The terms addiction, substance dependence, and substance abuse are on occasion separated by a few characteristics. In the DSM-IV, the American Psychiatric Association has combined the neurological nature of addiction and the withdrawal pattern typical of substance dependence to help define the disorder as a whole.
With a broader understanding and more inclusive terms counselling and medicine may cooperate to understand and treat both the brain and behaviour dysfunctions that comprise Substance Use Disorder.
Professionals currently use very accurate set of criteria to help them determine the presence of an addiction or a Substance Use Disorder:
- Tolerance: Do you have to use more of the drugs or alcohol over time to maintain a high?
- Withdrawal: Have you experienced physical or emotional discomfort when you have stopped using? Have you used to avoid feelings of anxiety, sadness, or to prevent shakes, sweats, nausea, or vomiting?
- Control: Do you find yourself taking larger amounts than you ever thought you would or use for longer than you expected?
- Desire to quit: Have you thought about cutting down your use? Have you tried to cut down or control your use and been unsuccessful?
- Time devoted to others: Have you ever cancelled activities with friends, missed important work occasions, or reduced the amount of socializing and recreation in your life because of your use?
- Time devoted to using: Do you spend the majority of your time obtaining, using, hiding, recovering from your use, and planning the next use? How much time do you spend thinking about using, avoiding getting caught, or ways to get more?
- Negative consequences: Have you continued to use once you learn about and see the harmful effects of the substance to your health and in your personal life? Do you keep the drug around even when your body and relationships begin deteriorating?
Because addiction does not resemble what we commonly think of when we imagine disease we often blame the addict entirely for choosing their life and for being too weak to walk away. It is true that one of the greatest positive indicators of substance use disorder is a person’s choice to use even when there are clear and immediate negative consequences for doing so. But why?
The brain of an addict is constantly reminding them of a need to use. Some people may be confused or left in disbelief when they learn that addiction is a brain disease and presents some predictable biological markers. However, with addiction the brain will show specific neurological deviations from the normal brain, and these are found mostly in the wiring of its reward center. Once strong neural pathways and dopamine feeds to our brain will diminish with drug and alcohol use. In turn, this can result in the behaviour of compulsively seeking out our drug, to help stimulate dopamine output once again.
The biological component of substance dependence is important because it shows that people can have a predisposition, a higher than normal risk, toward developing an addiction. It also shows that through the influence of drugs and alcohol the brain’s reward system will be extensively compromised and will lose the ability to function properly. This can lead a person to the conclusion that if they are doing well in recovery they will reach a point where they are now stronger and capable of using responsibly, and should perhaps even reward their progress with just a little smoke or drink.
As with other diseases we must approach the disease of addiction with a focus on managing its impact in our lives. You do not have to hit rock bottom in order to be ready for recovery, you simply have to reach a point where the pain, hurt, and regret have become enough for you to say “I’m ready”. When we move beyond denial and accept that our substance disorder will not leave us we can begin to make much needed repairs to our lives.
One of the biggest struggles come with the rebuilding of our self-esteem and self-confidence which both require trust. Trust requires honesty, a desire to help, and be helped, and a willingness to look into the future. We must believe that our addiction is forever a part of our lives but it is not our identity, and we can control its power over us through our everyday healthy choices.