Do I have a substance use/dependence problem?

[Doggygirl]

Lot's of us come here looking for the answer to that question. One thing I haven't seen posted here (of course it's possible I missed it) is the USA DSM-IV diagnostic criteria for Substance Abuse Disorder and Substance Dependence Disorder. If we were to be evaluated by a certified Addiction Counselor or Psychologist or Psychiatrist or MD, this is the official diagnostic criteria that is used. I was actually pretty shocked - I was clearly in the category of "Substance Abuse Disorder" at a very young age, and migrated into the "Substance Dependence Disorder" many, many years ago.

First I will just post the critera, then in a separate post I will write my own assessment of myself. You can do it too if you want to.

DSM-IV Substance Abuse Criteria
Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent* substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)

3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)

4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Note: The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time. **

* For purposes of diagnosis, "recurrent" equals 2 or more times.

**in other words, you would either be diagnosed with abuse disorder or dependence disorder but not both


DSM-IV Substance Dependence Criteria

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.

2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.

3. The substance is often taken in larger amounts or over a longer period than intended.

4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

6. Important social, occupational, or recreational activities are given up or reduced because of substance use.

7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183)

Hope this helps any who might be struggling with whether or not there is a serious problem.

DG

[Doggygirl]

Do I have a substance use/dependence problem?

Doggygirl's self assessment. Since I know I meet the criteria for dependence, I will not review the abuse criteria as it's irrelevant. (since I can only be diagnosed with one or the other, and the more serious trumps it)

DSM-IV Substance Dependence Criteria

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
My tolerance to alcohol developed very early on. When I was in college and then later in my professional life, I actually thought my ability to drink people under the table and still be standing was a sign that I did NOT have an alcohol problem. Quite the opposite. My body was adapting to a rediculous amount of alcohol - and that is not normal at all. On an all day drinkathon, a dozen drinks or more was not uncommon.

2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
Hangovers are withdrawal, and I had plenty of those. In the end, I drank in the morning on a regular basis. But for a lot of years, I would have a drink early in the day on weekends to "feel better." This is a sign of withdrawal. It doesn't have to be tremors and seizures to be withdrawal.

3. The substance is often taken in larger amounts or over a longer period than intended.
How many thousands of times did I tell myself "I'm only going to have two and then I'll stop." And I could NEVER do it. How many times did I say "I'm only going out for 2 hours, then I'll come home." That was not reliable for me either.

4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

I used to wake up most mornings and say "I'm not going to drink today." But alas, I did. Almost every time.


5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.

For many years, on most days I would have my drinking planned out very early in the day. I would feel unsettled until I had made arrangements to go to happy hour with someone after work, as an example. I was very attentive to the AL supply at home. I NEVER ran out and always had enough for extra people or emergency hurricanes, etc. If I had a social event where I would not be able to drink like I wanted to, I always had a plan. Some drinks before I went, and more drinking later at another place or at home.

6. Important social, occupational, or recreational activities are given up or reduced because of substance use.

I can't count the number of family holiday dinners, important friend events, etc. that I skipped so I could just drink instead. I would call people with all manner of lies and excuses. My drinking took priority more and more as the years went by.

7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

I continued drinking despite suicidal depression, chaos in my home life, inability to get past noon without a drink, etc.


When I finally got honest with myself, there is no question what category I fit into.

This next part would not necessarily apply to people taking meds such as bac or naltrexone - I don't know much about those so will not comment here.

The "invisible line" people talk about - that line we cross where there is no going back to a possibility of moderate drinking is considered by treatment professionals to be the line between abuse and dependence. If there is a reasonable hope of pulling back to safe levels of drinking, it would be most likely for people in the "abuse" category and not likely in the dependence category.

Hopefully that information will help people be realistic when setting goals.

FWIW - from a diagnostic perspective, I am considered Alcohol Dependent in Full Remission as I have been completely AF for more than 12 months.

I am not (yet) a certified addiction counselor, so this is my understanding of all this - not professional advice or input.

DG

[LillyE]

Do I have a substance use/dependence problem?

DG - thanks for posting this. It was actually reading this in one of my books that was one of the things that shocked me into real recognition. I was horrified to realise how much applied too and had for so long. I'm going to come back to this later today when I have more time and write my own responses. But I think it's potentially a very helpful thing for a lot of people struggling with this to read.

I am only just starting to really *get* what they say about denial being such a big part of this disease. I've been journalling my thoughts - and tracking my drinking, on-off and binges and how I feel after - something I highly recommend to anyone struggling with this stuff as the patterns really become clear over time and may shock you too. Yet, despite how clearly I was writing it all out in my journal I was (still am in a way) wrestling with the 'do I REALLY have a problem? do i REALLY have to quit?' and taking those tests over and over again. Madness. It's so blatantly clear to me I do and even at this stage there's a bit of me that wants to fight it and rationalise reasons to drink. Even more mad given how horrible I felt a week or so ago after bingeing and how much better I already feel for a week SF.

So, yes, anyone struggling with this question I urge you to take the time to really consider this and be honest with yourself with the answers.

[pingu1997]

Do I have a substance use/dependence problem?

I fall into the dependence category. Haven't got time to write much as have to take my daughter to school. This is quite useful for me. I have reached a "what now" point and reading this reminds me of the situation I was in before I gave up 6 and a half months ago

Morning everyone (if you're in the UK that is). It's a gorgeous Autumn morning here and promising to be a really warm September day

[patrice]

Do I have a substance use/dependence problem?

Thank you so much for posting this DG

No matter how much I may try to distort the truth ( ie that I am actually an abuser ..) I realise I fall fully into the category of dependence.

I read with interest and horror that, in reality, the possibility of once classified as dependent, it is unlikely to be able to pull back to safe levels of drinking....

Why? Is it because the chemistry of the brain is irreversibly altered?
Can it be reversed with time?
I would love to hear others' experiences with the whole idea of ' I can never drink again'

Thanks
Patrice

[pingu1997]

Do I have a substance use/dependence problem?

patrice;1183872 wrote: Thank you so much for posting this DG

No matter how much I may try to distort the truth ( ie that I am actually an abuser ..) I realise I fall fully into the category of dependence.

I read with interest and horror that, in reality, the possibility of once classified as dependent, it is unlikely to be able to pull back to safe levels of drinking....

Why? Is it because the chemistry of the brain is irreversibly altered?
Can it be reversed with time?
I would love to hear others' experiences with the whole idea of ' I can never drink again'

Thanks
Patrice

I am very interested in this post too, Patrice, especially the bit about once classified as dependent not being able to pull back to safe levels of drinking

Because I tick every single box for dependency, including the last one because I drank when I was down and drinking made me feel worse, so I drank because I felt shit... and so it went on

6 months later and there is something inside me that wants to try and moderate drinking but I am scared to try in case it gets back to the way it was, The idea for me of never drinking again is just beyond words. I get worried about it sometimes so much that it plays on my mind for ages at a time and makes me sad sometimes. Anyone else got anything to offer, this has really struck a chord with me right now

Corinnex

[Marshy]

Do I have a substance use/dependence problem?

DG, that's very interesting. I remember being asked by my addiction counsellor whether I was dependent on alcohol and I said I didn't think so. I had an idea that "dependence" meant having to drink all day, every day (which I sometimes did, but not all the the time), having the shakes in the morning (which I didn't have). Basically, I thought it meant worse than I was. But then my counsellor asked me a checklist of questions like that and, yes, I scored 10 out of 10!

I think it's maybe because alcohol is a legal drug that people (me) are surprised it can get that bad and control every aspect of life.

Pingu - I'm curious, what is it that scares you about the thought of not drinking again?

[pingu1997]

Do I have a substance use/dependence problem?

Marshy;1183938 wrote: DG, that's very interesting. I remember being asked by my addiction counsellor whether I was dependent on alcohol and I said I didn't think so. I had an idea that "dependence" meant having to drink all day, every day (which I sometimes did, but not all the the time), having the shakes in the morning (which I didn't have). Basically, I thought it meant worse than I was. But then my counsellor asked me a checklist of questions like that and, yes, I scored 10 out of 10!

I think it's maybe because alcohol is a legal drug that people (me) are surprised it can get that bad and control every aspect of life.

Pingu - I'm curious, what is it that scares you about the thought of not drinking again?

I liked wine, a lot, before I started being dependent on it. Most of my friends and families drink. I enjoyed a beer before football. I miss the buzz from having a couple of drinks.

This probably sounds weird but I am talking honestly here, in the hope that it might get clearer for me about which direction to go...

My counsellor has told me i am an alcoholic with an addictive/obsessive personality. I thought all alcoholics drank in the morning carried on for the rest of the day, and because I never started until about 4pm I didn't consider myself there.
I have learned a lot since I joined this forum. I am definitely (or was definitely) alcohol dependent.

[windy]

Do I have a substance use/dependence problem?

Good stuff Doggygirl,

I really like the way you broke it down for yourself. I tried to do that too, but lack that skill. I guess the important thing is to see it and really ask yourself if you fall into that category....and to be perfectly honest with yourself regarding the hangovers and drinking to get rid of that feeling. I think that at least one time on our journey most of us have felt that we are not quite there yet and continue to experiment with the inevitable. The key is admitting we are, and perhaps have been there for awhile. I think I fall in the Dependance Category and that scares me. I never thought I was that far along, but your breaking it down that way has cleared that up for me.

As far as ever being able to have the one-off drink and be able to quit when you should, rather than when you want to......Well.... I think some (very few) DO, and most DON'T... Can I? I've tried that experiment and I get close, a lot, but I fail more than I aim to. Then I end ups feeling the remorse and guilt and that leads to sadness and anxiety. I guess it takes more discipline than I have right now to moderate...So for now AF for this bag of wind.

Thanks for breaking it down for us and giving me a wake-up call.

[Doggygirl]

Do I have a substance use/dependence problem?

Interesting comments from everyone. My own denial ran VERY deep. I used to google up "surveys" related to alcohol dependence. Then I would lie to myself as I worked through it. And when I STILL came up being a "problem drinker" I would throw that one out and move on to a different one, or just ignore it for a while. :H

AL does change the brain chemistry, I believe. I also believe it heals over time. I also believe that whatever underlying factor(s) caused me to have zero control over AL in the first place are still there. (genetics? whatever?)

When I was in my first year AF I had urges and cravings just like everyone does. I had to really focus my attention on what I hoped to get out of AL v. the very high risk of drinking. Drinking just doesn't make any sense at all for someone like me.

The river of denial ran very deep for me. I am so happy to have the pull and the drag of AL out of my life. I NEVER want to go back.

DG

[windy]

Do I have a substance use/dependence problem?

Interesting....I can always pass those tests and "surveys".

I think my brain chemistry regarding alcohol really has been altered and it will take a long time to be able to "just take it or leave it". There is so much power in that craving, it is really a scary thing. Will it go away? Will I be able to think about it "like butter". I really don't think so. It would be interesting to see what the experts think and what THAT survey looks like. Such as: what long-term, admitted alcoholics have experienced if they tried moderation.

Deep down and realistically, I think it is poisoning by precious body and always will, with or without moderation.

[Marshy]

Do I have a substance use/dependence problem?

pingu1997;1183941 wrote: I liked wine, a lot, before I started being dependent on it. Most of my friends and families drink. I enjoyed a beer before football. I miss the buzz from having a couple of drinks.

Yes, I understand that. Can be difficult sometimes.

[Doggygirl]

Do I have a substance use/dependence problem?

windy;1184005 wrote: It would be interesting to see what the experts think and what THAT survey looks like. Such as: what long-term, admitted alcoholics have experienced if they tried moderation.

Deep down and realistically, I think it is poisoning by precious body and always will, with or without moderation.

The evidence on that one is incredibly clear. It's rare that people can go from the dependence category to normal drinking. VERY rare. There seems to be a bit more possibility for a positive outcome if one has not passed beyond the abuse category.

If you read the meds section, you will see that there are some interesting new treatment possibilities being explored using medications such as baclofen and naltrexone. Also topomax, which is the medication suggested in the My Way Out book. IMO, any one of these requires some research and there are significant pros and cons with each one.

For me, the simplest path is just to not drink. Then the problem and all the risk goes away.

DG

[mylife]

Do I have a substance use/dependence problem?

Thanks for the post DG.

This is a great reminder thread for why I'm here. Definitely qualify in the Dependent category!

[Doggygirl]

Do I have a substance use/dependence problem?

mylife;1184428 wrote: Thanks for the post DG.

This is a great reminder thread for why I'm here. Definitely qualify in the Dependent category!

The truth was so hard for me to see. I don't know why - it was pretty dang obvious! Self honesty is one of the hard parts of the recovery pathI guess.

DG