by Laura Geftman, LCSW
In the throws of addiction, it can be difficult to understand that a doctor could possibly understand all that you’re going through. Thinking about getting a doctor’s help may seem overwhelming. However like all medical conditions, doctors assess addiction disorders with a predetermined set of criteria. While each person’s experience of addiction is very different, there are still various symptoms to best diagnoses substance use disorder.
What is addiction?
These days it’s pretty common to hear someone say they’re addicted to avocados, binge watching TV, travel, makeup, working out, tattoos… It’s even become common practice to add “-aholic” to thing you claim to be addicted to like “shoeaholic” or “workaholic.” Really our attitudes about being compelled to do or use things too frequently has become all “sex, drugs and rock-n-roll.” All jokes aside, there’s a thin line between over use and addiction.
Addiction is a crippling disease that involves what you’re doing or using taking over your life.
In 1956, the American Medical Association first recognized what we now call “addiction,” “substance abuse,” “chemical dependency,” and “substance use disorder.” While the terminology has changed, the chronic brain disease continues to cause compulsive activity despite health, social and legal consequences. The disease is caused by a variety of factors and lead to long-term negative consequences that can be deadly.
The American Society of Addiction Medicine has described addiction as “a primary chronic disease of brain reward, motivation, memory and related circuitry.” It is all too common to think that addiction is only about a substance you can’t stop using. The brain disease causes those suffering from it to a need toward compulsory behavior or use of a substance.
6 Stages of Addiction
Yes, you read that right- there are six stages of addiction. It’s a bit different than what your high school health teacher probably taught you. They likely said that if you tried drugs just once, you’d get addicted. That’s pretty simplified. More of a scare tactic but not entirely wrong.
Addiction can be broken down to six stages. It affects the brain’s reward center controlling pleasure, memory and motivation, and doesn’t just pop up one day. Like other chronic illnesses, addiction occurs over a series of stages that turn into a habit or cycle.
- Initial Use Whether you give into peer pressure or are prescribed an addictive medication by a doctor, there are many situations that can lead to first use of substances. Regardless alcohol and drugs can present in your life in many ways, and not everyone gets addicted to the substances used. For initial use to lead to addiction, there are other risk factors involved including family history of substance abuse, previous abuse or neglect, mental health disorders, chaotic home environment, and permissive peer groups.
- Abuse The next stage is abuse. This may seems like a jump. Really if we break it down, it’s not. Abuse is using a substance on a recurring basis with higher doses that is having a harmful impact on daily living. So yes, any regular use of alcohol, cannabis, cocaine, etc…with an additional drink, hit or bump that has you oversleeping and gives you a hangover is considered abuse. This applies to all substances- legal or illegal, OTC or prescription.
- Tolerance In this stage, it’s evident that the brain has changed in response to the drug. As result of persistent use, the brain no longer craves the original doses. The brain wants to recapture the original result but requires more than the original dose to achieve it. It’s not about the social aspects of using but chasing the euphoric response you’d previously experienced, and ignoring the detrimental physical responses as a deterrent. (source).
- Dependence This stage is well beyond the previous. With dependence the brain and body can only function with use of the substance. Therefore without the drug, the person addicted to it will have physical and mental symptoms of withdrawal. This develops with the brain has fully adapted to the presence of the drug. Therefore the use will need to continue use to avoid withdrawal. (source). Dependence also doesn’t just effect the reward center of the brain but also the thalamus and brain stem. The main function of the thalamus is to communicate motor and sensory signals in the brain, and the brain stem communicates with the rest of the body. In dependence, the messaging of these parts of the brain are hindered or destroyed. (source).
- Addiction Without an ability to face life without alcohol or drugs, lack of control over your use, and detrimental consequences to your career, relationships, and other aspects of your life, the presence of addiction- now called substance use disorder- is evident. The disorder is much more than the symptoms as the chronic disease has taken over all aspects of your life. Use has changed your motivation, movement, emotion, judgement, and memory. All that seems to matter is obtaining and using your substance of choice.
- Relapse It’s important to keep in mind that chronic conditions over time can be managed. However there is always potential for relapse. In fact, relapse is a part of the disease and usually indicates how best to readjust treatment needs. Further understanding of how to interrupt the cycle of addiction is very helpful in recognizing the signs and symptoms that relapse maybe imminent.
Types of Addiction Diagnoses
Doctors and therapists need to consider many factors in properly diagnosing which a patient or client maybe experiencing. There’s often a fine line between substance abuse and dependence. While there are many different types of addiction diagnoses, they share the same criteria for diagnosis (a per the Diagnostic and Statistical Manual of Mental Disorders (DSM).) With the following eleven criteria, professionals also evaluate whether the severity of the condition denoting mild, moderate or severe. Other specifiers can include the notation of early or sustained remission.
11 Criteria Assessed for Substance Use Disorder
Addiction effects each individual differently but when assessing the condition, there are various criteria that help determine the clinical diagnosis. As determined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), each of the eleven criteria for substance use disorder are evaluated as mild, moderate or severe, and include:
- Amount used over time You will be asked to report what you’ve used, how much (has it increased?) and for how long.
- Cravings You will describe if and how you’ve desired or longed for continued use.
- Tolerance Chasing the high involves building up a tolerance and using an increased amount to get back to the high you first knew.
- Attempts to control use or quit Maybe you’ve tried to stop using or even cut back your use.
- Changes in daily living You no longer participate in the activities you used to enjoy prior to engaging in substance use.
- Neglected roles So you maybe avoiding activities- this is about your responsibilities at work, home and/or school.
- Interpersonal problems Often substance abuse causes problems for the relationships in your life.
- Health issues related to use Use had led to related medical and/or metal health conditions such as liver damage, anxiety or depression.
- Time spent using It’s not literally how long it take you to use but how much time you are spending thinking about obtaining the substance, actually getting it, finding a place to use, and everything leading up to actually using. It’s the preoccupation with using.
- Risky behavior Choices made under the influence aren’t always the best. This aspect deals with DUIs, overdose, unprotected sex, etc…
- Withdrawal There is a list of symptoms experienced when use is terminated. They are noticeable in any attempt and are best managed by a professional.
Substance Use Disorders Diagnoses
When assessing a client for addiction, there are many aspects mental health professionals take into consideration. All those factors are boiled down into a diagnosis. For all substance addictions, there are eleven categories or diagnoses. Often the language of a diagnosis doesn’t exactly describe what I person maybe struggling with but the category that struggle is considered part of. In order to help you understand the diagnoses and all that they include, here’s some more information about them:
Alcohol Use Disorder
This diagnosis refers to what is commonly thought of as drinking liquor, wine and beer. Alcohol may also be noted as its scientific name “ethanol” or abbreviated as ETOH. This depressant slows brain activity, and triggers dopamine associated with pleasure (source). It can also cause an increase of GABA providing stress relief (source). Alcohol is the most commonly misused substance (source). It’s widely believe that alcoholism is hereditary or genetically determined which actually is thought to effect half of those addicted (source).It’s also worth noting that alcohol isn’t just found behind the bar. There are various foods and household products that contain alcohol including mouthwash, hot sauce, sugarless gums, hand sanitizer, air freshener, and more.
Opioid Use Disorder
The term ‘opioid’ is an umbrella term describing opioids and opiates. Yes, there is a difference. Opioids are man-made drugs derived from morphine. Opiates are naturally occurring drugs devised from the opium poppy plant. And yes, that opium plant- that’s a DEA controlled substance and categorized as a Schedule II drug in the United States. All opioids are registered with the government and classified as controlled substances.
Thought to have many medicinally qualities especially for pain relief and muscle rigidity, opioids have created a significant problem in the US. Now the number of unintentional deaths by overdose of a prescription opiate has surpassed the number of deaths associated with illicit drug use by 15% (source).
Opioid addiction has proven to be very confusing. You wouldn’t think that a doctor could prescribe you a substance that would make you sicker, right? That’s not been the case with opioids.
This is a list of opioids- one note: if you’re looking at this list for anything more than what to avoid, please consider see a mental health professional and talk about your use. The opioid epidemic is real and has claimed too many lives already. So here’s a list of highly addictive prescription drugs to avoid and/or receive opioid use disorder treatment for:
- MS Contin
- Nucynta ER
- Zohydro ER
Sedative, Hypnotic, or Anxiolytic Use Disorder
Sedatives, hypnotics and anxiolytics are medicines prescribed by doctors and psychiatrists to relieve anxiety and/or induce sleep. These are drug were developed in create calm in its users. They are sometimes also prescribed for alcohol withdrawal and pain in pill and liquid forms.
There are two forms of prescription sedatives- barbiturates and benzodiazepines. Often referred to as “sleeping pills,” barbiturates offer short-term aid for relaxation and sleep. Benzodiazepines or “benzos” have a tranquilizing quality.
Hypnotics are also called “sleep aids.” They are mostly prescribed to induce sleep and treat insomnia. They are also sometimes used as a surgical anesthesia. They are supposed to lengthen sleep for those who don’t get adequate sleep.
Anxiolytics drugs are used to prevent or treat anxiety. These medications manage abnormal excitability targeting key chemicals in the brain. They are usually prescribed for short-term use as they also can be habit-forming.
All anxiolytic, sedative and hypnotic medications carry a risk for misuse or abuse. Discontinuation of these drugs should be monitored by a medical professional to manage symptoms of withdrawal.
- Amytal Sodium
- Antinaus 50
- Benadryl (*OTC)
- Butisol Sodium
- Chloral Hydrate
- Desyrel Dividose
- Diphenhydramine (*OTC)
- Doxylamine (*OTC)
- Lorazepam Intensol
- Nembutal Sodium
- Seconal Sodium
- Unisom (*OTC)
Cocaine Use Disorder
Call it “blow,” “coke,” “crack,” “snow”… it’s all cocaine. Made from the leaves of the coca plant, cocaine may seem like a good time but it changes the brain’s reward center and it highly addictive. Users snort, inject or smoke/freebase either powder or rock forms of cocaine.
The stimulant produces energy, alertness, happiness, hypersensitivity, irritability and paranoia. Cocaine increases levels of dopamine in the brain that stops normal communication flooding the brain. With increased use or addiction, people attempt to feel the same original high. However the brain has had to adapt to continue to access dopamine. Therefore it become less sensitive to it. Using more cocaine more frequently cannot create the same sensation but it can create habitual use (source).
It’s also worth noting that cocaine is often mixed with other substances that contribute to it’s addictive qualities. Cocaine has been found to be cut with various substances including opioids, spice/K2, and baking soda.
Cannabis Use Disorder
Before you jump all over this one with which ever side of the argument you believe is true, Cannabis Use Disorder is a diagnosis that is listed in the DSM and that many mental health professionals use in assessing clients. Whew…got that out of the way…now for more…
Cannabis Use Disorder is diagnosed with problematic cannabis use. There is new information about the addictive qualities of cannabis which has many questioning whether or not you can truly become addicted to the substance. According to the National Institute on Drug Abuse, 30% of those who use cannabis may have some degree of the disorder (source).
Cannabis is considered disordered when a person is unable to control their use even though it interferes with aspects of their lives. The brain adapts to heavy cannabis use and can reduce productivity.
Also widely debated is whether or not cannabis can be associated with withdrawal. Noted symptoms include: decreased appetite, irritability, physical discomfort, mood changes, and sleep difficulties. These symptoms are said to last up to two weeks after discontinuing use.
As of 2015, it was recorded that there are 4 million people int he United States who met the criteria for marijuana use disorder (source). Of them, 138,000 or 3.45% of those people have sought treatment for their condition. (source: Center for Behavioral Health Statistics and Quality (CBHSQ). Treatment Episode Data Set (TEDS): 2003-2013. National Admissions to Substance Abuse Treatment Services. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015. BHSIS Series S-75, HHS Publication No. (SMA) 15-4934.) Psychosis seems to be the prevalence caught for cannabis user to seek treatment (source).
Ultimately a mental health professional evaluates your overall relationship to the plant and it’s effects on your life.
Hallucinogen, Phencyclidine Use Disorder
Hallucinogens and Phencyclidine seem to be somewhat lesser know substances by their clinical terms. They are a diverse group of drugs that alter perceptions, thoughts, and feelings by creating images or sensations that seem real. Mushrooms, acid, ecstasy, and mescaline are types of hallucinogens, and PCP, angel dust, ketamine, and fry are all examples of phencyclidines.
Both of these types of substances tend to produce altered awareness, hallucinations, or disconnection from your body or environment. They are extracted from plants or synthetically created. Though they have been used in religious ceremony and more recently for fun, they deregulate the communication between your brain and spinal cord to effect mood, sensory perception and muscle control.
Though classic hallucinogens are only thought to at worst give you a “bad trip,” overdose can be a concern with some dissociative drugs. They both risk serious alteration of perception and mood. They’ve also been known to cause seizures, comas, and death (source).
More research is need to help determine the addiction potential of hallucinogens and phencyclidines. In some cases, ketamine is used to treat depression and chronic pain. However all of these drugs can produce tolerance and risk flashbacks and persistent psychosis.
Inhalent Use Disorder
Inhalants are a range of different substances that when fumes are deliberately inhaled cause a high. The toxic gases are typically found in household products including glue and paint thinner. It is also referred to as “huffing” when fumes are collected in a bag to then be inhaled. Abuse of nitrous oxide and popper are also considered under inhalant use disorder.
Nicotine, Tobacco Use Disorder
The leading cause of preventable death in the US is cigarette smoking. Tobacco isn’t just smoked but sniffed, chewed and vaped. Nicotine is the addictive ingredient that makes quitting difficult. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. Otherwise it is absorbed through the mucus membranes and reaches its peak more slowly. The use of nicotine stimulates the adrenal glands and causes an increase in blood pressure, breathing, and heart rate.
Amphetamine Use Disorder
Amphetamine is a central nervous stimulant. It can increase brain activity and produce a feeling of focus and energy. It has been know to be abuse for the purpose of managing hangover to weight loss. Prescription forms of amphetamine is also used treat depression, hyperactivity and narcolepsy. Students have been known to abuse amphetamine is increase their ability to study and perform. Common types of amphetamines are Adderall, Dexedrine, and Vyvanse. As prescribed use includes swallowing a pill; whereas snorting or injecting dissolved pills have been shown to create a faster, stronger high. Use is very difficult to cease and can induce depression and suicidal tendencies.
Polysubstance Use Disorder
Someone diagnosed with poly substance dependence has shown a pattern that doesn’t identify one substance of choice. Instead someone afflicted with polysubstance use disorder prefers to be intoxicated by any means. The use of alcohol is often combine with two other substances for this type of dependence.
Those assessing substance use disorders are also evaluating impaired control, social impairment, risky use, tolerance, and withdrawal to determine the severity of addiction. That severity is rated as mild, moderate or severe.
Understanding your diagnosis is a critical part of your treatment. Recognizing your drug of choice and how you’ve come to chose it can help you identify underlying cause for your use. Learn more about your diagnosis and the treatments others have found helpful in their recovery.
Seeing a Mental Health Professional
If you become concerned addiction, it’s best to seek the support of a mental health professional- such as a social worker, counselor, psychologist or psychiatrist. When you see someone professionally trained in mental health care, they can help you understand the difficulties you’re experiencing.
Sure just the thought of seeking mental healthcare can create more cravings. You may think they will make you talk about your past. Or that you won’t connect with them to feel comfortable to talk about anything. Maybe you’re afraid to cry in front of anyone let alone a stranger. Worse- you think they’ll put you in a hospital, rehab or institution.
Please know I don’t bring this up to elicit fear but to say- those who work in the mental health field are trained to work with you at your own pace. You don’t have to talk about anything you don’t want to. Ever. The idea is to create a safe space for you to feel comfortable to connect with someone who can help you understand your symptoms and learn to manage them. Therapist are legally bound to uphold privacy and confidentiality. That means they can only repeat what you’ve said to them if they are concerned about your safety or the safety of others. Anything else you tell a therapist, they cannot repeat to anyone else without your consent. You literally have to sign paperwork stating they can talk to others about what you’ve shared with them.
Keep in mind- Untreated substance abuse disorders can be harmful to your health and even fatal. If you think you or your loved one may have a substance use disorder or addiction, see a doctor or therapist to determine the best course of treatment.
When to seek emergency treatment
Here are the signs and symptoms would warrant a trip to the emergency room immediately:
- changes in consciousness
- trouble breathing
- seizures or convulsions
- signs of a possible heart attack, such as chest pain or pressure
- any other troublesome physical or psychological reaction to use of the drug
If anything listed is cause for concern, call 911 or go to your local emergency room immediately.
About Laura Geftman, LCSW
Laura Geftman, LCSW is the Founder of The Calm, Cool & Collected and a practicing therapist. Beyond all things cannabis and mental health, Laura is passionate about developing greater understanding for kindness and acceptance. In her free time, Laura can be found on her yoga mat, in a kayak or singing karaoke.