Addiction Guide

Every year, 21.5 million Americans battle a substance use disorder, according to the National Survey on Drug Use and Health (NSDUH). Due to the massive number of people struggling with it, the United States and the mental health community have responded by implementing new and improved addiction treatment methods.

Addiction, also known as a substance use disorder, is a mental health disorder recognized worldwide by medical and mental health professionals. The Diagnostic and Statistical Manual (DSM-V) has set forth certain criteria to help make professional and official diagnosis for people struggling from a substance use disorder (SUD).

The standardization of diagnosing the condition has made it easier for healthcare professionals to recognize the disease and treat it effectively and quickly. There can be confusion surrounding the differences between recreational usage, dependence, and addiction. The areas of the brain affected by dependence and addiction are physiologically different, meaning these two experiences are completely unique.

Recreational drug use is categorized by using drugs and alcohol on occasion without the repercussion of repeating the behavior toward negative outcomes and self-destruction.

Physical dependence is recognized as the body and brain requiring certain drugs and/or alcohol in order to maintain homeostasis. This affects a certain area of the brain that is different from addiction. Physical dependence occurs within the thalamus and the brain stem. Overcoming physical dependence is far easier than addiction since managing any withdrawal symptoms is the only action required.

Addiction, on the other hand, is different. The part of the brain affected is what’s known as the reward pathway. This is where dopamine is stored and synthesized. Dopamine is a neurotransmitter known as the “feel-good” chemical. Upon its release, euphoric and calming effects befall the individual. This is what makes repeating the patterns of using drugs and alcohol appealing and often impossible to stop by oneself.

When making a proper substance use disorder diagnosis, medical and mental health professionals look for certain symptoms and characteristics that can distinguish the difference among recreational drug/alcohol use, physical dependence on drugs/alcohol, and overall addiction to drugs and alcohol.

The criteria set forth by the DSM-V to make a substance use disorder diagnosis are as follows:

• Taking the substance in larger amounts and for longer than intended
• Wanting to cut down or quit but not being able to do it
• Spending a lot of time obtaining the substance
• Craving or a strong desire to use the substance
• Repeatedly unable to carry out major obligations at work, school, or home due to substance use
• Continued use despite persistent social or interpersonal problems caused or made worse by substance use
• Stopping or reducing important social, occupational, or recreational activities due to substance use
• Recurring use of substances in physically hazardous situations
• Consistent use of a substance despite acknowledgment of persistent or recurrent physical or psychological difficulties from using substances
• Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount

Should you or your loved one possess at least two or three of these qualities, then a mild substance use disorder diagnosis is given. Four or five of these characteristics equate to a moderate substance use disorder diagnosis. Finally, meeting six or more of the criteria is considered a severe substance use disorder. No matter what the level of severity is surrounding your addiction, seeking professional help for the disease is crucial to your success in life and recovery from addiction.

Causes Of Addiction

There has always been much debate surrounding what exactly is the root cause of addiction. It remains unclear what the direct cause of addiction is, but there are solid arguments for both sides of the disorder.

Environmental

It has been speculated to be entirely environmental, meaning addiction is culpable to the environment and external experiences of the individual as they progress throughout the various stages of life.

Biological

Others believe that addiction is strictly biological, meaning it is an inherited trait. People who have a history of addiction in their family tend to have addictive traits also.

Risk Factors

There are fair arguments for both sides of the source of addiction; however, most specialists believe it is a unique condition that is influenced by a combination of both. There are certain risk factors for people to develop a substance use disorder or addiction to self-destructive behaviors.

Experiencing traumatic events, having a genetic predisposition to an addiction, and growing up in an environment which supports drug/alcohol use are all pieces of the very complicated puzzle that is addiction.

The important part of looking at addiction isn’t so much the reason behind it, but the application of the correct method of addiction treatment in order to change the behaviors.

Signs Of Addiction

When it comes to identifying addiction in yourself and/or others, there are certain red flags and tell-tale symptoms to know. The most pertinent–you must first recognize that there is a problem.

The symptoms of addiction manifest differently in each person. As a mental health disorder, the manner in which it appears in a person is as unique and individual as that person. There are certain commonly seen symptoms of addiction associated with different drugs that may help narrow the search and shed some light on what’s happening.

Each individual substance category presents similar yet different symptoms of addiction.

Below are the main categories of substances and signs/symptoms for each that indicate misuse or abuse that are abused.

Alcohol

• Drinking as a way to forget about problems
• Drinking outside of social settings or regularly drinking alone
• Feeling the need to lie or avoid the truth about drinking habits
• Feeling irritable when you haven’t had a drink for a while
• Losing memories of time frames and events while drinking
• Suddenly struggling work or school performance
• DUIs or arrests related to alcohol
• Continuing to drink despite legal, social, or medical consequences
• A sudden change in mood or personality
• Engaging in risky behavior because of drinking (like getting behind the wheel of a car.)
• Isolation

Stimulants

• Strong, seemingly unbearable cravings for stimulants
• Constantly thinking about stimulant drugs
• Going to great lengths to obtain stimulants
• Isolation from others; strained interpersonal relationships
• Taking the drug in a manner inconsistent with what is prescribed
• Experiencing withdrawal symptoms 24-48 hours after the drug last taken
• Taking stimulants to avoid withdrawal symptoms
• Hiding stimulant use from family, friends, colleagues
• Feeling unable to stop using the drug despite repeated attempts to quit
• Feeling like you can’t function without the drug
• Mixing stimulants with alcohol or other drugs (polysubstance use)
• Using the drug despite the negative consequences that result from doing so, such as job or relationship loss
• Anxiety
• Delusions
• Depression
• Hallucinations
• Paranoia
• Suicidal thoughts

Depressants

• Depression
• Tremors
• Dysphoria
• Loss of appetite
• Difficulty with memory
• Muscle spasms
• Nausea
• Dizziness
• Motor impairment
• Feeling lightheaded
• Sensitivity to sound, touch, and light
• Having sensations of numbness
• Hallucinations
• Smell sensitivity
• Muscle pain
• Mood swings
• Drowsiness

Opioids

• Sudden changes in weight
• Withdrawing from different social activities/obligations
• Mood swings
• Aggression
• Irritability
• Lethargy or fatigue
• Depression
• Changes in social circles
• Insomnia or other changes in sleeping patterns
• Financial difficulties
• Lying and/or stealing
• Nausea or vomiting
• Red eyes
• Pinned pupils
• Sweating
• Cravings for opioids
• Experiencing withdrawal symptoms
• Unable to stop taking opioids even when faced with negative consequences

While many of the symptoms of opioid addiction are the same across the board (most often depression and anxiety are noted among many drug users), it’s important to remember it’s not always the same for everyone. Keeping an eye out for stark changes in demeanor and appearance is a crucial aspect of identifying symptoms of addiction before the situation becomes dire.

The massive increase in overdose deaths in recent years with most substances, time is of the essence when dealing with addiction. Receiving proper addiction treatment in a timely fashion may be the difference between life and death for some people.

Addiction Treatment

Addiction treatment is the only method available for dealing with substance use disorder. Unfortunately, addiction is a chronic and progressive disease. This means that it may continually manifest either consecutively or periodically, and will continue to worsen, never get better, with time. There is no cure for addiction currently available. However, with the advent of modern medicine, many treatment methods have become available.

The most commonly seen method of treatment is through alcohol or drug rehab. This is the process in which clients/patients undergo the full continuum of care in the quest to find lasting sobriety. Addiction therapies implemented during this process may vary, but the overall method of addiction treatment is often the same.

The full continuum of care refers to completing each level of addiction treatment in a stepped curriculum. When clients begin in the higher levels of care and slowly graduate to lower levels of care, they are allowed freedom and gain personal responsibility. This is extremely effective in treating addiction. It allows the appropriate amount of medical/clinical care for the client at their particular stage of treatment.

The full continuum of care has proven effective time and time again by medical and mental health professionals, and it is always recommended to complete all levels of care in order to better increase your likelihood for success in long-term recovery/sobriety.

Medical Detox

The first stage in the full continuum of care is medical detox. At this point, the client will experience withdrawal symptoms from suddenly stopping or greatly decreasing the intake of your drug of choice.

Medical detox is intended to provide medical stabilization and guide the client safely and effectively through the withdrawal process. Every drug has some sort of withdrawal symptoms associated with the cessation of use. However, some are more severe than others.

This is what makes at-home detox so risky. Many drugs like alcohol and benzodiazepines present potentially life-threatening withdrawal symptoms like seizures. Seizures can result in permanent physical injury or in certain cases, death. Attempting to detox on your own with medical intervention can be incredibly hazardous to your physical well-being.

Apart from the actual health risks associated with at-home detox, there is a greatly diminished success rate among those who choose to undertake detox at home. Dealing with withdrawal symptoms can prove to be too much, and relapse is likely despite desperately wanting sobriety.

Another risk factor for at-home detox is the availability of getting whatever substance you’re craving. During withdrawals, the craving for the substance will be at an all-time high. Without being in a protected medical environment, an individual will still maintain access to whatever the source was for your drugs, making relapse not only a possibility but also a likelihood.

At detox, you’ll undergo a full medical assessment by a team of doctors, nurses, and medical support staff. They’ll take into consideration the level of severity of the addiction, what substance(s) were used, and overall physical health and will create a personalized detox plan.

This individualized detox plan will typically use a combination of detox medication or medication-assisted treatment options with different behavioral and addiction therapies. You will also have access to a clinical team of therapists, case managers, and support staff who will start therapy sessions with you which intend to address the underlying causes of addiction.

Your progress throughout medical detox is closely monitored, to ensure your safety, comfort, and the effectiveness of your treatment. Upon completion of detox, you will be fully medically stabilized and ready to undertake the next level of addiction treatment.

Inpatient

Inpatient, or residential treatment, follows medical detox. This level of care requires patients to live onsite at the facility as they undergo intensive addiction therapy for an extended period of time, which may be anywhere from 30 to 90 days in length. Obviously, this will vary on a case-by-case basis, but this level is the one typically equated to “rehab.”

While here, you’ll have a full-time schedule of different addiction treatment methods and therapies. Every facility will feature a different treatment regimen and amenities, so it’s important to look into the drug rehab prior to attending the program.

Addiction has physical and psychological symptoms, and since the physical portion was addressed in medical detox, inpatient is left to sort out the majority of the psychological aspect.

During inpatient or residential treatment, you’ll learn new coping mechanisms, life skills, and different relapse prevention techniques designed to help you maintain your recovery even after you leave inpatient treatment. If you’re in medication-assisted treatment, you’ll undergo different treatment therapies.

The goal is to provide a solid foundation for recovery upon which you can build even after rehab ends. Since recovery is a life-long journey, you’ll need to take active measures to ensure you don’t fall back into old patterns and relapse.

Inpatient or residential treatment hopes to help you work out some of the more severe underlying issues in a sequestered environment away from external triggers. This is a crucial step in the full continuum of care that can be the difference between relapse and recovery.

Outpatient

Outpatient programs are the next phase of the full continuum of addiction treatment care. There are two levels of outpatient that are each important to the further development of your program of recovery. These levels will continue to address any physical and psychological needs you may have as you progress through treatment and should not be overlooked.

Intensive Outpatient

Intensive Outpatient (IOP) is a type of outpatient program that typically follows inpatient or residential. This level of care is different from inpatient in that you will no longer live at the facility while undergoing the program. You will be required to find alternative housing and transportation to and from your therapy sessions throughout your stay in the program.

Many individuals opt for sober living or halfway houses during this time as they provide structured living with strict rules regarding substance use that help provide accountability. Since early recovery is a precarious time, as relapse most commonly occurs within the first few months of sobriety, this can be very useful.

You may also choose to return home, but regardless of housing, you’ll still be required to maintain complete abstinence from drugs and alcohol during your IOP treatment.

The IOP sessions will utilize similar intensive therapy techniques seen in inpatient/residential treatment. IOP sessions will usually occur multiple times per week for several hours at a time, providing substantial clinical support to clients. Clients will also be required to submit to random drug testing to ensure abstinence during your off-hours.

At this stage, you’ll have more freedom and subsequent responsibility. You’ll be required to maintain your course in recovery even while not at IOP. Many people may return to work or family obligations during this stage of treatment, although it’s not required. IOP will usually last for six to eight weeks before moving to the next phase of treatment.

Partial Hospitalization

Partial Hospitalization (PHP) is another level of outpatient care. Very similar to IOP, it requires clients to seek alternative housing and transportation to multiple several-hour long sessions per week.

The primary difference between PHP and IOP is the location at which these therapy sessions occur. PHP will be conducted in a hospital or hospital-like setting. This may be beneficial for clients still in need of ongoing medical care during their treatment.

PHP is structured just like IOP in that consistent attendance is required, as is abstinence. Group and individual intensive therapies will be conducted, providing you or your loved one with ongoing clinical attention.

Aftercare

Once completing your outpatient program, it’s important to understand that your journey in recovery does not end. Recovery is an ongoing, lifelong process, and while that may seem scary and formidable in the beginning, there are awesome aftercare program options available to help keep you on track in recovery.

Many facilities offer what’s known as alumni programs. These programs keep you in touch with the facility even after you complete the program. They will often schedule outings and fun activities and invite past clients to help foster lasting sober relationships between recovering people. It also helps you maintain a point of contact should you ever need help or find yourself struggling with recovery.

Other aftercare options are maintenance programs such as 12-step programs or SMART Recovery. These are separate fellowships that each have their own approach to recovery that can help you access another network of sober support and have a program to follow as you venture through life as a sober person.

Other people still choose to find different sources of aftercare that may include private therapy sessions or groups dedicated to recovering people. Regardless of what your personal choice in aftercare may be, it’s important to find some form of it to continue growing and avoid slipping back into active addiction through relapse. Remember, if you’re not moving forward in recovery, you’re moving backward!

Overdose

An overdose occurs when you take an amount of a psychoactive drug that your body can’t process before it does psychological or physical damage. Overdose typically occurs accidentally when a person believes they can handle a high dose of a drug or don’t realize the size of the dose they are taking. However, some overdoses can be intentional in suicide attempts, particularly ones involving sedatives like barbiturates.

An overdose can cause medical complications, temporary or permanent damage, psychological consequences, and even death.

Overdose is one of the main concerns in the current addiction epidemic. The National Institute on Drug Abuse reports more than 70,000 people died in drug overdoses in 2017. That number has been steadily increasing since 1999 when it was 16,849.

Overdose can be difficult to avoid for people that are caught in a pattern of active addiction.

There are several situations that can lead to a potentially fatal overdose, including the following:

• Relapse after a period of sobriety. As you regularly take a drug, you may start to build up a tolerance to it. To achieve the same effectiveness it had when you first started using, you will need to increase your dose. If you stop using because you’ve decided to get sober, you are in jail, or you go through a medical procedure, your tolerance may diminish. If you relapse by taking the dose you were used to, it might be too high for your body to handle currently, causing an overdose.
• Combining drugs. Combining drugs can be dangerous, especially when recreational drug use is involved. Most common is when people drink while taking prescription drugs. However, it can be done intentionally when users believe it might enhance the positive effects or decrease the negative effects of the experience. The most dangerous recreational drugs to combine are opioids and depressants. This can cause your nervous system to slow down to the point of causing a heart attack or respiratory depression.
• Getting used to weak drugs. Illicit drugs like cocaine and heroin can be unpredictable in their strength and purity. But for many, illicit options are the only drugs they can get to satiate their addiction. However, dealers often cut their supplies with cheaper substances to stretch profits. In some cases, drugs will have inert substances in them that only serve to weaken the drug. If a drug user gets accustomed to a weak version of a drug, they might take a high dose believing that it’s an appropriate dose of that drug. When they get a new supply that’s higher in purity, their normal dose becomes deadly.
• Taking drugs with strong adulterants. Sometimes dealers will use other substances to increase the potency or effects of a drug supply, especially one that’s weaker than normal. They may even use extremely powerful drugs like fentanyl, an opioid that’s about 100 times stronger than morphine. Fentanyl is commonly found in heroin, but it’s also recently been found in stimulants like meth and cocaine.

Withdrawal

Withdrawal is an aspect of addiction and physical dependence. Whenever any substance, whether prescription or illicit, is used and/or abused for a long period of time, the body develops a physical dependence on the substance to function properly. This is true whether it’s merely physical dependence or addiction.

Withdrawal is a series of different symptoms the brain and body undergo as a result of the cessation of substance use. Whenever the substance that was being abused is suddenly removed, the body must go through an adjustment period to return to normalcy and regular functioning. This adjustment period is known as the withdrawal process, and it can be not only uncomfortable but also dangerous.

As mentioned earlier, different substances feature different withdrawal symptoms. Some withdrawals are worse than others. There are also a variety of factors that directly impact the withdrawal experience you or your loved one may encounter.

Things like age, overall physical health, the type of substance used, how long it was used for, the frequency of use, and the average dosage all factor into how the withdrawal process will play out for the individual. This is what makes medical detox decidedly important. Circumventing these symptoms is crucial to find and maintain not only recovery but your physical health too.

Taking control of the withdrawal process is key in setting yourself up for success in recovery.

Relapse

Relapse is sometimes a part of recovery, although it doesn’t have to be. However, if you do, unfortunately, experience a relapse, do not be afraid or blame yourself. Addiction is a chronic disease that is difficult to overcome, but entirely possible.

There are some key tips to help you respond appropriately to relapse should this become a reality two days or two years into recovery:

• Don’t toil in relapse; seek help immediately
• Take a look at what went wrong and correct that behavior in the future
• Undergo more relapse prevention therapy and learn/utilize new coping skills
• Reach out to other recovering people and your support system for help
• Be honest about your relapse and where you’re at in recovery
• If you feel a relapse coming, preemptively take precautionary measures to avoid falling victim to relapse
• Look at relapse as a learning experience rather than a mistake- there’s always an opportunity to grow and learn more

Relapse does not have to be the end of the road for you. Help is always available, and it’s up to you to seek it before falling deeply back into active addiction. The sooner you address a relapse, the better. Recovery is always possible, and finding what works for you can help you reach your end goal: long-term sobriety.