Assessment Guide to Diagnosing Addiction & Mental Health

Diagnosing substance abuse or addiction and other mental health disorders is a challenging task, sometimes even for the experts. For a person who is not trained in this type of work, it can be difficult to understand how doctors and addiction experts determine whether a person has an addiction or is simply abusing a substance, or whether what seems to be a mental health disorder may actually be a substance abuse problem.

Especially in the case where substance abuse and mental illness occur together, medical and psychological health professionals can find it challenging to figure out exactly what’s going on. These situations can be even harder to understand for the person or loved ones involved in or affected by the issue.

There are some consistent standards regarding diagnosis of addiction and mental health disorders that are relied on by mental health professionals to diagnose and treat these disorders, and to distinguish substance use disorders from other mental health issues. It can be reassuring for those dealing with a substance abuse or mental health disorder diagnosis to understand the process of observing and diagnosing these issues; in turn, this can make it easier to understand why certain treatment decisions are made, and to gain trust in and commitment to the treatment program.

How Are Addictions and Mental Health Disorders Diagnosed?

Various observations and tests are used to help professionals diagnose mental health disorders, including substance use disorders. In particular, over the course of nearly two centuries, one particular diagnostic guideline stands out, the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5.

What is in DSM-5?

DSM-5 is a detailed guideline to mental health disorders and their symptoms and manifestations, which is used as a standard for diagnosing these illnesses and determining appropriate treatment. Originally established by the American Psychiatric Association (APA) and contributed to by research from a large number of global health organizations, this manual is considered to be the main authority on psychological disorders in the US.

History and Updates

A predecessor of DSM was first published by the APA more than 170 years ago, in 1844. At the time, it was little more than a census tool used to note and classify the types of mental illnesses that were being observed in patients in mental hospitals and institutions. As time went on, it was used to gather and standardize mental health statistics across mental health institutions.

It was in the early 20th century that this document first began to be used for diagnostic purposes as well as classification. The classifications were also broadened after World War II through information provided by the U.S. Army.

After World War II, the DSM was created based on a similar document that the World Health Organization (WHO) was using. At this point, the information was intended to be used more as a diagnostic system – still classifying the conditions, but using the classifications and the growing understanding of mental health to begin to diagnose mental illness and determine how to treat it.

Over the next several decades, APA revised the manual and created a few revisions. Then, in 2000, APA began the 13-year process of creating the most recent revision, working in concert and collaboration with WHO. Released in 2013, DSM-5 is used as the current standard for diagnosing mental health disorders and determining treatment.

Who Manages and Updates DSM-5?

APA is the main body that manages the revisions of the DSM. However, the current revision of the manual was contributed to by 400 participants from 39 countries. Through a series of conferences, these global representatives reviewed research from around the world and reported to APA and WHO regarding the most current knowledge on mental health. This was then used to determine the categories and information that should be included in the manual.

What Information Is Covered?

DSM-5 includes three general categories of information. These are the:

  • Diagnostic classification: This is the listing of all the disorders that are recognized by the experts who compiled the manual.
  • Criteria sets: This includes the symptoms that must be present in order for the disorder to be diagnosed by a psychiatric medical professional.
  • Descriptive text: This includes a variety of information on the disorder, including other disorders that may look the same, how common the disorder is, what consequences the disorder may have on the person who has been diagnosed, tests to help determine whether the criteria have been met, and other relevant information.


Are There Other Authorities on Diagnosing Mental Illness?

Diagnosing mental illness and substance abuse disorder by a professionals

Over nearly the same time that APA was developing the DSM, WHO was developing a similar manual that covered all types of diseases. This manual, called the International Classification of Diseases, or ICD, is used in concert with DSM-5 to classify levels of psychiatric disorders.

A completely different type of diagnostic system is being developed by the National Institutes of Mental Health. Called the RDoC, which is short for Research Domain Criteria. This system includes many more levels of information in the diagnostic model for mental illness. These additional forms of information include genomics, brain biology information, and other biological markers, along with the traditional behavioral and physiological symptoms, that researchers hope will more definitively diagnose mental disorders.

RDoC is still being developed. While it may prove to be a solid tool for diagnosis, DSM-5 is still the most commonly used standard.

Tests for Diagnosing Mental Illness and/or Addiction

Unlike physical illness, there are no laboratory tests to diagnose mental illness at this point. As a result, mental health disorders, including substance use disorders, are diagnosed using self-reporting by the person being diagnosed and the doctor’s observations of the person’s behavior or attitudes. This is done through interviews, questionnaires, and other methods that are then compared to the criteria listed in DSM-5.

These diagnostic tools, along with the doctor’s experience and observation, can help determine the condition and potential treatment. Nevertheless, it is important for both the medical professional and the person who is dealing with the symptoms to be flexible, because some symptoms may indicate a number of potential conditions.

Diagnosing Alcoholism

According to DSM-5alcoholism and other alcohol use problems, such as binge drinking, are all classified as alcohol use disorders. These disorders are diagnosed using a series of 11 criteria that are measured through self-reporting by the person who is being diagnosed. If the person has met two or more of the 11 criteria in the last 12 months, an alcohol use disorder is diagnosed. The criteria include (but are not limited to):

  • Drinking more or longer than intended on an occasion
  • Wanting to stop drinking but being unable to
  • Being unable to focus on anything else due to a strong desire to drink
  • Finding that drinking or being sick from drinking interferes with responsibilities or pastimes
  • Taking excessive risks due to drinking (driving drunk, engaging in other dangerous activities, etc.)
  • Having physical symptoms if drinking is stopped, such as trembling, nausea, racing heart, or seizures

A person who has two or three of these symptoms is considered to have a mild alcohol use disorder. For those with four or five symptoms, the diagnosis is moderate. Six or more symptoms indicate a severe alcohol use disorder, which can indicate alcoholism or extreme alcohol abuse.
If the person does not volunteer information about alcohol use and habits, the doctor or psychiatrist may pay attention to behaviors, attitudes, and other symptoms to help determine whether alcohol may be a factor in the person’s symptoms. An obvious observation may be that the person has the smell of alcohol on the breath. A less obvious symptom may be the person having a low ability to focus or a lack of balance. People who are trained to recognize these types of symptoms can make a deduction about whether alcoholism may be a factor, and apply diagnostic questions from DSM-5 to verify the deduction.

Determining Whether Drug Addiction or Abuse Is Present

In DSM-5, alcohol abuse and various forms of drug abuse are all classified under a single, overarching category called substance use disorder. The criteria for determining drug addiction or abuse are the same as for alcohol abuse, as described above.

The added dimension in diagnosing these disorders depends on the professional gathering further information on both the person’s status and history, and the doctor’s experienced observations of the person’s behavior and attitude. These, in combination with DSM-5 criteria, can present a convincing diagnosis of drug abuse or addiction. The tests and information can include:

  • Laboratory tests: These can determine whether or not the person has drugs in their system. Urine tests and blood tests can help determine what the substances are.
  • Family history: If a person has a family history of substance abuse, the person is more likely to have a substance use disorder as well.
  • Previous diagnoses of substance abuse: People who have had substance use disorders are more likely to have additional or continuing drug abuse or addiction issues.
  • Physical symptoms: Certain drugs cause physical symptoms that can indicate abuse of the substance, such as restlessness in someone using cocaine or an inability to concentrate in someone using heroin.

There is no precise recipe for diagnosing these sorts of disorders. However, medical and psychiatric professionals can combine this information and observations to determine whether a substance use disorder is present.

Confirming or Ruling out Mental Health Disorders

Important of distinguish the symtoms that caused by alcohol and without alcoholWhen a person visits a doctor with a concern about having some sort of mental health disorder, the existence of any alcohol or drug abuse influencing the symptoms is unlikely to be volunteered by the person. For example, when a person sees a doctor regarding potential depression or other mood disorders, it is unlikely alcohol use will be brought up by the person in the discussion. For this reason, it is important for the doctor or psychiatrist to be able to distinguish between symptoms of mental health disorders that may be caused by alcohol use, and symptoms of a mental health disorder that exists independent of alcohol use.

This can be challenging, because often symptoms of substance abuse and symptoms of mental health disorders are not only similar, but also intertwined after a period of time. Whether the substance use disorder existed first or the mental health disorder did, there comes a point where they may influence one another to the degree that treatment for one cannot have a positive outcome without treating the other as well.

Tests or methods that can help the treatment professional make this distinction include conversations with the person that can flesh out the history of symptoms before, during, and after initiation of alcohol use and development of abuse. It is also helpful for the medical professional to talk with family, friends, and coworkers or employers of the person to get a better idea of what symptoms occurred first and when substance abuse began in relation to the symptoms. The doctor should focus on the point that the person began to exhibit signs of addiction, rather than the point at which the substance use began.

Using the diagnostic criteria in DSM-5 can help with some of this diagnosis. What may not be obvious to a layperson may be something that a doctor or psychiatrist will specifically look for to help in determining the true cause of symptoms. The main factor to determine is whether the mental health disorder came before or after the substance abuse.



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