publications appearing in premier outlets such as Clinical Psychological Science, Journal of Abnormal Psychology, Clinical Psychology Review, Behaviour Research and Therapy, and Psychological Review. Dr. Selby’s research has been funded by organizations such as the National Institute of Mental Health, the Brain and Behavior Research Foundation, and Janssen Pharmaceutica, and private philanthropists.
His work has been recognized with multiple awards including an International Academy of Suicide Research Young Investigator Award for 2013, NARSAD early investigator award, the Neil S. Jacobson Award for Outstanding and Innovative Clinical Research, and in 2015 Dr. Selby was name a Rising Star by the Association for Psychological Science. In addition, his ongoing program of research, Dr. Selby serves as the Director of Clinical Training for the Rutgers Clinical Psychology Ph.D. program and regularly teaches graduate level adult psychopathology and applied latent variable modeling and hierarchical linear modeling. Dr. Selby is a Data Analyst and Researcher at the BeWell Network, where he is responsible for clinical service effectiveness evaluation and research dissemination.