The word addiction is used for any problematic relationship with a substance, instead of only being reserved for describing the psychiatric diagnosis of a substance use disorder. Many people who use substances will never develop an addiction. They’ll try something once or partake periodically and never crave it, use it daily, or lose everything for their drug or drink of choice. Even when use becomes problematic, it might not reach clinically diagnosable levels.
Perhaps a useful way to think about this is to use the example of depression. The word depression, is actually a reference to clinical depression. While feeling sad is a natural human state and might require support and care, clinical depression is a severe form of sadness and a serious psychiatric diagnosis. Over time, however, at least in North America, it’s not uncommon to hear, “Oh, I’m feeling a little depressed.” The irony is, one can’t feel a “little” clinical depression; it’s either present and can be diagnosed, or it isn’t present. One can absolutely feel a “little sad,” but it seems we (as a society) are not allowed to say “sad,” maybe because “sad” doesn’t sound like it’s painful “enough” to be taken seriously. Using this example, saying “drug use has become problematic” is the same as saying “I feel sad,” and “addiction” is the same as saying “substance use disorder.” Both are painful, but one is a diagnosis. Not having a diagnosis does not mean something hurts less or should be taken any less seriously.
With “problematic substance use”, or a full-blown “substance use disorder,” most people won’t experience problems at first. Both usually develop gradually. Lots of people report that they never experienced problems until one day when they realised they were using substances more than they wanted to; their substance use had become problematic. Often, people start by using substances socially, but it gets dark when substance use is employed to cope with a particularly painful or stressful time in one’s life. Eventually, substance use could snowball into using in many different situations, and then it might have become an addiction.
So, how do you know when drug or alcohol use tips from “problematic” to a “disorder”? How do you know when you have crossed that line?
What is problematic substance use?
As described, use becomes problematic as soon as someone becomes aware they are using more than they want to and is unable to curtail their use. It’s when someone notices that the relationship they want to have with, for example, alcohol, is not the same as the relationship they do have.
This might look like going out for dinner and having four drinks when we’d planned on only having two. Four drinks could put someone over the legal blood-alcohol limit and prohibit them from driving, when they’d planned on having two drinks and being legally able to drive their car home. Alcohol use had a negative impact and caused a problem.
Many won’t even consider instances like that, chalking it up to a simple mistake, but many also don’t realise that is the moment when problems start and when a line has been crossed. Further, and the main takeaway, behaviours can be explored and changes made at any point – one doesn’t have wait until it might have progressed to a severe and diagnosable disorder.
It doesn’t take much for a behaviour to cross the line into becoming problematic, but the sooner we notice it, the easier it might be to cross back over the line to more acceptable use.
What is a substance use disorder?
A substance use disorder (often abbreviated to SUD) is diagnosed when an individual meets the diagnostic criteria for disordered substance use according to the DSM-5’s (Diagnostic and Statistical Manual of Mental Disorders, version 5) clinical cut-offs. The DSM-5 is the standard that mental health professionals use to diagnose a wide range of severe mental and psychological conditions, including substance use disorders. The DSM is used throughout North America but is also recognised in much of the world.
How a substance use disorder is diagnosed
So, how is someone diagnosed with a substance use disorder? They schedule an interview with a trained professional (as of this writing, only licensed psychologists or psychiatrists can provide diagnoses of this nature) who will assess someone’s use through a series of questions, most likely including the patterns of use, how substances are impacting the individual’s life, and other inquiries related to tolerance, frequency of use, and negative consequences.
Why does substance abuse disorder matter? It gives the person and the practitioner a framework for understanding what’s going on and how severe things have gotten, and it can grant greater access to support. As the disorder is still quite stigmatised in society, people are afraid to reach out for help. Like depression, many will never seek help for myriad reasons.
“Unmanageability” and its role in addiction
One of the critical indicators of a substance use disorder is the concept of social dysfunction. This concept is acknowledged in many ideologies. Alcoholics Anonymous, for example, would call this “unmanageability”. Social dysfunction refers to no longer being able to meet social obligations, such as arriving at work on time or behaving appropriately while at work, and generally feeling out of control due to substance use. This feeling of a loss of control will look different for everybody, yet most people in recovery from substance use can, in hindsight, point to a time they felt like that.
The tricky thing about social dysfunction is that it’s hard for many to be aware of the warning signs because of the notion of having to wait until it gets “bad enough” – going back to the language we use, this odd notion that saying “My use is problematic” isn’t serious “enough”. The idea of waiting until we hit “rock bottom” to seek help seems to cause an incredible amount of damage; waiting until problems have progressed to being severe, when we might have made changes when it would’ve just taken a little awareness to nudge our relationship with alcohol from “problematic” to “healthy”.
Signs that you’re heading towards addiction
Everybody has a different relationship with substances before they recognise the need for a change. However, there are often shared signs that many people in recovery are able to pinpoint looking back on their road to addiction.
Some of the signs to look out for include:
- Hiding substance use from family, friends, and colleagues.
- Downplaying the effects of the substances.
- Drinking or using substances more often than intended or for longer periods.
- Ignoring friends and family to prioritise spending time with acquaintances who use or are “drinking buddies”
- Noticing a stronger tolerance and withdrawal symptoms when using the substance.
- Missing work and neglecting other essential responsibilities.
Ultimately, whether or not you think you need to get help is up to you. The biggest predictor of change is willingness, and, ultimately, that can only come from you. Nobody can make anyone else do anything. Keep in mind that examining one’s relationship with substance use and possibly exploring what change might look like is a valuable and necessary step.
What if you are worried about your substance use?
Reach out to speak with someone today. You don’t need to hit “rock bottom” to recognise that you are starting to struggle with substance use or that you might be heading towards an addiction. If you are worried about yourself or someone you care about, speak to a certified substance abuse counselor.
If you don’t know who to call, you can start with the 24/7 Substance Abuse and Mental Health Services Administration’s (SAMHSA) national hotline at 1-800-662-HELP (4357). They can help you discuss what’s going on, create a plan, and start moving towards reclaiming your freedom from substances.
If you live in the Vancouver, British Columbia area and want to speak to a trained and empathetic substance abuse counselor, book a complimentary consultation with Bill Arbuckle with through the Hard Road Counselling website.
If you want to attend a 30-day recovery programme in a healing coastal sanctuary in Baja California, Mexico, then contact After the Storm Recovery to learn more about their programme.
Bill Arbuckle has worked in the field of addiction treatment since 2009. Bill specialises in treating addiction and trauma using accelerated experiential dynamic psychotherapy (AEDP) and eye-movement desensitisation and reprocessing (EMDR). Bill also has personal experience with addiction and substance use. He found the way back to the light and works to help others do the same. He is the founder and clinical director of Hard Road Counseling, a practice specialising in addiction counselling in Vancouver, British Columbia. He is also the clinical director of the After the Storm Recovery Center in Todos Santos, Baja California, Mexico.