This entry is intended to bring a little educational understanding to those who are unsure of what all the different terms mean in the world of people with drug/alcohol/behavioral issues. For the sake of discussing the individual, he/she/they are known as such and will be in active use, active recovery, or active wellness (complete remission, perhaps). There are those that will state that one cannot be cured and there is only a state of recovery because the individual is never not addicted to whatever caused problems. I contend that an individual can achieve active wellness which would include complete abstinence and a life without psychoactive substances and/or other excessive repetitive patterns know as behavioral addictions (e.g., gambling, sex, shopping &c.) in healthy, sustainable, and satisfying ways.
Yes, if someone who has been in the throes of chemical dependency or behavioral disorder return to the substance and/or behavior, the cycle begins where it left off for many biological reasons. The point is it is absolutely possible and very much achievable to never return to that way of existing. If you follow medical orders after realizing a high blood pressure diagnosis, the problem becomes completely manageable. If you get your blood pressure down then revert back to a lifestyle which caused it to increase then guess what, it will return with a vengeance. Same exact thing.
I’ll step off of my “You can live well” pulpit and get into the terminology because the layers to wellness are many, deep, and worthy of their very own post(s) .
What is drug addiction, and should we use the term or its derivatives?
According to the National Institute of Drug Abuse (NIDA, 2019), it is “a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and changes in the brain, which can be long-lasting”. Note how it is considered a medical disease by the established medical community. This gets some people in a tizzy and those are often heard exclaiming, “You did this to yourself!, It’s not a disease!, Cancer is a disease!”, &c. The number one cause of death in these United States is heart disease caused largely by; you guessed it, the sufferer (Weatherspoon, 2019). Smoking, diet, overweight, sedentary, all contribute significantly to this problem. Those previously mentioned anger mongers will often retort “Yeah, well it is also genetic!”, and so is chemical dependency (Johns Hopkins, 2021).
Whether or not the term is used or not is always up for debate, and only time will determine its existence. Addiction as a term is fairly straightforward and accurate; however, the term addict is filled with negative connotation, stereotype, and stigma. I can assure you that easily half of everyone I have ever treated looks and behaves just like every other citizen walking around in any neighborhood anywhere. Rich, poor, elderly, young, and all points in between describe people with substance use disorders and behavioral addictions, many of whom you would never guess. I have also known many straight edge folks who the average American might easily mistake for someone who abuses drugs based on appearance alone.
How does someone get diagnosed?
Well, it must be done by a licensed and qualified medical professional who has spent many years in study and has the student debt to prove it. Or you can generally ask someone who is suspected of having a problem with drugs, alcohol, or circumstance and they will know if it can be controlled or if help is needed. This does not take into account those in denial or fear of losing something by the very nature of the question (like safety, shelter, liberty, &c). In the case of the former, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) by the American Psychiatric Association (APA) uses the following criteria to determine whether a problem exists and/or the degree of severity if present (APA, 2013):
A. A problematic pattern of [insert substance or circumstance] use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
- [insert substance or circumstance, e.g., alcohol, opioids, gambling, &c.] are 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 [insert substance or circumstance] use.
- A great deal of time is spent in activities necessary to obtain the [insert substance or circumstance], use the [insert substance or circumstance], or recover from its effects.
- Craving, or a strong desire or urge to use [insert substance or circumstance].
- Recurrent [insert substance or circumstance] use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued [insert substance or circumstance] use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of [insert substance or circumstance].
- Important social, occupational, or recreational activities are given up or reduced because of [insert substance or circumstance] use.
- Recurrent [insert substance or circumstance] use in situations in which it is physically hazardous.
- Continued [insert substance or circumstance] use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of [insert substance or circumstance] to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of an [insert substance or circumstance]. (Note: This criterion is not considered to be met for those taking [insert substance or circumstance] solely under appropriate medical supervision.)
- Withdrawal, as manifested by either of the following:
a. The characteristic [insert substance or circumstance] withdrawal syndrome (refer to Criteria A and B of the criteria set for [insert substance or circumstance] withdrawal).
b. [insert substance or circumstance] (or a closely related substance) are taken to relieve or avoid withdrawal symptoms. (Note: This criterion is not considered to be met for those individuals taking [insert substance or circumstance] solely under appropriate medical supervision.)
NONE – Presence of 0-1 symptoms
MILD – Presence of 2-3 symptoms
MODERATE – Presence of 4-5 symptoms
SEVERE – Presence of 6 or more symptoms
Questions? Anyone? Let’s keep moving. Now with this information held firmly in your mind, you still need to be properly credentialed in order to affix a legitimate diagnosis to anyone, so this is for informational purposes only. Here are a few more terms to add to your lexicon though:
- Drug Intoxication. This is elusive because many people with a substance use disorder(s) have been using for so long that their strange and erratic behavior has become accepted traits. Often the presence of intoxication is a sudden change in demeanor, i.e., one moment a person is restless and anxious, they go to the bathroom and after emerging proceed to pass-out after sitting down anywhere (opioids). Or an individual is nervous and even a little shaky but after a few moments alone returns happy, smooth in gait, and chatty (alcohol). Perhaps a loved one is lethargic and grumpy, but after returning from the bathroom is full of energy and talking a mile a minute (cocaine, methamphetamine). Of course, there are many indicators, but you get the point.
- Drug Abuse. The continued use of a psychoactive drug or behavioral patterns despite the knowledge that it is causing social, occupational, psychological, or physical problems (APA, 2013). Put simply, doing something to excess where the consequences outweigh the benefits; An ice cream cone is great, a half-gallon makes you vomit (in most cases).
- Drug Dependence. Maladaptive pattern of use resulting in significant impairment or distress, as shown by compulsive use, increased tolerance, withdrawal, and obsessive thoughts about it (APA, 2013).
You know, the word withdrawal has been presented several times in this post and it deserves its own little section because it is this experience alone that keeps more people in active use than any other single precipitating factor. The human mind is in a constant state of seeking homeostasis or normal acceptable functioning. All people, not just those with drug/alcohol issues seek the avoidance of pain. Ok, somewhere there is a body builder claiming no pain no gain but let that pain be a sciatic or tooth nerve and he/she is reduced to a tower of gelatin seeking immediate relief.
This next sentence is a value statement directly from the horse; withdrawal is an exquisitely harrowing experience engulfing the entirety of the human experience and reducing it to the most detestable overall sensation of prolonged living death. The only relief which is desperately sought and despised simultaneously is more of the substance that caused it. I really don’t know a better way to explain it. I know of septuagenarian Rockwellesque grandmothers who have sold themselves for heroin because their medical provider overprescribed opioids for years and due to pressure from governing authorities cut them off, just to avoid withdrawal. People question this but its sadly true, and not even the worst of the stories.
If you ever want to chat with me about this or anything else related to relief from substance and/or circumstance please contact me here or at the clinic. Feel free to click on any of the links provided for more reading. Thanks for taking the time, enjoy.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Johns Hopkins. (2021). Substance Abuse / Chemical Dependency. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/substance-abuse-chemical-dependency on 2021, June 30.
NIDA. (2019, January 17). Treatment Approaches for Drug Addiction DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction on 2021, June 30
Weatherspoon, D. (2019, March 29). What Are the 12 Leading Causes of Death in the United States? Retrieved from https://www.healthline.com/health/leading-causes-of-death on 2021, June 30.