How Much Is Too Much?

I think I’ve mentioned it already, but my internship is in an addictions treatment center. We do like 2 – 3 groups a day. Some are small groups for just checking in and catching up. Some have a purpose. The clients can go to groups like Music Therapy or Relapse Prevention. Some are optional, some kind of aren’t. Client are responsible for showing up to groups, but if they don’t go it’s on them. You only get from treatment what you put into it. Kind of like life, huh?

Something I think about in these groups at internship and just my general day-to-day interactions is, “I wonder how many people don’t know what qualifies as addiction?” So naturally, I thought I’d write a blog post about it in case you might be curious what the clinical definition of substance abuse and addiction are for your own reference. I’ve had many friends and acquaintances fulfill these outlines and I honestly think that this piece of the DSM-IV-TR is on the money.

I’ll give you the long academic version and then I’ll give you the short Jenned-up version.

Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

  1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
  2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
  3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
  4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).

Note: The symptoms for abuse have never met the criteria for dependence for this class of substance. According to the DSM-IV, a person can be abusing a substance or dependent on a substance but not both at the same time.

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

  1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
  2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  3. The substance is often taken in larger amounts or over a longer period than intended.
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

Okay, I side with Patronus. That’s boring, white-glove sounding, and doesn’t really inspire me to care. What do you need to know if you want to know?

1.  You can’t be diagnosed with substance abuse and substance dependence (addiction). You are either one or the other. The marked difference between the two is that those who are addicted cannot function without their drug of choice. They view it as essential to living.

2. When I mean “essential to living,” I mean that person uses it to regulate emotions and tackle activities they find unpleasant for one reason or another. So yes, you can be addicted to marijuana and activities like gambling and sex. Your brain produces the same chemicals in both situations.

3. For substance abuse, it just has to be at least one of the four criteria.

4. For substance dependence, it must be at least three of the seven criteria.

My last opinion-based tid-bit:

5. Telling someone they are likely an addict or abusing substances will probably make them incredibly defensive and much less likely to do anything about their problems. When it comes to change, they have to want to do it for themselves. You can’t bully an addict into treatment and/or recovery. Most of them have already tried #4 in the dependence criteria. Unless the law or the cosmos intervene, these folks keep going until they’ve hit most of the criteria. Even “functional addicts” have met these outlines.

As I’ve said, addiction is a family disease. So, you may likely have a family member or friend who has struggled with these issues. Their family members have probably struggled with these issues. It probably goes back for generations.

What are your experiences with this?

Do you agree or disagree with the DSM?


Ah, I JUST remembered I forgot to do a Case Files post for this week. Ugh, major fail! I’ll do one tomorrow, any requests?

Author: Jennifer Bingaman Mazur

I like writing about what I think about what I think. I also like writing about what other people think and what I think about that. Yes? Yes.

13 thoughts on “How Much Is Too Much?”

  1. Excelllllent post!! I agree with DSM, and I wonder if in some cases, having 1 or 2 of the substance dependence criteria would qualify for some of us. This has def been an issue in both sides of my family, and come to think of it, I know very few people who don’t face addiction issues in their family. Can someone be addicted to BC pills? I think I could be cause I love the convenience despite knowing the risks I’m taking being on it for so long. Thanks for this revolutionary post, it might be a game-changer for me. I heart you. : )

    1. Always glad to help! It was definitely a life-changing moment for me when I learned about the classifications. Some of my drinking habitd in undergrad would have scanted the line on dependency. I definitely abused, haha. Always time to grow up and learn better! I heart you!

  2. Wow. This post hit home. My dad is an alcoholic, just as my grandfather was. I attended several group/family therapy sessions with him. They outlined the 7 criteria for substance dependence in one session. It completely changed the way I look at addiction. It’s a disease. I completely agree with the DSM. Before my dad sought treatment, I guess I always sort of thought of it [alcoholism/addiction] as something will-power could overcome, but that has absolutely nothing to do with it. No one told either of them to seek treatment- it came from within. My grandfather had 30+years sober when he passed. My dad is 10 months sober, and I am proud of him every day! Addiction is most definitely a family disease, and so should be the treatment. Without a strong support network, recovering addicts face many more challenges. Thank you for bringing light to a very misunderstood topic! There are so many struggling with addiction- many more than most people realize.

    1. What an awe-inspiring story! Thank you for sharing, Sammy Jean. The primary motivator for recovery is a determination to change and it sounds like your grandfather and father possess(ed) those qualities. It takes courage and strength to face an addiction and battle through it. I commend both you and your dad because it’s a family effort to make recovery work.

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