Help! I’m a (fill in the blanks) Addict!

Different people talk about being addicted, but how can you tell if you are? says it is a:

compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly :  persistent compulsive use of a substance known by the user to be harmful.

Compare this, however, to the American Society of Addiction Medicine:

Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

And that’s the short definition! You want more?

One commonly hears that the addict is “in denial” when they claim their use is not a problem while everyone else thinks it is. Well, that can be a bit tricky, can’t it? If I’m a Baptist deacon and I like to have a beer every now and again, I can be in trouble with my church. If I say it’s not a problem and they say it is, most people wouldn’t call that addiction, and they wouldn’t say I’m in denial.

On the other hand, there are lots of addicts who know they have a problem and still can’t stop. These are the ones that Hollywood traditionally loves. They make great tragic characters, or bad guys depending on the angle.

Suppose you want to diagnose yourself? Well, you could use the DSM 5 substance use disorder criteria. They are, roughly speaking,

1 (substance) Often taken in larger amounts or over a longer period than was intended. (See DSM–
IV, criterion 7.);

2 There is a persistent desire or unsuccessful efforts to cut down or control  use. (See
DSM–IV, criterion 8.);

3 A great deal of time is spent in activities necessary to obtain, use, or
recover from its effects. (See DSM–IV, criterion 9.);

4 Craving, or a strong desire to use;

5 Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home. (See DSM–IV, criterion 1.);

6 Continued  use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects. (See DSM–IV, criterion 4.);

7 Important social, occupational, or recreational activities are given up or reduced because of  use. (See DSM–IV, criterion 10.) ;

8 Recurrent  use in situations in which it is physically hazardous. (See DSM–IV, criterion 2);

9 Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. (See
DSM–IV, criterion 11.);

10 Tolerance (with an associated definition of tolerance);

11 Withdrawal (with an associated definition of withdrawal).

What’s interesting to me as a practitioner is that under the old DSM IV system, you could have tolerance and withdrawal and not be diagnosed with a substance use disorder. So, to use a real life example,  I get busted up an an accident and go on opiate pain killers for a long time. As I stay on them, I develop tolerance. When I come off them, I experience withdrawal. I never used them any way other than the way the doctor said. This actually happens to a lot of people, if they get in serious accidents. So you could say they have a doctor-caused substance use disorder. In my opinion, they don’t have a disorder; they have a physical response to having the substance in their bodies. Nothing more.

So all this seems pretty technical. Well, it is. Addiction is a brain disorder, even though the DSM doesn’t seem to know that. It also doesn’t know the difference between a problem and an addiction, which is probably the result of academic politics, I’ll guess.

However, for the rest of us, I’ll boil it down to the simple version:

* Loss of control;


*Continued use despite adverse consequences.

Diagnose yourself. Could be booze, your smart phone, anything. You be the judge.




About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in Alcohol, behavioral health, physical health, Uncategorized. Bookmark the permalink.

1 Response to Help! I’m a (fill in the blanks) Addict!

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