There is a lot of misinformation about alcoholism and drug addiction in our society. It is common for people to think that an alcoholic is someone who lives in the street constantly drinking. There is a lot of variation amongst people who abuse substances.Addiction is thought of as a disease because it mirrors a lot of the properties of other medical illnesses: It has an identifiable set of progressive symptoms, it is chronic and impacts mortality if not treated.
While there are extreme forms of chemical dependency that lead to the loss of everything, the American Psychiatric Association’s manual, the DSM-5, quantifies symptoms in gradients of mild, moderate, and severe for Alcohol Use Disorder.
From a treatment perspective, if someone with a mild Alcohol Use Disorder can get help before their problems gets more severe, the impact on their life is much less negative.
Criteria to Diagnose Alcohol Use Disorder
In this article, the focus will be on the criteria for Alcohol Use Disorder and the questions used in treatment to diagnose that there is a problem. Many of the questions for Substance Abuse Disorder are the same and can be cross applied.
Explanation for each question will be provided so the reader can better understand how to decide whether they or someone they care about has a problem that needs treatment.
DSM-5 Scoring for symptoms 1 through 11:
The presence of at least 2 of these symptoms indicates an Alcohol Use Disorder (AUD).
The severity of the AUD is defined as:
Mild: The presence of 2 to 3 symptoms
Moderate: The presence of 4 to 5 symptoms
Severe: The presence of 6 or more symptoms
11 Chemical Dependency Evaluation Questions
1) In the past year, have you had times when you ended up drinking more, or longer, than you intended?
A huge myth with people thinking they don’t have a substance abuse problem is that they can control their use sometimes. For example, a business man may go out for drinks every Thursday and limit himself to two drinks four out of five outings. On the 5th outing he has 15 drinks and can’t work the next day due to his hangover.
The problem isn’t that he can’t control his drinking sometimes. The problem is that he can’t predict when he will lose control. It is the inability to predict that suggests there is a problem.
2) In the past year, have you more than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Not being able to stop is an obvious sign of addiction. In recovery circles there is a saying, “Once you become a pickle you can’t go back to being a cucumber.” Some people lose their ability to control substance use and it does not come back.Changing from beer to wine, spirits to weed does not matter. Not being able to choose anymore is the main issue. People that want to stop and realize they can’t are more likely to seek out treatment or respond to a negative life circumstance caused by their usage.
3) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Pavlov was a Russian scientist who discovered that a dog’s salivation for food could be paired with the ringing of a bell. He showed that they would produce saliva by just hearing the bell ring, without food even being present.
In addiction treatment, we call this effect “ritualizing.” Addicts can spend a lot of time thinking, planning, and organizing their lives to get high. Like Pavlov’s dogs, stimuli associated with usage stimulates brain chemicals that anticipate the excitement of getting high. It becomes reinforcing to spend time around people, places, and things associated for this reason.
Conversely, when a person gets into treatment, one of the first lifestyle changes they need to make is around people, places, and things associated with usage. It is to break the pairing associated with being high/drunk. People who refuse to make these changes rarely get sober.
4) In the past year, have you spent a lot of time drinking? Or being sick or getting over other aftereffects?
Addiction is not just the consuming of a substance. It becomes a complete hijacking of a human being’s reward system for life. As a person becomes more invested in getting drunk/high, their interest in getting rewards from other aspects of life (work, relationships, hobbies) shrinks.
More and more time and lifestyle choices are made to better facilitate getting and staying high. This is one of the major reasons a person emotional, spiritual, and relational life deteriorates because of addiction. The parts of a person that grow from finding satisfaction in everyday life are neglected and deteriorate as a result.
5) In the past year, have you found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
I have worked in the addiction field for 20 years and rarely have seen anyone seek treatment because they wanted it. Most people enter treatment for the first time not because they think they have a problem, but because of some outside consequence of their drinking. Their boss threatening to fire them or their wife threatening to leave them are pretty common situations.Addiction counseling often has a confrontational approach to it because the addict needs help tying their life problems to their problem drinking. Blaming others for their problems and the reasons for their drinking is pretty common. Learning to take responsibility for one’s choices and problems is a huge part of early treatment for the recovering person.
6) In the past year, have you continued to drink even though it was causing trouble with your family or friends?
Denial is a powerful psychological defense that keeps people from owning their problems. It is a particularly strong defense for addicts/alcoholics. I have seen people with multiple DUI’s and job and relationship losses directly due to drinking, and they persist in the doubt of whether they have a problem.
When the people affected by the user’s addiction stop enabling the addict’s behavior through active support of their lifestyle, it often helps break through that denial and helps the person see the wreckage their addiction is causing.
7) In the past year, have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
As mentioned earlier, drinking becomes an alcoholic’s great reward in life and everything else shrinks. A recovery exercise I used to do with patients is to have them write a “goodbye letter” to their addiction. It was amazing the significance that people would describe their substance of choice. A lover, best friend, comforter, companion were common descriptions people used to describe their favorite drug.Learning how to re-enter life and get rewards the normal way through balanced life activity is a huge learning curve for people who have abused substances most of their adult lives. One reason 12-step programs are so effective is because recovering people literally show other recovering people how to participate in life again without substances.
8) In the past year, have you more than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
Alcohol is a central nervous system depressant that directly crosses the blood/brain barrier, affecting a person’s ability to think when drunk. The prefrontal cortex is the part of our brain associated with thinking, planning, and judgment.
When drunk, it is like putting the “good judgement” part of our brain to sleep. People are way more vulnerable to making risky choices when drunk. A very high percentage of emergency room visits are associated with alcohol abuse as a result.
9) In the past year, have you continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
A good definition for “insanity” I have heard is, “doing the same thing over and over, expecting different results.” Addiction is not a rational process. It may be that the person keeps hoping they will achieve the positive results with substance use associated with their early use. It may feel like they have to use just to feel normal.
Some that acknowledge their inability to control usage are just resigned that they are just “choosing” how they will die. From the outside it seems obvious that people continue to drink despite it making their life worse is insane. This viewpoint is lost on the alcoholic who is stuck in the cycle of “insanity.”
10) In the past year, have you had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
Tolerance is the medical term that describes how the body adjusts to chronic substance use. Slowly, the body stops producing the chemical that the substance provides. The body depends on the alcohol or drugs and adjusts. Over time, the body needs more of substance to produce the same effect so the person ingests more.
A person may start by only needing two drinks to feel relaxed. Daily drinking causes their body to adjust and then they need 4-5 drinks to get the same effect. Tolerance is a sign of a progressing addiction.
11) In the past year, have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
Withdrawal is the process the body goes through when it is used to daily consumption of alcohol (or some drugs) and then the person stops drinking. The person’s nervous system is physically dependent on alcohol for functioning and without it there is not time to switch back to normal bodily processes.
Alcohol affects a neurotransmitter in the brain called “GABA.” GABA is like the brakes of the brain. It slows brain signals down and is associated with relaxation. When alcohol takes over for GABA, the brain stops naturally producing it. Taking away alcohol suddenly, the brain gets overwhelmed with electrical signals. There are literally no brakes.
An alcoholic who is physically dependent on alcohol can have a Grand Mal Seizure if they stop drinking without seeking medical attention. It can be very dangerous and possibly life threatening.
The above questions are criteria used by the American Psychiatric Association to diagnose Alcohol Abuse Disorder. Getting a loved one or family member to enter treatment who needs help is a difficult issue.
Sometimes treatment starts with a concerned family member learning how to set boundaries and create leverage on the addicted person’s life by withdrawing support that allows them to continue in their addiction. Seeking out a mental health professional with training and experience in Addiction Treatment and Intervention can be key in getting a person into treatment.
If you’re reading this article and you meet the criteria for a problem as described above, do yourself the favor of getting professional help. Often, the first step of asking for help is the hardest part of getting better.
People can and do overcome problem drinking and drug use. A good treatment plan often consists of professional counseling, medical treatment, support groups, family therapy, peer mentoring, and spiritual development. If you are sick and tired of being sick and tired, pick up the phone and get help today!
“Drowning,” courtesy of Nikko Macaspac, unsplash.com, CC0 License; “Down and out,” courtesy of Nik Shuliahin, unsplash.com, CC0 License; “Chained,” courtesy of Jose Fontano, unsplash.com, CC0 License; “Victory, courtesy of Jake Ingle, unsplash.com, CC0 License