The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, often called the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s “gold-standard” text on the names, symptoms, and diagnostic features of every recognized mental disorder, including addictions. It is the manual upon which health insurance companies in the United States base their accepted diagnoses of psychological conditions including substance use disorder, and their guidelines to pay for treatment thereof.
The DSM 5 criteria for substance use disorders are based on decades of research and clinical knowledge. In a nutshell, the DSM-5 defines addiction as “continuing to do the same behavior even though negative consequences result.” For example, when non-addicts first experience a problem because of their drug or alcohol use, they immediately change their behavior so as not to drink or use again in a manner such that they experience negative consequences. Conversely, when addicts have problems because of their drug or alcohol use, they consider it a fluke and don’t believe it will happen again (denial). So the addict keeps doing the same thing over and over while expecting different results. Albert Einstein called this “the definition of insanity.”
Addiction is a disease. It produces physical changes in the alcoholic or addict’s brain. And like any other disease, addiction must be treated to achieve recovery. An addict can’t just “will” his or her addiction to go away any more than someone suffering from cancer or diabetes can “will” their disease to go away. If a person has cancer or diabetes, that individual goes to a doctor or hospital to receive treatment. Similarly, when a person suffers from an addiction, he or she also needs to seek professional help to recover. That is where Virtue Recovery Center comes in – we are professionals in addiction recovery.
What Are Substance Use Disorders
The DSM 5 recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.
Therefore, while some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.
The activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.
The pharmacological mechanisms for each class of drug are different. But the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is commonly referred to as the “high” produced by substance use/abuse.
The DSM 5 recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders. It is believed that some people have lower levels of self-control than others which may predispose them to develop problems if they’re exposed to drugs. Similarly, research is being done into potential genetic predisposition to addiction and addictive behaviors.
There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders:
Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result.
Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are detailed alongside substance use disorder
Criteria For Substance Use Disorders
Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:1
- Taking the substance in larger amounts or for longer than you’re 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 you in danger.
- Continuing to 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.
Severity of Substance Use Disorders
The DSM 5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder;1 four or five symptoms indicate a moderate substance use disorder, and six or more symptoms indicate a severe substance use disorder.
Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy” for certain substances, and “in a controlled environment.” These further describe the current state of the substance use disorder.
Substance/Medication-Induced Mental Disorders
Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances. They include:
- Substance-induced psychotic disorder
- Substance-induced bipolar and related disorders
- Substance-induced depressive disorders
- Substance-induced anxiety disorders
- Substance-induced obsessive-compulsive and related disorders
- Substance-induced sleep disorders
- Substance-induced sexual dysfunctions
- Substance-induced delirium
- Substance-induced neurocognitive disorders
Substance intoxication, a group of substance-induced disorders, details the symptoms that people experience when they are “high” from drugs. Disorders of substance intoxication include:
- Marijuana intoxication
- Cocaine intoxication
- Methamphetamine intoxication (stimulants)
- Heroin intoxication (opioids)
- Acid intoxication (other hallucinogen intoxication or “acid trip”)
- Substance intoxication delirium
Is There a Cure for Addiction?
Can an addict learn to control their addictive behavior with the right addiction information? What are the causes of addiction, and can it be prevented? This is a complicated disease of the brain. So, the answer to these and other common questions is yes, no, and it depends. An addict suffers from the compulsive need for a habit-forming substance or behavior.
Addiction is defined as the “persistent compulsive dependence on a behavior or substance or the practice of something that is psychologically habit-forming, a chronic disease of the brain that leads to individual biological, psychological, social, and spiritual dysfunction reflected by the pathological pursuit of the reward or relief in the form of a substance or behavior.” Because what motivates an addict is his/her drug or behavior, the only real prevention is abstinence. There exist these types to all kinds of different things. Because we don’t live in a perfect world, some are more harmful than others, but each bears its level of pursuance and degree of necessity for the addict.
The complexity of this disease and overcoming it and the devastating effects are the ultimate goals so many addicts are trying to reach. Let’s take a look at some of the different abuse levels and how they affect the addict and their loved ones’ lives. Of the most likely things to become quickly addicted to are narcotic pain relievers in the form of opioids. Among the most commonly prescribed opioids are codeine, Fentanyl, Hydrocodone (Vicodin), Methadone (often used to treat heroin addicts), Morphine, and Oxycodone (Percocet, OxyContin). Doctors prescribe these medications to treat moderate to severe pain. Many people quickly become addicted to these drugs as they are often prescribed in around-the-clock dosages. This allows the body to get accustomed to the opiate very quickly. Those who are aware that they have an addictive personality should not take these medications.