Defining and Assessing Addiction- The ChallenGe
Defining addiction is a challenge, however historically there have been numerous definitions of addiction continually being refined and adjusted to encapsulate exactly what addiction entails.
Assessing an individual for an addiction seems inherently obvious and easy, however it is difficult to differentiate individuals who fall inbetween the grey areas of occasional or nonproblematic, use of alcohol/drugs from those who excessively use and have an alcohol/drug problem. Along with the ambiguities associated in assessing and individual for a substance use problem, adolescents or youth pose even greater difficulty in assessment. It is often difficult to recognize what is typical teenage behaviour from a substance use issue. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a primary reference tool used by mental health practitioners to diagnose both mental disorders and substance-related disorders. Substance related disorders are divided in the DSM into two categories of Substance Use Disorders and Substance Induced Disorders. More importantly, through the diagnostic categories, the DSM helps us blur the "grey area" between individuals so we can pinpoint exactly where an individual fits in relation to their substance use.
The DSM-IV outlines specific diagnostic criteria for Substance Abuse, Substance Dependence, Substance Withdrawal and Substance Intoxication. For more information, or to find out if YOU fit any of the outlined diagnostic criteria for each of the above mentioned, please visit http://allpsych.com/disorders/substance/index.html.
Before diving into addiction, it is important to note that before addiction occurs, there are certain stages of substance use that are reached and surpassed in order to distinguish an addiction.
The following flow chart illustrates the Stages of Substance Abuse:
Assessing an individual for an addiction seems inherently obvious and easy, however it is difficult to differentiate individuals who fall inbetween the grey areas of occasional or nonproblematic, use of alcohol/drugs from those who excessively use and have an alcohol/drug problem. Along with the ambiguities associated in assessing and individual for a substance use problem, adolescents or youth pose even greater difficulty in assessment. It is often difficult to recognize what is typical teenage behaviour from a substance use issue. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a primary reference tool used by mental health practitioners to diagnose both mental disorders and substance-related disorders. Substance related disorders are divided in the DSM into two categories of Substance Use Disorders and Substance Induced Disorders. More importantly, through the diagnostic categories, the DSM helps us blur the "grey area" between individuals so we can pinpoint exactly where an individual fits in relation to their substance use.
The DSM-IV outlines specific diagnostic criteria for Substance Abuse, Substance Dependence, Substance Withdrawal and Substance Intoxication. For more information, or to find out if YOU fit any of the outlined diagnostic criteria for each of the above mentioned, please visit http://allpsych.com/disorders/substance/index.html.
Before diving into addiction, it is important to note that before addiction occurs, there are certain stages of substance use that are reached and surpassed in order to distinguish an addiction.
The following flow chart illustrates the Stages of Substance Abuse:
Stages of substance abuse- a flow chart
As demonstrated by the Stages of Substance Use Flow Chart, it is evident that substance use is a progressive disease. A substance use problem can begin with positive initial contact to a substance and lead to sequential stages that perpetuate the progressive cycle of addiction.
It is important to keep in mind that nobody is immune from addiction. Addiction is not discriminatory from any gender, race, ethnicity or socioeconomic status.
It is important to keep in mind that nobody is immune from addiction. Addiction is not discriminatory from any gender, race, ethnicity or socioeconomic status.
Stages of Substance Use- Another Look
Another look at the thought processes surrounding substance use at each of the stages of substance use.
INITIAL CONTACT- "isn't this a great drug?"
EXPERIMENTATION- "its sure expensive, buts its worth it"
EXCESSIVE USE- "I really should cut down"
ADDICTION- "I know I need to stop, but I can't"
INITIAL CONTACT- "isn't this a great drug?"
EXPERIMENTATION- "its sure expensive, buts its worth it"
EXCESSIVE USE- "I really should cut down"
ADDICTION- "I know I need to stop, but I can't"
The road to Defining Addiction- A Little bit of history
In the early 1980’s, the rise in cocaine use challenged the basic framework of our definition of alcohol/drug addiction. At this time addiction was defined as a physical dependence measured by a significant noticeable medical withdrawal symptom. Cocaine was thought to be a drug that incurred psychological dependence with no physical dependence. Although cocaine had no significant, medically noticeable withdrawal symptoms, users reported a severe addiction to it. At this point in time, Dr. David Smith acknowledged this discrepancy and proposed a behavioural definition of addiction.
Today, we can credit Dr. David Smith for developing the current definition of addiction used in the alcohol/drug field. Smith’s definition is more functional and is used by counsellors in the fields of chemical and substance dependency treatment and addictionology. Counsellors often apply this vastly encompassing behavioural definition of addiction to a variety of disorders including eating, gambling, sex, workaholism, television, smoking, spending and other activities.
The three basic components of Smith’s behavioural definition of addiction are the 3 C’s:
1- COMPULSION- users obsessive concern and preoccupation follow an incessant use of substance in a continuous pattern and compulsive lifestyle
2- CONTROL- inability to stop using the substances
3- CONSEQUENCES- continued use despite adverse consequences (family, social, interpersonal, economic)
Today, we can credit Dr. David Smith for developing the current definition of addiction used in the alcohol/drug field. Smith’s definition is more functional and is used by counsellors in the fields of chemical and substance dependency treatment and addictionology. Counsellors often apply this vastly encompassing behavioural definition of addiction to a variety of disorders including eating, gambling, sex, workaholism, television, smoking, spending and other activities.
The three basic components of Smith’s behavioural definition of addiction are the 3 C’s:
1- COMPULSION- users obsessive concern and preoccupation follow an incessant use of substance in a continuous pattern and compulsive lifestyle
2- CONTROL- inability to stop using the substances
3- CONSEQUENCES- continued use despite adverse consequences (family, social, interpersonal, economic)
Addiction- in today's society
In today's society, when the term "addiction" is mentioned, most individuals automatically think of alcoholics and drug addicts. Although addictions to alcohol and drugs are found most commonly, the term addiction is vastly encompassing and more ambiguous than one may perceive.
As previously mentioned, addiction is a widely encompassing term. Addiction may refer to both SUBSTANCE DEPENDENCE (alcohol, drugs) or BEHAVIOURAL ADDICTIONS (sex, eating, exercising, gambling). Addiction not only elicits feelings of shame, guilt, hopelessness and failure but can also encompass numerous related negative consequences including but not limited to psychological, sexual, interpersonal, social, physical, financial and legal consequences. We encourage you to visit our tab "Consequences of Substance Use" for more information of these potential negative consequences.
Addiction to drugs/alcohol or other substances has been a major concern in society for decades. Addiction and substance use continues to be a major social issue in today's society as well. Generally speaking, there are numerous reasons substance abuse is a serious concern but more alarming today, is the seemingly rapid rate at which adolescents and youth are engaging in substance use, paving way to future addictions. Substance use among adolescence has recently been suggested to be near "epidemic" level and can potentially be detrimental to a young persons future. Adolescents facing negative health consequences, the development of mental illness, the implications on academic and future career success, linkage to other drugs, addiction and potentially criminal behaviour can be substantial costs to the young individual, their family and society in general.
The youth or adolescent generation today is so enveloped in the culture industry, that it is not surprising that a lot of youth substance abuse are perpetuated and maintained through the mass media. Seemingly every facet of the media from billboards promoting enticing alcoholic beverage adverisments, reality television shows such as Celebrity Rehab and more recently athletes and professional sports promote and potentially glamorize the use of substances further perpetuating the wheels for addiction and substance use in adolescents.
Although the media plays some role in adolescent and youth substance use and addiction, there are other and infinite possibilities that may influence an adolescent or individual to use a substance. Some of these possibilities include but are not limited to:
- curiosity
- sensation seeking
- family system
- peer influences/pressure
- media influences
- as a coping mechanism
- depression
- traumatic events
Adolescents are among the most difficult to assess for substance abuse problems. Clarifying what is “normal” adolescent behaviour versus what is a substance abuse problem can be very difficult. For tips on how to asses your adolescent's behaviour and acknowledging when to step in for professional help, please visit our "For Parents" tab for more information on early intervention and behavioural assessment criteria if you suspect your child has a substance use problem or addiction.
As previously mentioned, addiction is a widely encompassing term. Addiction may refer to both SUBSTANCE DEPENDENCE (alcohol, drugs) or BEHAVIOURAL ADDICTIONS (sex, eating, exercising, gambling). Addiction not only elicits feelings of shame, guilt, hopelessness and failure but can also encompass numerous related negative consequences including but not limited to psychological, sexual, interpersonal, social, physical, financial and legal consequences. We encourage you to visit our tab "Consequences of Substance Use" for more information of these potential negative consequences.
Addiction to drugs/alcohol or other substances has been a major concern in society for decades. Addiction and substance use continues to be a major social issue in today's society as well. Generally speaking, there are numerous reasons substance abuse is a serious concern but more alarming today, is the seemingly rapid rate at which adolescents and youth are engaging in substance use, paving way to future addictions. Substance use among adolescence has recently been suggested to be near "epidemic" level and can potentially be detrimental to a young persons future. Adolescents facing negative health consequences, the development of mental illness, the implications on academic and future career success, linkage to other drugs, addiction and potentially criminal behaviour can be substantial costs to the young individual, their family and society in general.
The youth or adolescent generation today is so enveloped in the culture industry, that it is not surprising that a lot of youth substance abuse are perpetuated and maintained through the mass media. Seemingly every facet of the media from billboards promoting enticing alcoholic beverage adverisments, reality television shows such as Celebrity Rehab and more recently athletes and professional sports promote and potentially glamorize the use of substances further perpetuating the wheels for addiction and substance use in adolescents.
Although the media plays some role in adolescent and youth substance use and addiction, there are other and infinite possibilities that may influence an adolescent or individual to use a substance. Some of these possibilities include but are not limited to:
- curiosity
- sensation seeking
- family system
- peer influences/pressure
- media influences
- as a coping mechanism
- depression
- traumatic events
Adolescents are among the most difficult to assess for substance abuse problems. Clarifying what is “normal” adolescent behaviour versus what is a substance abuse problem can be very difficult. For tips on how to asses your adolescent's behaviour and acknowledging when to step in for professional help, please visit our "For Parents" tab for more information on early intervention and behavioural assessment criteria if you suspect your child has a substance use problem or addiction.