The diagnosis of addiction caused controversy in previous editions of the Diagnosis and Statistical Manual for Mental Disorders (DSM). The newest edition has combined substance abuse and dependence into a new category, substance use disorder.
DSM-V was the first edition to include gambling addiction in the definition, as the behavior triggers similar reward circuits.
The diagnostic process
A GP will be able to diagnose and refer an individual showing signs of a substance use disorder.
The first step in diagnosis relies on a friend, family member, or the person with addiction themselves acknowledging a need for treatment.
This can often be the most difficult step and might sometimes involve a personal or group intervention if an individual with substance use disorder is not aware of the extent of the problem.
The person with suspected substance use disorder visits a family doctor or primary care physician, who may then refer them to an addiction or rehabilitation specialist.
The doctor will ask questions about frequency of use, impairment of daily living, and whether the use of a substance is increasing and how the pattern of use is impacting important social, occupational, educational or other functional areas.
They will also ask about withdrawal symptoms which may have occurred at times when the person attempted to decrease or stop use.
The doctor will complete a physical examination and run some blood work to assess overall health. This helps to determine if medical treatment is needed.
The DSM-5 separates substance use disorder into nine different categories:
- alcohol-related disorders
- caffeine-related disorders
- cannabis-related disorders
- hallucinogen-Related Disorders
- inhalant-related disorders
- opioid-related disorders
- sedative-, hypnotic-, or anxiolytic-related disorders
- stimulant-related disorders
- tobacco-related disorders
- other, or unknown, substance-related disorders
- non-substance-related disorders
DSM-V lists varying criteria for each of these categories, and many dependencies have different withdrawal symptoms that occur when an individual does not have access to the substance.
To receive a diagnosis of substance use disorder, a person must demonstrate two of the following criteria within a 12-month period:
- regularly consuming larger amounts of a substance than intended or for a longer amount of time than planned
- often attempting to or expressing a wish to moderate the intake of a substance without reducing consumption
- spending long periods trying to get hold of a substance, use it, or recover from use
- craving the substance, or expressing a strong desire to use it
- failing to fulfill professional, educational, and family obligations
- regularly using a substance in spite of any social, emotional, or personal issues it may be causing or making worse
- giving up pastimes, passions, or social activities as a result of substance use
- consuming the substance in places or situations that could cause physical injury
- continuing to consume a substance despite being aware of any physical or psychological harm it is likely to have caused
- increased tolerance, meaning that a person must consume more of the substance to achieve intoxication
- withdrawal symptoms, or a physical response to not consuming the substance that is different for varying substances but might include sweating, shaking and nausea
The number of criteria a person demonstrates defines the severity of the dependence. If a person regularly fulfills two of three of these criteria, the DSM advises that they have mild substance use disorder.
A person with four or five of these criteria would have moderate substance use disorder. Six criteria would denote a severe addiction.
As new evidence emerges around addictive disorders, researchers attempt to determine whether or not they can develop reliable diagnostic criteria.
Some addictive disorders appear in the International Classification of Disease, Tenth Edition (ICD-10), such as sex addiction, which the ICD-10 classes under the category of “other sexual dysfunction not due to a substance or known physiological condition”.
The DSM-5, however, does not acknowledge sex addiction as a diagnosis.
One study from 2016 suggests that smartphone addiction is a developing condition and fits within the criteria of addiction.
The concept of video game addiction and the validity of the phenomenon as a diagnosable condition is currently controversial, as it involves the same brain circuitry as other addictions. In some parts of East Asia, clinics already exist to treat gaming addiction.
However, no accepted set of criteria exists in the DSM-5 at present.
The DSM-V uses a category called “substance use disorder” to group addictive disorders.
Diagnosing substance use disorder involves an important first step from either the person with the condition or someone close to them: Acknowledging and accepting the fact that a health problem exists. The person with must first want help, otherwise treatment is unlikely to have a lasting effect.
A doctor will ask about patterns of use to determine whether a person fits the criteria for addiction. They will also assess the impact of any physical damage already present as a result of the disorder.
To fit the criteria, a person must show two or more signs of addiction over the previous 12 months, including consuming ever-larger quantities, continued use despite severe consequences, and a reducing interest in activities and socializing.
A person who fits a high number of criteria has a severe substance use disorder.
The doctor will then refer the individual for specialized care.
What signs can I pick up on to identify a friend or family member as having an addiction?
This depends on the addictive disorder. For instance, with alcohol use disorder, you may notice that your friend or family member is using more and more alcohol with the passage of time. You might notice that the bulk of their free-time activities center around alcohol use.
You may see that the person is having problems fulfilling major obligations, such as showing up for work on time or missing school.
They may also give up or significantly reduce their participation in recreational or social activities that they once enjoyed in favor of drinking. The individual in question might be having problems with relationships.
If you notice these signs, try to connect them with support.
Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.