What Is the Process for Diagnosing Addiction?
Addiction is a chronic condition that can be difficult to diagnose and treat properly. Addiction is not a disease that can be treated solely on the diagnosis from a doctor. While the signs may be glaring, diagnosing the disease requires the person struggling with addiction to acknowledge the problem and having the desire to address the disease.
Initially, the diagnosis of addiction caused controversy in previous editions of the Diagnosis and Statistical Manual for Mental Disorders (DSM). However, the newest edition has combined substance abuse as well as dependence in a new category, substance abusedisorder.
The DSM-V was the first to include gambling addiction in the definition, as the behaviors associated triggers similar reward circuits as with other substance abuse disorders.
The Diagnostic Process
The first step in diagnosis requires acknowledgment from either the person with addiction themselves, a friend, or family member.
This is typically the most difficult step. Often times this step involves a personal or group intervention if an individual with substance use disorder is unable to see the extent of the problem.
Those with a suspected substance use disorder can begin their recovery process by visiting their primary care provider who can refer them to an addiction facility or rehabilitation specialist.
The suspected addict will go through a series of questions with their PCP about frequency of use, impairment of daily living, and whether the use of a substance is increasing. The primary care provider will also ask questions about how the pattern of use is impacting important social, occupational, education or other functional areas of the person’s life.
Questions regarding withdrawal symptoms that will have possibly occurred during times when the person has attempted to decrease or stop will narrow in on the severity of the disease progression.
The doctor will the complete a physical exam and run blood work to assess the overall health of the individual. This will help to determine
the type of facility that is appropriate for the individual.
The DSM-V separated substance abuse disorder into nine individual 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 the above categories and many dependencies are accompanied with different withdrawal symptoms that occur when an individual does not have the ability to obtain the substance.
To receive a diagnosis of substance use disorder, an individual must demonstrate two of the following criteria within a 12-month period:
- Regularly consuming larger amounts of a substance than initially intended or for a longer amount of time than anticipated
- Often attempting to moderate the intake of a substance without actually reducing consumption or at least wishing to moderate the intake
- Spending long periods trying to obtain or recover from use of the substance
- Expressing a strong desire or craving the substance
- Failing to fulfill professional, educational, and family obligations
- Regularly using a substance in spite of social, emotional or personal issues it may be causing
- 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 physical or psychological harm it is likely to have caused
- Increased tolerance, meaning that the person must consumer 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 may include sweating, shaking and nausea.
The number of qualifying criteria a person demonstrates helps define the severity of the dependence. If a personal regularly demonstrates two of three of these criteria, the DSM advises that that have a mild substance use disorder.
A person with four to five of these criteria would have a moderate substance use disorder. Six or more continuous prevalence in criteria would denote a severe addiction.
As new evidence emerges regarding 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 such as sex addiction, which the ICD-10 classes under the category of “other sexual dysfunction not due to a substance or know physiological condition”.
Whereas the DSM-V does not acknowledge sex addiction as a diagnosis.
A study from 2016, suggests that smartphone addiction is a developing condition and fits within the criteria of addiction.
The DSM-V uses a category called “substance use disorder” to group addictive disorders.
Diagnosing the substance use disorder is a vital first step from either the person with the condition or someone close to the individual. Acknowledging and accepting the fact that a health problem exists must also be accompanied with wanting help, otherwise treatment is unlikely to be a success.
A doctor will ask about the patterns of use to determine the fit within the criteria in the DSM-V. Primary Care Providers will also assess the impact of physical damage already prevalent as a result of the substance use disorder.
To match the criteria, an individual must present two or more signs of addiction over the previous 12 months, including consuming more and more quantities, continued use despite severe consequences, and a reducing interest in activities and socializing.
A person who fits a large number of criteria is diagnosed with a severe substance use disorder.
The doctor will then refer the individual for specialized care.