Diagnosing Substance Use Disorder

Submitted by a Guest Author.

Prior to the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), most addictions were seen as either abuse or dependence–two separate and distinct diagnoses. Abuse was viewed as a more subdued form of chemical use, while dependence was thought of as an addiction to a substance, characterized by an increase in a physical need for drugs or alcohol. This distinction helped insurance companies determine level of care. 

Regardless of motivation, classifying addiction with either of these terms is just wrong. Using the word abuse is particularly egregious. Consider how the word is routinely utilized in today’s world. The term spousal abuse is familiar to all. In this situation, one person is the cause, while the other is on the receiving end of the abuse. The perpetrator elects to inflict harm–a choice is made.

The very idea that deliberate choice is involved in addiction is absurd. A person does not abuse a bottle of alcohol or a syringe of heroin. On the contrary, the person using the substance is being abused by the disease of addiction through the substance. This person is a victim of a potentially fatal illness, which could cause death without treatment. Furthermore, the label abuser is not only inaccurate, but it embodies many negative and unfair connotations. Using this type of terminology only serves to exacerbate the terrible stigma already attached to addiction.

The truth is, this is no longer even how we conceptualize addiction in the dsm-5 or addiction medicine. How symptoms manifest in one person may be very different than those in another. The disease begins in the brain and proves highly individualized and genetically mediated.  This is why, those in recovery need to also steer clear of other substances; for example, a person recovering from cocaine use may have an increased vulnerability to the lure of alcohol.  This extends to certain foods that are likely to cause dopamine spikes in the brain.

Substance use disorder (SUD) is an extremely individualized and complex disease. At SunCloud, we know this complexity includes underlying trauma, depression, anxiety and other co-occurring disorders. The client must discover that their substance use is typically a symptom of much deeper issues. Once this connection is recognized and exposed, these co-morbidities can be worked through, giving the client an increased opportunity to achieve complete recovery.