Substance Use, Abuse, and Addiction

The single most common reason people seek counseling across the world is for substance use problems. I'd personally estimate that 40% of people I have worked with over my career either primarily focused on a substance use issue, or had that as a secondary concern. The following is a brief overview of how to determine the severity of any level of use.

Quick note: In this article when I use the term "substance," I am referring to any type of intoxicant (alcohol, marijuana, nicotine, caffeine, opiates, narcotics, prescription meds, hallucinogens, etc).

Additionally, there is a lot of debate among psychologists, legal experts, doctors, philosophers, and sociologists on whether using any type of illegal substances even once is "OK." Instead of taking a position on that, this article will generally be written from a practical, open stance that accepts that we are curious, sensation-seeking beings that can make choices to have various experiences in our lives, some of which have been determined to be illegal by our governments or institutions we are affiliated with. This article is not going to cast many moral judgment or advocate any side, but instead will lay out the knowledge and facts about this subject.

Symptoms of Substance Use
In the past year, the main psychiatric diagnostic manual (DSM-5) updated its criteria for what constitutes substance "abuse" and "dependence" (addiction), into what is now called a "substance use disorder", which has levels of severity. The symptoms related to substance use issues are below. Take the number of them that are experienced and plot them on the continuum to determine what the level of concern should be.

Additionally, only licensed mental health professionals can make accurate diagnoses. So only use the list below as a a rough guide, but consult with a psychologist for an accurate diagnosis.

• 1. Using the substance in larger amounts, or for longer, than was intended. Some examples of this would be planning to just have two drinks, but ultimately having more; or planning to smoke and relax for a couple hours, but spending significantly more time high than you originally intended.
• 2. Making efforts to reduce or stop use, but not being able to do so. Basically this means that you have tried to stop, cut down, or put some boundaries on your use, but they ultimately do not hold.
• 3. Spending increased amounts of time getting, using, and/or recovering from using the substance. An example of this would be going from using the substance casually at a party when it was available, to investing substantial time and money obtaining it, using it, and dealing with hangovers or other effects of it.
• 4. Having cravings or urges to use the substance. This is self-explanatory but means having a drive to use a substance.
• 5. Having some role failures (not adequately fulfilling life obligations) or major life consequences related to it. This means things like missing work, not completing tasks on time, forgetting things, showing up hungover to something, or having your performance in something suffer due to substance use.
• 6. Continuing to use the substance despite relationship and social problems that have been caused by it. This basically means that some relationships have suffered, or important people are hurt or displeased with you, because of the substance use.
• 7. Giving up important social, occupational or recreational activities because of it. This means that things you used to enjoy or invest your time in (including work, school, hobbies, etc) have been given up or are suffering because of the substance use.
• 8. Having increased risk taking related to the substance, and/or using it in physically hazardous situations. Some example of this include driving drunk or high, going to dangerous places to get the substance or use it, or placing yourself in some other kind of danger to get it or while you are intoxicated.
• 9. Continuing to use the substance even after gaining awareness that it is causing or exacerbating physical and psychological problems. Examples of this include continuing to use the substance even after you realize that your use is harming your body in some way, or your mental health is suffering directly or indirectly.
• 10. Tolerance: needing more of the substance to get the desired effect, or having a reduced effect with the same level of use. This is a physiological change that happens when we use substances regularly over time. A way to determine this is to think about the level of intoxication someone would have if they never used the substance before and did the amount you are doing. If it's more than you experience, then you have built a tolerance.
• 11. Development of withdrawal symptoms, which can be relieved by taking more the substance or something similar. This means that when your body starts to recover from the substance use, you experience a set of symptoms related to it (e.g. a hangover from alcohol).

Treatment
There is no one-size-fits-all treatment for substance use disorders and problematic behaviors. As you can see above, there are a huge number of configurations of symptoms, all at various severity levels, and all for different reasons. The reality is that many people can learn to control their use and reduce their problems (something called 'harm reduction'), whereas other people will truly never be able to do that, and need to quit altogether or dramatically change their lives ('abstinence'). This is especially tricky for highly addictive substances. Treatment options include counseling, support groups, and various hospital situations for the most severe addictions.

How to Be a Support
Many people who are struggling with some type of substance use problem have people that care about them who want to help. The advice I usually give is that it is very important to stay in the original role you have in the person's life, rather than trying to become the treatment professional yourself. In the meantime, check out How People Change, How to Help Others, Healthy Relationships, and Overfunctioning & Underfunctioning for some additional ideas.

Final Words
If you are reading this because you have a moderate or severe substance use disorder, I'd suggest:

a) being honest with yourself about how serious it is,
b) coming to terms with what is driving it,
c) making efforts to cut down if you haven't before,
d) letting someone you care about know, and then
e) talking to a counselor, doctor, or support group.

You are not alone and there are people out there that can help.

Will Meek PhD is a counseling psychologist in Providence, Rhode Island. Get notifications of all his new posts through Facebook.