Diagnosing a drug addiction requires assessment by a medical or mental health professional. A thorough diagnosis often includes assessment by multiple professionals, such as a general practitioner, psychiatrist, and psychologist. Individuals should undergo assessment and testing not only for drug addiction, but also other conditions that could contribute to or affect the addiction, such as medical conditions and mental health disorders.
In a formal addiction treatment program, the diagnostic process often takes place during the initial assessment. After that assessment, which may involve medical tests in addition to an interview with the client, initial diagnoses may be made. These diagnoses may be fine-tuned as the treatment process begins.
The Steps to Diagnosing Addiction
Before enrolling in a treatment program, an individual may go through the following steps in the diagnostic process.
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Step 1: Visit a general practitioner or other medical professional.
A doctor will assess general health and perform tests to evaluate drug use. Blood or urine tests can be used to establish levels of illicit substances within the body and to provide an accurate view of how much drug use is occurring. Medical tests cannot diagnose an addiction, however; they simply establish drug use. Other blood tests may be performed to check for co-occurring diseases.
A medical professional is a good point of entry for anyone who needs to be evaluated for addiction issues. A general practitioner can then refer you to a psychiatrist or other addiction specialist. Clients will likely continue to see a general practitioner throughout the recovery process so general health and drug use can be monitored.
Step 2: Visit a mental health professional.
A psychiatrist – a medical doctor specializing in mental health – or a psychologist can diagnose a substance use disorder. A mental health professional will typically begin an evaluation by having a conversation about what substances are being used, and at what frequency and dosages.
Most mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose addiction and other mental conditions. Mayo Clinic lists the following DSM-5 criteria for substance use disorders:
- The individual uses increasingly higher doses or uses the substance with more frequency than intended.
- The person wants to quit, but feels unable to do so.
- A large amount of time is spent getting and using the drug, and recovering from the effects of the substance.
- The person experiences intense urges or cravings for the drug.
- The substance use prevents the individual from meeting obligations and fulfilling responsibilities.
- Substance use continues in spite of negative consequences.
- Social, occupational, and recreational activities are neglected in favor of substance use.
- Use of the substance occurs in dangerous situations, such as before driving.
- The substance is causing physical or psychological harm, but use continues regardless.
- The individual has built up a tolerance to the substance and must use a higher dose to achieve the desired effects.
- The person experiences physical or psychological withdrawal when stopping or cutting back use, and uses the substance to avoid these symptoms.
At least two of these criteria must occur within a 12-month period for a substance use disorder to be diagnosed. DSM-5 includes various diagnoses for substance use disorders, which organize addictive substances into six categories. SAMHSA lists the following substance use disorders as being included in DSM-5:
- Alcohol use disorder
- Tobacco use disorder
- Cannabis use disorder
- Stimulant use disorder
- Hallucinogen use disorder
- Opioid use disorder
Addiction can often be diagnosed through an informal conversation with a mental health professional, through which the professional can gather needed information and establish if the person is suffering from a disorder. Sometimes, a more formal assessment is needed, and the psychiatrist or psychologist will use a clinical assessment tool.
Step 3: Undergo a formal assessment.
Various assessment instruments can be used to diagnose a substance use disorder. These instruments are often lists of questions the interviewer will ask in order to determine if the person has a substance use disorder, or to determine what kind of disorder is present. The following is a list of common substance use disorder assessments:
- Addiction Severity Index
- Composite International Diagnostic Interview
- Structured Clinical Interview for DSM-5
- Alcohol Use Disorders and Associated Disabilities Interview Schedule
- Psychiatric Research Interview for Substance and Mental Disorders
- Semi-Structured Assessment for Drug Dependence and Alcoholism
Which assessment the mental health professional uses depends on the professional’s level of training, and which provides the most accurate picture of the specific client’s mental health and drug use. Regardless of what type of assessment is administered, the mental health professional will use the answers to establish whether or not the client meets the criteria for a substance use disorder.
Step 4: Create a treatment plan.
Once a substance use disorder has been diagnosed, a treatment plan will be created. The treatment team will often include not only a therapist or counselor, but also a psychiatrist and a medical doctor. The appropriate treatment plan will depend on the client’s unique circumstances. The therapist or doctor may recommend inpatient or residential treatment, which requires the client spend 24 hours a day within a treatment facility for an agreed-upon length of time. A less severe substance use disorder may only require outpatient treatment, in which therapy is provided while the client continues to live at home.
Treatment typically involves individual therapy, group therapy, and sometimes medication. According to SAMHSA, medications are most often used to treat alcohol, tobacco, and opioid dependence. It is important that treatment addresses not only the addiction, but also any co-occurring physical or mental health disorders.