Addiction to alcohol and illicit drugs affects millions of Americans each year. In fact, the National Institute of Health estimates that around 4% of the US population meets the criteria for Substance Use Disorder (While there are many specific disorders, like Alcohol Use Disorder, Cannabis Use Disorder, etc…, I will be lumping them together into SUD for the purpose of this conversation), and the CDC estimates that excessive alcohol use alone accounts for over 95,000 deaths per year in the United States. On a positive note, both the scientific and social communities have begun to reframe our understanding of addiction. Substance use is NOT a failure of the individual, it is not a lapse in moral character, and it should not be treated as such. SUD comes from the dysregulation of biological mechanisms and should be thought of in the same way we conceptualize all illness. Today we are going to break down how we define addiction.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V for short) has 11 criteria that they use to diagnose SUD:
- The substance is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control the use of the substance
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
- Craving, or a strong desire or urge to use the substance
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
- Important social, occupational, or recreational activities are given up or reduced because of the use of the substance
- Recurrent substance use in situations in which it is physically hazardous
- The substance 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 the use of the substance
- Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect;
and/or (b) A markedly diminished effect with continued use of the same amount of the substance
- Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance;
and/or (b) The substance is taken to relieve or avoid withdrawal symptoms
According to the American Psychiatric Association, if you meet 2 or more of these criteria you can be diagnosed with SUD (2013).
SUD is incredibly difficult for the individual as well as their family and friends. That said, we must remember how important social support is for the healing process. Individuals struggling with addiction need medical and social support to overcome their urges. Moral incredulity, fines, and prison sentences only further isolate our suffering communities. Rather than isolate, we must work together to bring people back into the community and tackle the underlying issues that make sobriety so unbearable!