Diagnosis of addiction
Diagnosis of addiction, i.e. how to correctly identify addiction? What you should know about the “21st century plague” and what to look for when in doubt. Addiction is a mental disorder and as such has its place in the International Classification of Diseases and Disorders (ICD-10). To diagnose them, you only need to know and understand the diagnostic criteria. And there are only six …
According to the International Classification of Diseases and Disorders (ICD-10) in force in Poland, six diagnostic criteria of addiction are distinguished. Based on these criteria, any professional addiction diagnosis is created. In order to recognize an addiction in a given person (make a diagnosis), it is necessary to state that a minimum of three of these criteria were met within one month within the last year from the examination.
Professional diagnosis requires clinical experience and understanding of the nature of the disorder. At the basic level, knowledge of diagnostic criteria and the ability to recognize them in practice are sufficient. The following are the diagnostic criteria for addiction syndrome along with explanations and descriptions of how they can be observed, Recovery Direct in South Africa
The six diagnostic criteria for addiction are:
the difficult to master need to take or contact with the subject of addiction – the so-called hunger;
Hunger (e.g. alcohol or drug) is easiest to recognize during abstinence, usually caused by malaise or pressure of the environment. When an addict refrains from addictive behavior, he experiences tension all the time or only periodically. Because of this, she can be irritable, restless, can’t find a place, persistently looks for work to divert attention from an unpleasant condition. The tension associated with hunger is also responsible for sleeping problems, lack of appetite or a constant search for something to eat. There are also often intrusive thoughts about addictive behavior (e.g. taking a drug or smoking a cigarette). These recurrent thoughts mean that an addict during abstinence may have problems focusing attention, lose the thread in conversation, forget what he was supposed to do, seem absent and distracted. Often, as a result of “hunger”, addicts unconsciously search for a substitute for addictive behavior – they are happy to mention and talk about their “feats”, dream or fantasize about taking or even tell jokes about addiction. Often, an addict experiencing hunger seeks contact with the substance on which he is addicted – he accompanies other users, saying: “It does not move me.”
Another convenient moment for observing “hunger” is the beginning of use after, even after a short period of abstinence. Such behavior is usually accompanied by considerable greed and euphoria caused by the sudden relief caused by the drop in tension. A blissful smile or deep sigh tells us that hunger has gone away for a moment. Usually, attempts to disturb this moment, which is most pleasant for an addict, can cause strong opposition and even an outbreak of aggression. After a moment of relief, hunger increases rapidly, which causes further use.
impairment of control over the amount, time or intensity of use – so-called loss of control;
It is worth highlighting the word control impairment. So we are not talking about a total lack of control, but only about its reduction compared to non-addicted people. What is healthy behavior control? A non-addicted person takes a substance or performs an activity when he wants it, has the conditions to do so and it is good for him. We can hypothetically imagine an addicted smoker. He wants to inhale tobacco smoke, the situation and surroundings favor it, he has the right amount of money to buy tobacco products, and he feels that smoking serves him in every respect. At the same time, without any effort, it stops smoking if only one of the above conditions is not met. We can only imagine it because in reality such smokers are hardly ever found.
And what about addiction control? Well, she is handicapped. This means that a person is not always able to control the amount, time or circumstances of addictive behavior. E.g. an alcoholic – he doesn’t have to drink every day, really! sometimes he has longer or shorter periods of total abstinence. However, when he starts drinking, it is difficult for him: to drink as much as he planned; to devote as much time or money as he wanted; stop when it’s good for him. Only so much and so much. The effects can be different – from drinking beer 15 minutes before the planned trip, because “I have a good metabolism” – to the weekly drinking cycle “day and night” ended with serious intoxication of the body.
The addict’s environment experiences his impairment of control over use as illegality, unpredictability, irresponsibility and ultimately the tendency to lie. An addicted person, unable to control his own behavior, in time begins to camouflage, hide and cheat the environment in order to avoid confrontation with his own powerlessness. He has more and more difficulties with performing timely tasks, keeping contracts, controlling expenses and time.
change in tolerance (demand) for a given substance or activity;
A change in tolerance is simply an increase in the need for a substance or addictive behavior. Both in the case of addiction to substances (e.g. alcoholism, drug addiction) and addictive activities (e.g. gambling, internet use), as addiction develops, the frequency and amount of addictive behaviors increases. Lekoman increases the dose of medicine and “netoholic” spends more and more hours in front of the computer. Just the earlier dose is not enough, it does not bring the expected effect, it does not give the impression of saturation. For example, a sex-boy who used to vent his needs on weekends and had several relationships with newly-met women, after a while, feels great tension if he does not have sex several times every day. Characteristic for this criterion is the search for more and more strong sensations, so the sextoy mentioned earlier will need frequent sex with time, but in public places in order to increase the intensity of sensations, while the drug addict will begin to experiment with stronger drugs, because currently he will be taken as, simply , too weak – addiction recovery in South Africa
It is worth mentioning that after substance addiction, after reaching a critical point related to the deterioration of their health and fitness, we can see a secondary decrease in tolerance, i.e. a reduction in the amount or “strength” of a substance that a person can take once.
Changes in tolerance in alcohol addiction are clearly visible – the demand for alcohol, which grows at a very fast pace, often causes the transition from weaker drinks to stronger drinks, how much beer can be poured into each other … Alcoholic in the middle of the development of addiction often drinks large amounts of vodka, or mixes her with another alcoholic drink, to find out after several dozen years of heavy drinking that vodka “began to harm him” and is too expensive. It then becomes the “foodie” of cheap wines and tinctures. This is not a rule, of course, but a pictorial example of changes in “tastes” caused by changes in alcohol tolerance.
withdrawal symptoms – so-called withdrawal syndrome;
The presence of this criterion is the best proof that abstinence is a permanent element of any addiction. Nicotinian “throws”, alcoholic “takes a break”, drug addict “stops”, etc. At the same time, difficult to imagine for the addicts unpleasant withdrawal symptoms, is the main reason for the persistence and murder of addictions.
What is withdrawal syndrome? It is a group of symptoms that appears in an addicted person after “discontinuation” or a sharp decrease in the amount of substance used, or after cessation or significant reduction of addictive behavior. Non-addicted persons do not have withdrawal symptoms. For example, the so-called “Hangover” is not a withdrawal syndrome, although its symptoms also appear in addicts. The difference is illustrated by the term withdrawal symptoms used by alcoholics – they call it the “giant hangover.” In the withdrawal syndrome, in addition to the usual symptoms of poisoning – after all, any intake of a substance that causes unpleasant effects can be so defined – there are symptoms that indicate that the safe dose of the substance is repeatedly exceeded and the body adjusts to the chemically changed way of functioning. Each addiction has its own distinctive course of “withdrawal”, although it can vary significantly from person to person. In some addictions, it lasts longer on average in others, and some withdrawal symptoms are also specific. Addicted people say that they “get sick”, “die”, “get tired”, “get over their heads”. It is worth emphasizing that although the majority of people undergo withdrawal withdrawal at home, in many cases it is a dangerous condition for health and medical consultation is recommended, and often hospitalization of the patient.
Common and common withdrawal symptoms for various addictions include a marked deterioration of mood, e.g. anxiety, fearfulness, irritability, depression. and somatic disorders: body tremor, weakness, sleep problems, increased sweating, various pains of unknown origin. There are also seizures or psychotic disorders, e.g. auditory or visual hallucinations.
These symptoms are usually caused by prolonged and harmful intake of a given agent, which results in severe intoxication of the body and the occurrence of many side effects of taking a given psychoactive substance. Hence, the withdrawal process is sometimes called “detoxification” or clever sounding “detoxification”, and the facilities that care for patients with withdrawal symptoms are sometimes called “detoxies”.
continuing to use a substance or activity despite being aware of the harm it is causing;
The key to understanding this criterion is the word ‘awareness’. It is met only if the addict is clearly aware of the harmful consequences of taking the substance, and yet does not show motivation to change habits or has serious difficulties in stopping destructive behavior. A striking example of how many people meet this criterion is the popularity of many psychoactive substances despite widespread and legally sanctioned warnings targeted at potential buyers. Possession of drugs is a punishable act, at the points of sale of alcohol there are mandatory inscriptions saying that “alcohol harms health”, packaging of tobacco products are largely covered with cautions for smokers, leaflets attached to medicines are sometimes small books containing a list of side effects and possible complications in people taking a specific drug. Addicts develop defense mechanisms that allow them to question or overlook these obvious facts. They want to see the substance they depend on as helpful and at the same time ignore its negative impact on their lives. A striking example of this behavior is the story of a patient who, having lung hemorrhage, lit a cigarette because she had “heard that nicotine narrows the blood vessels.”
Addicts often persistently say that they smoke, drink or take drugs “because they like” or “because they deserve something from life” and equally consistently downplay or ignore the facts that show that they lose health, fall into conflict with the environment, have financial problems they neglect their duties. Because of this criterion, it is said that an addict “must reach the bottom to bounce off him.” This means that the breakthrough in the life of an addict is most often an event that touches so painfully that it is impossible to ignore it. The most common “turning points” include: recognition of a serious illness, severe punishment imposed by a court, loss of job, family breakup.
neglecting other sources of gratification, e.g. interests, work, socializing; neutralization.
Gratification means delivering a prize. We are looking for satisfaction and pleasure in many different ways. The need for rewards is one of the most important drivers of our behavior. The wider the range of gratification sources a person has, the easier it is to maintain well-being and have the energy to act. We perceive people with a rich repertoire of behavior-improving behaviors as fulfilled, cheerful, coping well with problems. If, at the moment of deterioration of mood, we have the choice: to meet friends, listen to music, go for a walk to a favorite place, develop a hobby, eat something good, engage in physical activity, read, take a nap, play with a beloved animal, engage in our own creative activities, to act socially in a place that interests us or to devote ourselves to spiritual practice, we can certainly say about myself “I am an internally rich, satisfied person”.
An addicted person does not have such freedom. As the addiction develops, the range of behaviors that improve her mood becomes narrower. At the moment of “hole” or “nerves” the mind presents one, best suited solution – “drink”, “smoke”, “take medicine”, take a drug. ” At the same time, periods of bad mood are becoming more frequent and more and more problems appear. A vicious circle is being created: “problems – taking – problems – taking …”. In the addict’s life, he absorbs more and more time and effort: acquiring substances and funds for its purchase, planning “departure”, taking it, and then returning to reality. With time, “not eating” becomes a source of frustration and unpleasant emotions. The addicted person is becoming less and less involved in their own hobbies, family life or social contacts and prefers addictive behaviors to activities that make them difficult (e.g. an alcoholic is increasingly reluctant to weekend car trips, and a nicotinist visits non-smoking home). Addiction covers an increasing area of the addict’s life, gains the highest priority among his activities and displaces everything that could threaten him. The addicted person does not want to allow the awareness of the facts showing how much she has changed, due to the strongly gratifying role of addictive behaviors and the relief she experiences at the time of taking. Such an attitude deepens conflicts and a sense of misunderstanding both on the part of the addict and his surroundings.
To recognize addiction, it is necessary to state that the person has met (minimum) three of the above criteria for one month during the last year. At the same time, it is assumed that addiction is a permanent change in the body (chronic disorder) and requires measures to prevent the patient’s recurrence throughout his life. Once diagnosed, addiction does not have to be confirmed again, even after a long period of remission (no symptoms).
The essence of addictive behavior is not the amount and frequency of use, but difficulties with controlling these behaviors, their destructive impact on the life of an addict, and a sense of internal compulsion to use (not always conscious). Signals of developing addiction reach the addictive environment much faster than themselves. Below are six sentences – which can be used to quickly estimate the risk of addiction in someone around you or yourself:
he sometimes conceals his use;
informs or praises when he is able to stop or limit this behavior;
after stopping or restricting use, he clearly feels worse or cannot find a place;
I need or buy more than ever before;
he enjoys it more and devotes much more attention to it than to other matters;
he avoids talking or gets upset when he hears it hurts him.
If you find that at least three of the above six sentences are true about substance use or other addictive behaviors, you should seek the help of an addiction therapist. The earlier such consultation takes place, the better, over time, each addiction becomes stronger and more destructive, and its treatment – more difficult (you can read about addiction therapy here >>).