Issue # 10

Diagnosing Substance Use Disorder 

By 

Andrew John Tucker, LCSW, CASAC 

“Addiction or any other self-harm behavior tends to, by in large, reside in one of the following three states of self-reflection. The first is accepting and internalizing the issue, resulting in a proactive behavioral shift that enlightens the individual and those around them. The second is the understanding that there is an issue but not feeling or believing change can occur, resulting in frozen debilitation. The last is an almost complete denial as if the person is running through the forest with a blindfold on, screaming, who put all these trees here”. ~ Unknown

Introduction 

“Do I actually have the disease of Addiction” is a big question. Whether someone is suffering publically from misuse or choosing to debate what a functioning alcoholic is for the next 25 years, the criteria on if someone is clinically and diagnostically experiencing Substance Use Disorder is quite clear. It’s a simple checklist at the end of the day, and the more you check, the more severe it is. It’s accurate and terrifyingly straightforward, and those unyielding letters on the page can be paralyzing. The worst part is that it’s a progressive illness – and if left untreated, it leads to increasing consequences, self-hatred, and death in way too many cases.  

It’s always interesting to me how we manage the dilemma of self-reflection when it’s too painful. We live our lives doing the voodoo that we do to deal with external forces thrust upon us, only to discover later on that the coping skills employed to manage it all may or may not have been in our best interest. In fact, the substances we longed for to help us “feel better” may very well be the thing that ends us. And somehow, somewhere, we know this, but change can seem impossible. So in times like these, it behooves us to remember Mandela, who said, “it always seems impossible until it is done.” 

We have choices, and we aren’t wrong, stupid, or bad because we chose destructive coping skills as a form of medication. We do the best we can with what we have or were given. The real question becomes – what we’re we medicating? 

We Admit…Yes Yes…Admit, Confess, and Repent 

The “moment” we are forced, cajoled, reduced, or hornswoggled into staring dead in the eye of our substance use issue is sobering. How did I get here? How bad is it? Do I need to tell someone about this? There are many questions, and they all seem to have a running theme; shame. It keeps us from asking for a life raft despite drowning. It tells us we’re stupid, incapable, or a failure. It separates us from the herd. The stigma and shame of this illness are killing us. 

You’re not alone – According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 19.3 million people aged 12 or older (or 7.3% of the population) had a substance use disorder in the United States in 2020. This includes an estimated 14.5 million people with an alcohol use disorder. We know it’s more than that – more than 1 in 10 of every citizen over 12 in our country. 

Still, we feel ashamed because Substance Use Disorder gives others the wrong impression of who we really are. In this way, it is different from other diseases. Cancer patients don’t lie to your face, pee themselves and crash into a tree (usually). It’s tough. Alcoholics have woken up only to be reminded of the damage they caused others. Fortunes have been lost. Loved ones have left, and self-esteem has tanked into the ground. 

As consequences increase, so do shame and guilt. This can worsen the substance use disorder and perpetuate the progressive elements of the disease alongside its consequences for self and others. Does this sound like someone being willful or feeling out of control? 

Is Addiction really a Disease?

Absolutely. The American Medical Association (AMA) classified alcoholism as a disease in 1956 and included addiction as a disease in 1987. It’s essential to recognize that substance use disorder is a medical condition that requires treatment, just like any other chronic disease. Let’s take a look at the criteria as indicated by the Diagnostic and Statistical Manual of Mental Disorders, which is considered the gold standard for diagnostics for healthcare professionals. There are slight variations per drug or alcohol, but we will use alcohol for this example. It is vital to pay attention to the nuance of the language. It only takes two of the eleven to be considered problematic drinking. I have not altered any of the following texts written in the book. If you have any questions, please reach out, and I’d be happy to explain – or listen. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the criteria for Alcohol Use Disorder (AUD) are:

A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
    1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
    2. Markedly diminished effect with continued use of the same amount of alcohol.

      11. Withdrawal, as manifested by either of the following:

1. The characteristic withdrawal syndrome for alcohol.
2. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Specify current severity:

Mild: 2-3 criteria met

Moderate: 4-5 criteria met

Severe: 6 or more criteria met

What Do I Do Now:

If you find yourself experiencing two or more of these criteria or are simply uncomfortable with your drinking or drug use, please consider reaching out for help. Whether it’s individual therapy or a twelve-step program, you are not alone.