Most people know the textbook example of addiction as the vicious, consuming black hole that can ultimately destroy one’s family, career, mental and physical health, and severely compromise the quality of life. Indeed, many of us have struggled with addiction or have encountered someone who has. Because of all the attention this disorder generates, it is easy to make sound judgment, to assume that a heavy drinker is an alcoholic or a cocaine user is a drug addict. Yet, as we will see, the criteria for diagnosing true substance dependence (addiction) is complex.
First of all, not everyone who indulges in their vices, whether it be smoking, drinking, drugs, gambling, shopping, etc. is considered dependent. People who repeatedly continue their self-destructing behavior, despite recognizing how the habit is negatively affecting their quality of life, are engaging in substance abuse. They may face serious ramifications, such as legal trouble, financial struggles, problems at home, etc. However, unlike those with substance dependence, they do not exhibit substance tolerance or withdrawal symptoms.
Substance abuse however can transcend into substance dependence. The theories about this spiral into addiction are both controversial and plentiful: neurological disruptions regarding levels of serotonin and dopamine, genetics, environmental cues, etc. Still, it should be noted that abuse does not always lead to dependence. Many people go through an “experimental stage,” especially during their teenage and young adulthood years, and they do not suffer from addiction later on.
For people with substance dependence, however, the user acquires tolerance to the substance, therefore requiring a dosage increase to achieve the same intoxication or altered state. Likewise, the individual is deemed unsuccessful in reducing or quitting from the substance, despite his or her willpower or desire to do so. Withdrawal symptoms, such as hangovers, headaches, tremors, nausea, and shakes, occur during periods of abstinence. When the individual engages in the substance, he or she often often intakes more than intended and a “loss of control” feeling is common. Individuals may go to extreme measures (theft, lying, spending inordinate amounts of money or time) to find the substance when experiencing strong cravings for it.
It is critical to understand that the two mental illnesses are not interchangeable. In other words, a person cannot have both diagnoses at the same time. For users to be considered substance dependent, they must have already surpassed the stage of substance abuse. Furthermore, the necessary course of treatment action is different. Treatment plans for substance abuse often promote learning the appropriate strategies and techniques to reduce environmental and social triggers for cutting back intake. Some, but certainly not all, individuals choose a path of sobriety at this point. While people may seek professional help at this point, others are able to quit or cut back and improve their quality of life on their own. However, for people who are substance dependent, the treatment tends to be more aggressive. Recovery programs, such as the popular Twelve Steps and rehabilitation centers, usually advocate full sobriety. Most individuals must seek professional help in order to achieve this.
It should also be noted that the amount and frequency of abuse does not necessarily determine dependence. In fact, the face of addiction is difficult to detect, simply because some people engage in their substances secretly or do not fit the “addict” stereotype. Others may go through stages of heavy use followed by stages of abstinence or steady use. For instance, a college student who goes out to the bars and staggers home drunk every night for one week cannot automatically be deemed an alcoholic. For one, dependence patterns must have been evident for at least twelve months. This rules out most situational factors and variables that can lead to substance abuse. Also, we must consider the context. Is this drinking binge an isolated event? Did an emotional event, whether happy or sad, just happen? Let’s examine an elderly woman who drinks a glass of wine a night to calm her nerves. A few months, noticing she is feeling more stressed, she starts drinking two glasses. Sometimes, on particularly bad nights, she finishes the bottle. Is she substance dependent? If she finds that she cannot curtail her habit, despite a longing to quit and the withdrawals provoke a sense of anxiety and relentlessness, she may be developing a problem.
To conclude, we are quick to throw around the terms like addiction and addict, but automatic labeling can be harsh, false, and detrimental to a person who is not actually suffering from dependence. While there is a plethora of research discussing the proposed models of addiction, it is important to continue studying why most people engage in substance abuse at some point and why only some of them transcend into substance dependence. This knowledge can help prevent and raise awareness about the addiction epidemic.
All information can be retrieved from the DSM-IV-TR or behavenet.com; substance abuse and substance dependence.