Sweating. Nausea. Restlessness. An overwhelming urge to use. Nonstop cravings. These are symptoms that people often associate with addiction. But if someone's not experiencing any of these symptoms, surely that use isn't problematic—right?
Not exactly. When mental health professionals are assessing for potential substance use disorders, cravings, or withdrawal symptoms, only two of the factors make up a diagnosis. Evaluating for a disorder involves considering 10 criteria that indicate how a person's use is affecting their life. The severity of a substance use disorder is based on how many of those 10 factors are present in a client.
The diagnosing guidelines that mental health professionals look at are:
- Increasing use
- Inability to cut down use
- Increasing amount of time substance plays in your life
- Inability to fulfill tasks of life
- Conflict with loved ones
- Changes in leisure activities
- Experiencing dangerous situations because of the use
- Using despite knowing it is causing personal harm
- Increased tolerance and withdrawal
From the the perspective of a person who uses, here are some of common misunderstandings about substance use disorders along with the actual facts.
- "If I don't feel like I physically need a substance, I'm not addicted." Physical dependence is only part of the equation. Psychological dependence is also a possibility. If a person finds themselves repeatedly reaching for a substance when they're sad, bored, or stressed as a way to manage those emotions, that also counts as dependence. Withdrawal doesn't always manifest as intense physical symptoms, such as tremors or body aches, or hallucinations. Symptoms can be as simple as elevated anxiety, increased irritability, and sleep disturbance.
- "Substance use disorders are diagnosed based on how much people are using, or when." The picture of the alcoholic drinking alone has been burned into popular culture as one of the most important signs of problematic use. However, current methods of evaluation are focused on how substance use is affecting that person’s functioning. Have you tried to cut back and not been able to maintain that reduction? Is your substance use causing conflict in your closest relationships? Do you lose control over the amount that you set out to use in one sitting? These are all factors that a substance use professional would help a client consider when looking at their relationship with the substance.
- "I have to admit I'm an addict." A substance use disorder does not equal addiction. The diagnosis is based on the behavior, not a name or title they call themselves. When determining a disorder, the word “addiction” does not appear once in the diagnostic criteria, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Whether or not someone identifies as “addicted” or “an addict” is a personal choice and not required for treatment.
- "If I'm diagnosed with a substance use disorder, I'll be stuck with it forever." Not true! If a person stays sober or sustains healthy behaviors, then a substance use disorder diagnosis is not a life sentence.
- "I'm not interested in being sober, so I'm not going to look for help." Substance use professionals don’t provide support solely for complete sobriety. Harm reduction is also a way to improve relationships with substances. If a person feels that their use might be interfering with their relationships or day-to-day activities, a counselor can help them evaluate whether moderation is possible or what reducing substance use might look like for them. Not all substance use qualifies as a disorder.
Simply being mindful of how a substance is impacting your life and whether your relationship with it needs to change is a helpful way to look at substance use.
Keep in mind that a person does not have to be completely convinced that they have a problem to engage in treatment. Mental health professionals can help someone explore the potential impact on their daily living in a non-judgmental way and aid them in living the meaningful and healthy life that they determine for themselves.
Note: This content originally appeared on Mind Matters from Menninger, our blog on PsychologyToday.com.