Do you have an addiction?

There is a fine line between substance misuse or abuse and addiction. How do you know if you have crossed that line? The simple answer is addiction is present when your substance use or behaviour is harming your physical, mental, social or financial wellbeing.

The keyword is harm, meaning you are putting your physical and psychological health at risk because the compulsion to seek out the drug, alcohol, or behaviour is challenging to control.

The American Society of Addiction Medicine defines addiction as:
“a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences.”

The harmful consequences of addiction include:

  • permanent changes to brain chemistry
  • health complications
  • relationship problems
  • legal problems
  • financial problems
  • injuries or disabilities
  • overdose
  • death

Types of addiction

Addiction is broadly grouped into two categories:

Chemical addiction

Chemical addiction involves the compulsive use of manufactured substances that contain harmful natural or synthetic substances. Chemical addiction can lead to chronic, progressive brain chemistry changes that are potentially fatal.

Chemical substances that have a high risk of abuse include:

  • alcohol
  • opioids
  • stimulants
  • sedatives
  • hallucinogenics
  • psychedelics
  • marijuana
  • nicotine

Behavioural addiction

Behavioural addiction involves compulsive, persistent, repeated actions or activities that you carry out without any real benefit to yourself.

Behavioural addictions include:

  • gambling
  • sex
  • Internet
  • video games
  • shopping
  • binge eating or starvation
  • risky behaviour

What criteria are used to diagnose an addiction?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a criteria list that must be met for substance use disorder to be diagnosed. The latest version of the official text – DSM-5 – replaces the term addiction with substance use disorder, which combines substance abuse and substance dependence into one classification.

The DSM-5 criteria for substance use disorder – addiction – is grouped into four main categories:

Impaired control

  • spending an excessive amount of time seeking out drugs, alcohol or risky behaviour
  • cravings so intense they impair your ability to function
  • using larger doses than intended or increased participation in risky behaviour
  • a cycle of recovery and relapse

Social problems

  • substance use or risky behaviour impacting family, friend and work relationships
  • loss of interest in activities that usually bring joy
  • absence from school and work
  • abandonment or neglect of children
  • gender-based violence
  • social phobia

Risky use

  • physically dangerous situations (driving a car drunk, jaywalking, walking alone at night)
  • using in risky places
  • declining physical and mental health
  • financial ruin
  • divorce, estrangement
  • robbery, attack, rape
  • death

Physical dependence

  • using more potent doses more often to get the same effect
  • increased compulsion to use or engage in risky or harmful behaviour
  • experience withdrawal symptoms when you quit the substance or activity

What are the 11 official DSM-5 criteria for a substance use disorder?

Substance use disorder – addiction – is diagnosed if you meet two or more of the eleven DSM-5 criteria within twelve months. You have a mild addiction if you meet two to three criteria, a moderate addiction if you meet four to five, and a severe addiction if you meet six or more.

Source: DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

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