How do I know if someone is an addict?- Part two- The diagnosis of substance use
This week, I’ll focus on the diagnosis of substance use. To put it simply, I think if someone has a problem with substance use, then they need help. In our culture, we seem to always want some sort of diagnosis.
How we diagnose
The ICD-10 International Statistical Classification of Diseases and Related Health Problems (mental and behavioural disorders) is what medical professional use to diagnose health problems. It is led by the World Health Association and is the main reference guide in the UK.
Interestingly, the ICD-10 does not even refer to ‘addiction’ as a disorder and hasn’t done since 1964.
Instead, it refers to:
Harmful use– A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).
The diagnosis requires that actual damage should have been caused to the mental or physical health of the user and not just the social impact on themselves or their family members.
OR
Dependence syndrome– A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value.
The explanation given is that people have an overwhelming desire to take their particular drug(s) of choice or alcohol and if they do give up temporarily, they are more likely to return to old behaviours quickly, as opposed to someone who does not have a problems with substances but uses them.
Criteria
ICD10 states, ‘A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:
(a) a strong desire or sense of compulsion to take the substance;
(b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
(c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
(d) evidence of tolerance, such that increased doses of the psychoactive substances are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
(e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
(f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm
Screening tools
Here are some handy screening tools which can be self-scored. If you can get your loved one to complete it, great! If not, you may know enough about their substance using patterns to be able to give it a go yourself.
AUDIT
The Alcohol Use Disorders Identification Test (AUDIT) is considered the most accurate alcohol screening tool for identifying potential alcohol misuse, including dependence. Here is a self-screening that you could explore with your loved one or have a look yourself on their behalf.
DUDIT
The Drug Use Disorder Identification Test is here in PDF form to use if you suspect your loved one is using drugs.
A note about language
I always refer to ‘people who have problems with substance use’ or something similar. I don’t like labels, but what individuals choose to refer to themselves as is their choice. As long as we are not labelling each other, then I think that’s fair enough. There is lots of choice around the help people get for their drug and alcohol use which means that people tend to label themselves depending on the model they use to get help. This doesn’t mean we should be doing it on behalf of individuals or making assumptions.
In summary then, although most of us are not medical professionals and therefore technically shouldn’t diagnose others, we can get a fair idea from the above to figure out whether we are on the right track with our loved one’s substance use.
I can help
My service, The Vesta Approach, supports families affected by a loved one’s substance use. You can access confidential support from me wherever you are in the world. I will help you to get your loved one into treatment and lead a better life. I offer face to face sessions in the Manchester (UK) area or via Skype worldwide.
I also have an online therapeutic programme. Take a look at my services here
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Take care,
Victoria.
