In 2017, the National Survey on Drug Use and Health reported that 19.7 million American adults (aged 12 and over) battled a substance use disorder. Almost 74% of them struggled with alcohol, 38% battled illicit drug use and 1 out of every 8 adults struggled with both alcohol and drug use disorders simultaneously.
In the same survey, 8.5 million adults suggested from both a mental health disorder and substance use disorder, or a “co-occurring disorder.” It’s estimated that drug use and addiction cost American society more than $740 billion annually in lost workplace productivity, healthcare expenses and crime-related costs.
People most often think of addiction only as it applies to substances, but we can have addictions to activities or processes as well.
I’d like to talk some about how therapists go about determining when a behavior has become addictive.
There are 11 individual criteria in the DSM-5 that assist in this determination. The major ones are:
• Tolerance: Do you need more and more of the substance or activity to achieve the same outcome?
• Withdrawal: When you stop the activity, do you miss it such that you feel the need to do it again? Are there physical effects when you stop?
• Activities of Daily Living: Does the substance or behavior result in not completing activities or chores that are important to you or your life? (work, school, relationship responsibilities, personal/bodily care).
• Cravings: Do you carry out the activity in spite of having told yourself you are going to stop?
• Time: Do you spend lots of time carrying out the behavior – seeking drugs, playing video games, on the computer?
• Physical/Emotional Problems: Does the activity result in any physical or emotional problems for you or others who are important to you?
When we think of substance abuse it can include substances that are both legal and illegal.
Alcohol, tobacco and prescribed medications can be as big a problem for someone as the use of methamphetamine, cocaine or opioids.
In the United States, there are also significant addictions involving eating, gambling, internet porn and shopping – all of which are not directly substance-related. It is not uncommon, though, for there to be multiple addictions simultaneously (for example drug use and gambling or gambling and shopping.)
Likewise, people can have ‘co-occurring’ disorders that are a combination of a substance use excess and another mental health disorder (anxiety, depression, bipolar disorder, etc.)
Most medical and mental health professionals see addictions as a medical problem for people, that is, something that at some level has exceeded the person’s ability to control themselves. The best and most effective treatment for addiction can be a combination of medical and mental health treatment.
Treating addicts as criminals may reduce the negative behaviors, but there is no evidence that it changes the person enough to avoid the behavior in the future.
Addiction at its core involves an activity or substance that creates pleasure or a reward. In some people, there is also evidence that there can be genetic predispositions such that some people are more likely to act addictively than others in the same situation. When the pleasure or reward is activated frequently enough it becomes something that people develop a dependency for, and the behavior becomes more and more frequent and harmful.
Treatment for addictions usually involves cognitive-behavioral therapy (CBT) where the goal is to understand what the thought processes are that create the behavior and then adjust them so that rewards can be identified and achieved in less harmful ways.
In some cases, psychotropic medication for depression or anxiety might be used to assist with the transition. For substance abuse, there are also medically-assisted treatments (MAT) that can be used to substitute for the harmful effects of the substance or even block if from having the positive effect.
Successful treatment of any addiction requires several elements that include treating any withdrawal symptoms effectively; approaching the client holistically, that is, considering mind, body and spirit; remain in treatment longer than the time it takes to overcome the initial hurdles; build a support system both within the family and within the community (e.g. 12-step or other groups); accept that abstinence is usually the key for sustained recovery; and create relapse-prevention plans to guard against any potential triggers.
Whayne Herriford, MS, LPCC is a licensed professional clinical counselor in the state of Kentucky and practices in both NKY and Cincinnati. He lives in Bellevue. This column is intended to provide general information to people about mental health-related issues and is not for diagnostic or treatment purposes. You should always consult with a mental health professional when you have concerns about thoughts or feelings.
