The Signs of Substance Abuse:
The Diagnostic and Statistical Manual of Mental Disorders, also referred to as the DSM-5, defines the clinical definitions of mental health disorders and the criteria through which these disorders can be diagnosed. For substance use disorders, the DSM-5 has established a list of 11 criteria through which a diagnosis can be made, as explained by the American Journal of Psychiatry:
- Substance use in larger amounts or for longer periods of time than intended
- Repeated, unsuccessful attempts to stop using the substance
- Need for increased amounts of the substance over time to get the same effect
- Cravings for the substance
- Large amounts of time spent using or pursuing use of the substance
- Relationship problems or social difficulties related to substance use
- Physical or psychological issues related to substance use
- Decreased participation in favorite activities due to substance use
- Neglect of responsibilities due to substance use or its effects
- Use of substance in risky situations
- Withdrawal symptoms if substance use is stopped
At times, substance abuse can be hard to recognize. People who suspect that use has crossed over into abuse, or who may think that a loved one is abusing drugs or alcohol, may not know what signs to look for to know with certainty that substance abuse is present.
Because of this, it can help to have an understanding of the ways in which substance abuse affects the individual who is struggling with it, as well as the people and situations around that individual. Those effects can be used to establish a checklist of signs to watch for, helping the individual or loved ones to determine whether or not it is time to seek help for a substance use disorder.
By reviewing the criteria for substance use disorders in the DSM-5, it is possible to come up with a set of signs to watch out for that can help to determine whether substance abuse is occurring.
1. Substance Use in Larger Amounts or Longer Periods than Intended
One of the hallmarks of a substance use disorder is the inability to control use of the substance. Most people who use a medication or drink alcohol can stop after the course of medicine is done or just one drink. However, for those who struggle with substance abuse, the intention to have just one drink or not to use a drug after a certain point is often thwarted by the person’s loss of this control.
This compulsion to keep using drugs or alcohol is often affected by circumstances. Situations that make the person feel the need to drink or use the drug, called triggers, can often lead to this compulsion without the person understanding why on a cognitive level. Triggers can contribute to several of the other signs, below.
2. Repeated, Unsuccessful Attempts to Stop Using the Substance
Substance abuse is considered to be a chronic disorder, similar to chronic physical illnesses. In fact, according to the Journal of the American Medical Association, relapse rates for drug abuse resemble those of asthma, hypertension, and type 2 diabetes. This means that a person who tries to stop using drugs or alcohol and cannot may potentially have a substance use disorder.
Because relapse is common in substance abuse, it is important to realize that relapse may also occur with and after treatment. This does not mean that treatment is failing, but that it needs to be adjusted. Nevertheless, repeated relapse to substance use can be a convincing sign of a substance use disorder, in combination with other signs. In particular, the person experiencing a trigger that leads to renewed substance abuse can be a manifestation of this sign.
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3. Need for Increased Amounts of the Substance over Time to Get the Same Effect
Another physical aspect of substance abuse is a concept called tolerance. As defined by the National Institute on Drug Abuse, tolerance is a state at which a person’s body has become accustomed to a drug and has a diminished response to the original drug dose. In this case, the person needs to use the drug more frequently or at higher doses to feel its effects.
Tolerance leads to a spiral in which the body becomes accustomed to higher and higher dosages, so the person can often take dosages of the drug that might be immediately harmful to people who have not developed a tolerance. For this reason, people who have heavily abused a drug or alcohol over a long period of time can be at risk of overdose if they take the same high dose after having stopped taking the drug for a period of time. This is one of the risks of multiple relapses after abstinence.
4. Cravings for the Substance
Often, when a person who is addicted to a drug or alcohol encounters a trigger, the first response is a craving for the substance of abuse. In fact, as described in Psychology Today, a craving for a drug or alcohol can be described as a strong memory of the positive feelings associated with substance use. These memories lead to a desire to re-experience those feelings by having the substance.
Cravings occur as part of a complex neurochemical response to drug abuse. Most drugs of abuse affect the dopamine pathway in the brain, which controls pleasure and reward. They also affect memory pathways, associating the memories of substance use with the pleasure response. This makes the desire to keep using the drugs very strong, from both behavioral and biological standpoints.
5. Large Amounts of Time Spent Using or Pursuing Use of the Substance
These compulsions and cravings lead the individual to focus a large amount of attention on getting and using the substance of abuse. An individual who is dealing with this type of dependence, therefore, may be hyper-focused on the next opportunity to have a drink or shoot up, to the point of obsession in some cases. If an individual seems to have a heavy focus on needing a substance, this can be a sign of a substance use disorder.
6. Relationship Problems or Social Difficulties Related to Substance Use
According to the American Association for Marriage and Family Therapy, substance abuse contributes to a great deal of discord between marriage partners and within families. The partner who is abusing drugs or alcohol often becomes distant, and arguments may arise around the substance use or other topics.
Marriage is not the only relationship that is affected by substance abuse. The individual may decrease participation in family activities or spend less time with friends due to the substance use. If this is occurring, it could be a sign of an addiction.
7. Physical or Psychological Issues Related to Substance Use
Data shared by the American Cancer Society shows that about 14 percent of lung cancer patients are found to still be smoking five months after a cancer diagnosis. This is an example of how a substance use disorder can affect people. Sometimes, people continue to have trouble stopping drug use even when the abuse causes physical or psychological harm.
In some cases, the substance abuse and the harm it can cause feed each other in a spiraling cycle. For example, a person may start drinking or using benzodiazepines to self-medicate the symptoms of depression. However, these drugs can contribute to worsening depression, resulting in a feedback loop that keeps the person stuck in substance abuse.
8. Decreased Participation in Favorite Activities Due to Substance Use
When a person’s focus is on substance use behaviors, it may become harder and harder for that person to commit time to other activities. As a result, as substance abuse increases, the person stops spending as much time pursuing favorite hobbies, participating in events, or taking part in other activities that used to be enjoyed.
In addition, the person may withdraw from social circles where drug abuse is not encouraged, and begin spending more time with others who abuse drugs or support drug use.
9. Neglect of Responsibilities Due to Substance Use or Its Effects
Similarly, a person who is using drugs or alcohol may be so focused on use that responsibilities at work or home are forgotten or missed. This can occur for various reasons, such as the person wants to spend more time using, or the person has cognitive disruptions that make it hard to focus on responsibilities.
In addition, the person may have problems with hangovers, aftereffects of drug use, or other physical or psychological reactions to the drug use that make it hard to function as normal even when not currently high. The recovery from drug use can be just as disruptive as the drug use itself.
10. Use of Substances in Risky Situations
A person who has trouble with alcohol or drugs often engages in dangerous activities while under the influence of the substance, making those activities even more dangerous. These can include:
Because the person’s cognitive skills may be limited by the substance, or the person may not even recognize the level of impairment, it can be hard to convince them that the behavior is risky or dangerous. The insistence that the person is okay to participate in the activity when that is clearly not true may be a sign of a disordered relationship with the substance.
11. Withdrawal Symptoms if Substance Use Is Stopped
For those who use drugs or alcohol heavily for a long period of time, tolerance and the other effects of the abuse can lead to severe withdrawal symptoms should the person attempt to stop using the substance. In some cases, as with alcohol or benzodiazepines, these symptoms can even be life-threatening. Withdrawal symptoms described by WebMD include:
- Shakiness or nervousness
- Changes in heart rate or breathing
- Depression, anxiety
If the person experiences these types of symptoms when abstaining from the substance, it can be a sign of addiction.
It is important to remember that each of these signs can indicate substance abuse in combination with the others, but none is a sure indicator of addiction on its own. If two or more of these signs are present, it is time to seek the help of an addiction professional for analysis and diagnosis. With professional help, the degree of the disorder can be determined. Treatment is available to help the individual learn to manage addiction and get on the path toward recovery.