A many-faceted challenge for families, interventionists, and other addiction pros alike is defining an addiction. We have textbook definitions. We have tests. But when it comes down to addressing the addiction with an addict in denial that he or she has one, we are consistently challenged with breaking down denial.
Signaling the problem, we turn to the Diagnostic and Statistical Manual (DSM). The latest version is October 2016’s DSM-5. Its 11-part impersonal analysis for any substance use disorder:
- Taking the substance in larger amounts or for longer than the you meant to
- Wanting to cut down or stop using the substance but not managing to
- Spending a lot of time getting, using, or recovering from use of the substance
- Cravings and urges to use the substance
- Not managing to do what you should at work, home or school, because of substance use
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational or recreational activities because of substance use
- Using substances again and again, even when it puts the you in danger
- Continuing use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Signs, signs, everywhere signs
The DSM 5 allows clinicians to specify how severe the addiction is, depending on how many of the 11 signs are present. Two or three symptoms indicate a mild substance use disorder, four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.
BOOM! That was easy.
Now tell the addict he or she is one and needs help. The 947 pages of the American Psychiatric Association’s ‘bible’ do little for that discussion. Assume very few people under the influence of a mind-altering drug have the capacity to use that same mind to analyze (honestly) the symptoms.
A simple pair of personal questions gets at the a-ha moment the impersonal DSM can’t get at eyeball-to-eyeball:
Are you hiding your use? Why?
The answers are C-R-I-T-I-C-A-L to making change. You can get at any of those 11 DSM criteria with those two questions. We hide use because we don’t want anyone to see. Or judge. Or evaluate us on a DSM scale. We don’t want them to see because we don’t want to hear that it’s “wrong” or “shameful” or fill-in-the-blank. Yet, family sees. Counselors see. The addict needs that vision and it comes from that introspection. And very few – if any – are ever asked directly what they are hiding, and why are they hiding it.
Addicted Minds’ Editor-in-Chief, Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Buy the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere books are sold. Stevens also heads up BlogTender LLC, a content marketing firm headquartered in Lake Geneva, Wis.
Photo by Vasilisa Karpova, used with permission.