There are several ways that we can determine if there is a problem. As a clinician, I look for repeated consequences. This can come from the legal system, work, family, or even one’s health. For example, if one has had a DUI and gets behind the wheel again, even if they don’t get caught, that is a repeated consequence. I once heard it said that if drinking causes a problem at work and then it causes a problem with your health and then a problem with your spouse, THAT’S A DRINKING PROBLEM!
According to the DSM-V, Alcohol Use Disorder contains two or more of these criteria. These criteria are meant to educate so those who read this can make an unbiased judgment regarding one’s usage. Now, these criteria work for all of the other drugs and potential addictions as well:
- Substance used in larger amounts or over a longer period of time than intended
- Persistent desire or unsuccessful attempts to cut down or control substance use
- Significant time spent obtaining, using, and recovering from the effects of substance
- Craving to use substance
- Recurrent substance use leading to failure to fulfil major role obligations at work, school, or home
- Recurrent use of substance, despite having persistent or recurring social or interpersonal problems caused or worsened by substance
- Recurrent substance use despite having persistent or recurring physical or psychological problems caused or worsened by substance
- Giving up or missing important social, occupational, or recreational activities due to substance use
- Recurrent substance use in hazardous situations
- Tolerance: markedly increased amounts of substance are needed to achieve intoxication or the desired effect, or continued use of the same amount of substance achieves a markedly diminished effect
- Withdrawal: there is the characteristic alcohol withdrawal syndrome, or substance is taken to relieve or avoid withdrawal symptoms.
The more extreme diagnosis is Alcohol/Substance Dependence. These criteria are:
- A strong desire or sense of compulsion to take substance
- Difficulties in controlling substance -taking behavior, in terms of onset, termination, or levels of use
- A physiologic withdrawal state when substance use has ceased or been reduced, as evidenced by the characteristic withdrawal syndrome or by use of substance to relieve or avoid withdrawal symptoms
- Evidence of tolerance to the effects of substance, such that increased doses of substance are required to achieve the same effects
- Progressive neglect of alternative pleasures or interests because of substance use, and increased amounts of time needed to obtain or take substance, or to recover from its effects
- Persistent substance use despite clear evidence of overtly harmful consequences related to its use.
The common denial phrase is that these criteria “can apply to everyone.” or “it doesn’t mean anything.” The truth is that not everyone who drinks or uses drugs has these problems. A friend told me that he asked his client to go up and down the street and see if his neighbors deal with any of these issues. If you or someone you know meets any of the criteria mentioned earlier, it is probably time to look at it seriously. Make a genuine attempt to stop using. Sometimes, it can be done easily. There are other times where it is too overwhelming. This is not uncommon and the important thing is to get an independent assessment to evaluate the extent of the problem. The positive part of this entire disorder is that there is help available along with many successful outcomes. Reach out to find out what has to be accomplished to meet these long term goals. I cannot promise it will be easy. But, I can promise that it will be worth it.
Michael J Pollak, PCC-S, LICDC
Director, Dual Diagnosis Intensive Outpatient Program