Addictive substances and how they affect the mind [1] have been a key issue in recent years and have been studied extensively.
Rather than treating Alcohol Use Disorder or addiction to drugs as a moral failing, scientists now refer to these illnesses as mental health conditions.
To reflect this research and reduce stigma [2], the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, broadened its definition of addiction and included the disease in its official text.
But what exactly is the DSM-5, and how can it help those suffering from mental health conditions?
In essence, the DSM-5 is a handbook that includes the diagnostic criteria for hundreds of mental disorders.
While it was created by the American Psychiatric Association (APA) [3], this gold-standard text is used worldwide by health professionals, addiction treatment providers, and psychiatrists. The number 5 refers to the most recent edition of the book: released by the APA in March 2022.
However, this is not your average academic text that sits on shelves gathering dust. Rather, the DSM-5 is used by those with clinical knowledge to reach an accurate diagnosis.
It not only defines substance use disorders but provides diagnostic classification: giving a list of common signs and symptoms.
This allows doctors to provide treatment options that will actually work based on whether their patient has a mild substance addiction or severe substance use disorder.
Despite being a medical text with many scientific terms, it can also be used by individuals without clinical knowledge of mental health disorders.
For example, someone who thinks they might be suffering from substance dependence can access the DSM-5 symptoms, and see how many they relate to.
They can also read more about the DSM-5 definition of addiction [4] and access the science behind substance-related disorders.
Understanding Substance Use Disorder
A large part of removing the stigma surrounding addiction and helping people understand what’s going on in their bodies is having a comprehensive definition. The DSM-5 has recently revised their take on how substances such as drugs and alcohol impact the brain.
The handbook states that if someone has a substance-related and addictive disorder, they’ll use alcohol or drugs despite negative consequences. With so many addictive substances out there, the DSM-5 has created subdivisions: recognising ten types of substance addiction.
These include but aren’t limited to, Alcohol Use Disorder (AUD) [5], Opioid Use Disorder (OUD), Hallucinogen Use Disorder (HUD), Tobacco addiction, and Stimulant Use Disorder.
The DSM-5 addiction definition recognises that while addiction can befall anyone, not everyone is vulnerable to physical dependence in the same way. Addiction is a complex web of different causes, with contributing factors including unresolved trauma, co-occurring mental disorders, and even genetic dispositions.
Despite this, Substance Abuse Disorders are a form of brain disease [6] that affect people similarly: hence why they are included in the DSM-5 statistical manual. Whether you’re consuming alcohol or taking drugs, addictive substances activate the brain’s reward system in the same way.
This is because each class of drugs produces an instant “high” or feeling of relaxation that keeps people coming back for more.
Over time, the brain’s reward system comes to associate substance use with feelings of pleasure, especially since it receives a hit of dopamine every time drugs or alcohol are consumed.
As the American Psychiatric Association notes, this repeated cycle of substance use disrupts the brain’s natural balance (homeostasis) and alters its chemistry.
In this way, addiction is very much a disease of brain reward that tricks victims into thinking that they need to take substances above all else. If they stop, debilitating cravings cause harrowing cycles of relapse.
The DSM-5 strengthens this understanding of addiction by making a clear division between Substance Use Disorders and Substance-Induced Disorders.
As we’ve explored, Substance Use Disorder describes the dangerous symptoms that arise from repetitive drug or alcohol use. On the other hand, Substance-Induced Disorders include other mental disorders [7] that have been caused by the effects of substances.
These mental problems will have developed in people who had no such issues before their substance abuse issues.
For instance, research has shown that stimulants such as cocaine can have long-term impacts on an individual’s brain activity and cognitive functioning. Sadly, they’ll be at risk of developing chronic conditions such as depression and anxiety.
Breaking Down The DSM-5 Criteria
The invaluable DSM-5 criteria and list of 11 adverse effects are grouped into four categories. These are physical dependence, social problems, risky use, and impaired control.
Placing each symptom of addiction into these categories has helped professionals to broaden their understanding of addiction, and view a victim’s overall experience.
Without further ado, here’s an explanation of each behavioural symptom according to the latest edition of the DSM-5.
1. Taking a Substance In Larger Amounts Over Time
In most situations, before an addiction develops, someone will take drugs or consume alcohol recreationally, even as a one-time experiment. However, those predisposed to addictive behaviours will notice that they take substances in larger doses as time goes on.
For example, alcohol is frequently consumed in social settings: whether it be on nights out, at parties, or to celebrate an achievement.
While someone without an addiction can have just one or a few beverages, someone with an addiction will struggle to limit their consumption.
They’ll find that many drinking sessions end in them blacking out and being unable to recall events as their intake spirals out of control.
2. Wanting to Cut Down Or Quit, But Being Unable To
When someone gets to the point where their substance abuse is impossible to ignore, they might decide to try cutting down, or even make attempts to stop using altogether.
They may have come to this realisation themselves, or because a loved one has alerted them to certain issues.
Regardless of the reasons behind someone wanting to quit, an addicted individual will be unable to do so without professional help.
This is because drug or alcohol use has changed their brain chemistry [8] and created a host of unwanted side effects. Despite wanting to stop and knowing it’s the best thing for them, their brain’s reward system has been rewired into thinking that it needs the substance.
Oftentimes, attempts to quit will be made, but cravings and other withdrawal symptoms will arise and make it impossible to see the decision through.
This can cause immense distress to both the individual and family members that are forced to watch them self-destruct.
3. Spending Large Amounts of Time Getting, Using, or Recovering From Substance Abuse
The DSM-5 notes that when someone is in the midst of an addiction, they’ll have little time for anything else. While healthy individuals strike a balance between working, socialising, and having time for hobbies, those who are addicted may not be able to do any of these things.
Instead, large chunks of time are spent obtaining, using, and recovering from bouts of intoxication [9]. If someone is addicted to an illegal drug such as heroin, they’ll spend many hours locating the drug and contacting dealers to fuel their dependency.
The rest of the day might be spent ingesting the drug or recovering from adverse symptoms that arise. Harrowingly, this cycle is doomed to repeat itself without proper treatment.
4. Intense Cravings to Use Drugs or Alcohol
Cravings are the compelling urge to seek a substance and are one of the main driving forces behind continued use. Depending on the type of substance being abused, someone may experience psychological urges, or physical cravings that manifest as bodily discomfort.
However they occur, cravings are viewed by the DSM-5 as a sign of moderate to severe addiction, especially when they interrupt thought processes and daily activities.
Cravings can be triggered by a number of environments, situations, and emotions: basically, any cue that the brain associates with substance use.
Studies have shown that on average, cravings rise and fall within seven minutes, but can be so severe that repressing them seems impossible. Moreover, while cravings are often associated with the detox process [10] they can occur at any point: even during active recovery.
5. Inability to Complete Tasks at Work, Home, or School
The longer an addiction lasts, the less likely the victim will be to function normally. Even if someone has remained high-functioning for many months or even years, the point will come when they’re unable to complete everyday tasks.
As a drug or alcohol addiction takes hold, responsibilities that once seemed easy to complete, such as going to work or cooking dinner, can seem impossible for the sufferer to complete.
If left unchecked, these behavioural changes can spiral out of control and end up ruining the life someone has built for themselves.
For example, someone battling Alcohol Use Disorder may spend their mornings unable to get out of bed and face the day because of a hangover.
Similarly, a victim of Heroin Use Disorder might miss entire days of work as their cravings compel them to spend hours seeking out the drug.
6. Continuing to Use Even at the Expense of Personal Relationships
As it’s no doubt becoming clear, substance addiction affects all areas of an individual’s life including their dynamic with others. Whether it be a child, parents, siblings, or best friend, the tangible way that addiction affects the victim’s health can be a difficult burden to bear.
Perhaps the biggest reason for the downfall of an addicted person’s relationships is that they cannot simply stop using.
The inability to quit without professional help [11] is often a cause of much pain and confusion for concerned significant others. Fuelled by cravings, addicted individuals might also steal or lie to their loved ones, all so they can continue using.
However, though many family members will see this behaviour as a personal choice, it’s yet more evidence that their loved one is in the throes of a chronic disease.
7. Giving Up Important Hobbies and Recreational Activities Because of Substance Misuse
During active addiction, the brain no longer produces the same levels of dopamine as before in response to natural cues. As previously mentioned, the brain has been rewired to seek out the immediate dopamine response received from drugs or alcohol, at the expense of anything else.
Because of this, addicted people will find that they are unable to derive pleasure from activities that once gave them joy. This can be anything from spending time with a loved one to producing art or playing a once-loved sport.
Even if they are high-functioning enough to engage in these past times, they’ll find that they cannot feel much satisfaction without taking drugs or consuming alcohol.
8. Using Substances In Dangerous or Risky Situations
Using substances in risky situations seemingly without care is another sign of chronic Substance Use Disorder [12]. Once again, the addicted person won’t be putting themselves in danger because they actively want to, but because their consumption has spiralled out of control.
Consistent alcohol binges and drug consumption will lower someone’s inhibitions: making them more likely to use in dangerous or inappropriate settings. Such behaviour is exacerbated as their tolerance grows, and then need to ingest a substance more and more frequently.
For example, addicted individuals are more likely to drive under the influence, operate machinery while intoxicated, or drink at work.
9. Continuing to Use Despite Knowing that a Substance is Worsening a Physical or Psychological Problem
Even though many substance addictions start in an attempt to self-medicate a pre-existing problem, using drugs or alcohol will make these issues worse in the long run.
However, these individuals find themselves in a catch-22 situation whereby substances have made their other problems worse, but they are unable to quit.
A large proportion of individuals entering treatment do so under a dual diagnosis: meaning they suffer from both addiction and an additional mental or physical illness.
Common examples include mental illnesses such as anxiety, depression, or Post Traumatic Stress Disorder (PTSD).
10. Needing Larger Doses to Achieve a Substance’s Desired Effect
Many individuals in recovery explain feeling a need to chase the “high” they experienced in their first days of drug-taking. After all, it was this surge in dopamine and feelings of elation that started their downward spiral toward addiction.
However, part of what makes addiction so inescapable is that for individuals to feel the same high as before, they’ll need to take larger doses. This phenomenon is known as increased tolerance and is cited by the DSM-5 as a prominent addiction symptom.
Increased tolerance occurs because cell receptors in the body that activate when drugs or alcohol are present stop responding in the same way. This leads many people to increase their dosage, which then causes adverse symptoms to accelerate.
11. Developing Withdrawal Symptoms
When someone is physically dependent on drugs or alcohol, their body can only function normally when drugs or alcohol are present. This means that any attempts to cut down their usage or quit entirely will be met by the rapid onset of withdrawal symptoms [13].
These side effects are more common among those who have built up a dangerous tolerance to drugs or alcohol and can be as mild as nausea or as fatal as grand mal seizures.
Other common withdrawal symptoms include anxiety, tremors, abdominal cramps, migraines, or flu-like symptoms.
Using the Criteria to Determine Severity
The more of the above symptoms that a patient admits to experiencing, the more severe their addictive illness is likely to be.
So, depending on how many red flags of addiction someone presents, patients will be categorised as having a mild, moderate, or severe addictive disorder.
From here, doctors, therapists, or psychiatrists can determine the best course of treatment, provide additional resources, and design a personalised recovery programme.
1. Mild Substance Use Disorder
The DSM-5 explains that someone meeting 2-3 symptoms of the criteria likely harbours a milder form of addiction. This means that while they may not require residential rehabilitation or a medicated detox, some form of therapy is usually prescribed.
Healthcare professionals might give them access to 12-step programmes [14] in their local area. These groups are indispensable forms of peer support: allowing people going through similar addiction struggles to learn and grow together.
2. Moderate Substance Use Disorder
If someone is experiencing 4-5 symptoms of the DSM-5 criteria, they’re diagnosed as having a moderate form of Substance Use Disorder.
While they might not have developed a full-blown addiction, these individuals are already suffering from many adverse symptoms and will have a physical dependence.
As such, it’s usually recommended that those with a moderate substance addiction undergo a medicated detox, often with follow-up therapy. While their addiction might not be at the highest level of severity, they are still at risk of relapsing without the proper care at a drug and alcohol rehab.
3. Acute Substance Use Disorder
In cases of severe addiction, individuals will meet a minimum of 6 DSM-5 symptoms, and it’s at this stage that choosing the correct level of care becomes urgent. Oftentimes, the effectiveness of treatment is determined by whether or not the SUD victim is in residential rehab care or an outpatient facility.
To get them the help they desperately need, clinicians will refer these individuals to an inpatient recovery programme: allowing them to convalesce on-site for a minimum of 30 days. Due to the seriousness of their condition, staying at home to detox will allow withdrawal symptoms to become debilitating, and could even be life-threatening.
Get The Help You Need Today
Thanks to the DSM-5 and what it says about addiction, this condition is now classified as a chronic brain disease rather than a personal or spiritual failing.
Since its publication, there has been a rise in engagement in recovery activities, with more people than ever getting the help they need to battle this life-changing illness.
We understand that coming to terms with an addiction, whether it’s your own or someone else’s, is far from easy. The good news is, having read this article and familiarised yourself with the symptoms of addiction – you’ve already taken the first step of many.
If you suspect that you or someone you love is battling an addiction, contacting OK Rehab today could be the first crucial step towards recovery. Calling 0800 326 5559 [15] will put you in contact with a member of our expert team, many of whom have first-hand experience with addiction struggles.
During your phone consultation, you’ll be asked to disclose the nature of your call and tell us a little about yourself and your unique situation.
From here, our professional team will help you design an actionable plan: whether this is looking into rehab options, attending therapy, or staging an intervention for a loved one.
References
[1] Drugs, Brains, and Behaviour: The Science of Addiction https://books.google.com.vn/books?id=n-OeI0fPx38C&printsec=frontcover&dq=substance+addiction&hl=en&sa=X&ved=2ahUKEwjk_Ynan639AhWDsVYBHQm3AoM4ChDoAXoECAUQAg#v=onepage&q=substance%20addiction&f=false
[2] Ending Discrimination Against People with Mental and Substance Use Disorders, The Evidence for Stigma Change https://www.google.co.th/books/edition/Ending_Discrimination_Against_People_wit/j6PKDAAAQBAJ?hl=en&gbpv=0
[3] American Psychiatric Association Psychiatry.org – Home
[4] DSM-5 Criteria for Addiction Simplified https://www.addictionpolicy.org/post/dsm-5-facts-and-figures
[5] Dynamic Pathways to Recovery from Alcohol Use Disorder: Meaning and Methods https://books.google.co.th/books?id=rA9NEAAAQBAJ&printsec=frontcover&dq=alcohol+use+disorder&hl=en&sa=X&ved=2ahUKEwiR0MKsrLf5AhWT3jgGHaDmAb0Q6AF6BAgCEAI#v=onepage&q=alcohol%20use%20disorder&f=false
[6] The Brain Disease Model of Addiction https://www.hazeldenbettyford.org/research-studies/addiction-research/brain-disease-model
[7] Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment https://www.google.co.uk/books/edition/Co_occurring_Mental_Illness_and_Substanc/vkQ4DwAAQBAJ?hl=en&gbpv=0
[8] The Addiction Solution: Unravelling the Mysteries of Addiction Through Cutting-Edge Brain Science https://books.google.co.th/books?id=_HlQfxWyJogC&printsec=frontcover&dq=valium+addiction&hl=en&sa=X&redir_esc=y#v=onepage&q=valium%20addiction&f=false
[9] Substance Withdrawal Syndrome https://books.google.com.vn/books?id=KexyPgAACAAJ&dq=withdrawal+symptoms&hl=en&sa=X&redir_esc=y
[10] Alcohol Detox: The Guide to Safely Clean Up Your Lifestyle, Detoxify & Maintain Healthy Body Without Drugs https://www.google.co.uk/books/edition/Alcohol_Detox/JrLpzgEACAAJ?hl=en
[11] Innovations in the Treatment of Substance Addiction https://www.google.co.th/books/edition/Human_connection_as_a_treatment_for_addi/B1CqEAAAQBAJ?hl=en&gbpv=0 https://www.google.co.uk/books/edition/Innovations_in_the_Treatment_of_Substanc/vzbzuAEACAAJ?hl=en
[12] Ok Rehab: Drug Addiction – Signs & Symptoms https://www.okrehab.org/drug/drug-addiction-signs-symptoms/
[13] Ok Rehab: Alcohol Withdrawal Symptoms https://www.okrehab.org/alcohol/detox/withdrawal-symptoms/
[14] Modern 12 Step Recovery: Alcoholics Anonymous for the 21st Century https://www.google.co.th/books/edition/Modern_12_Step_Recovery/44kszgEACAAJ?hl=en
[15] Ok Rehab: Help For Myself https://www.okrehab.org/help/myself/
