Inside a Substance Disorder—the Mechanics of the Illness
A Substance Disorder is an illness—what we commonly call substance abuse or addiction. It is diagnosable by a standard list of symptoms medically, and its ‘remission’, or recovery from it, is diagnosed by the absence of those symptoms. A Substance Disorder (or more accurately, a Substance Use Disorder) can be mild, moderate or severe. That is determined by how many of 11 possible symptoms are present.
More and Longer Than Intended…
The first medical symptom listed in the Diagnostic and Statistical Manual of Mental Disorders—the standard for diagnostics–is taking the substance in larger amounts or for longer than you intend to when you begin using. This can happen in one episode of use such as an evening when you intend to have 2 drinks but have more than 2 drinks, or even binge severely.
This is a symptom that indicates loss of control and is characterized by losing control once the substance is ingested. This happens in several ways. On a biological level, the body is triggered to want more, for example, if an addictive illness is already activated. Psychologically, the defenses are lowered by the substance, and one decides that if one or two feel good, more would be better.
Can’t Stop Myself Even When I Want To…
The second symptom of a Substance Disorder listed in the diagnostic criteria is the desire to cut down or stop using the substance, but not managing to do so. This is a confusing and complex symptom, and many onlookers don’t understand that the addicted person may want to stop, but can’t. Often, the issue seems like one of little willpower or onlookers believe the addicted person is happily continuing to use.
The inability to follow through on a desire to stop use demonstrates the biological power of addictive substances. Once the body (and brain, of course) become used to having the substance, willpower is not enough, and use is not always fun. This is what we can call compulsion or compulsive substance use. One has an overwhelming urge to use even when not wanting to.
Preoccupation and Involvement…
Another symptom of a Substance Disorder is that one becomes preoccupied with using and spends time getting, using, or recovering from use of the substance. In short, substance use begins to move into more prominence in one’s life. And, this steadily increases as one uses over a longer period.
Eventually, the substance and its use take center stage in one’s life, becoming the one constant, no matter what else occurs in life. And, as use progresses, eventually the substance will somehow be related to any realm of life.
Overwhelming Urges to Use…
Substance Disorders are typically characterized by cravings for the substance. We use mind and mood-altering substances for their enjoyable effects and we have what is known as euphoric recall. Euphoric recall involves remembering only the good things about substance use. We selectively remember the euphoria and forget the negative parts of the experience such as hangovers or embarrassing ourselves.
Remembering the good feelings psychologically makes us want more. It is natural to be drawn toward the things we think of as positive and rewarding. Also, once an addictive process is activated, the brain wants more without any of the psychology involved. It has become used to living with the substance and feels odd without it.
Responsibilities and Performance Decline…
Another symptom of an addiction is that one’s daily life tasks slip into unmanageability. It is characteristic of an addiction that your responsibilities and performance of them become less important, and you decline in your performance of usual and necessary tasks. This can be at work, home or in school. And, as the use continues, the unmanageability becomes more evident. It is common, for example, for work performance to decline noticeably and for grades to fall.
A Substance Disorder eventually can take a serious toll on relationships. They become stressed, estranged, and even damaged beyond repair, but loved ones always suffer as your addiction becomes more prominent in your life. You cannot be authentically present when intoxicated or recovering from intoxication and others feel the increased distance and emotional unavailability. Also, commitments, promises, and responsibilities can’t be consistently managed, and this causes hurt, resentment, anger and conflict.
Giving Up More and More…
You will notice that more and more of life is given up as substance use continues, and this symptom summarizes that dynamic well. It is the symptom of giving up important social, occupational, or recreational activities because of substance use.
If you can imagine that an addiction wants to be the end all, be all in someone’s life, and continues toward that goal, then this dynamic makes perfect sense. Eventually, all life activities give way to the addiction, and one gives up large chunks of life to continue to use.
Despite Danger and Risk…
Another symptom of addiction is that use continues even when there is danger or risk in using. This is evidence of overwhelming urges, but also is often evidence of denial. One simply doesn’t perceive the risks and dangers when denial is strong enough. Everything seems fine.
This is also one of the most maddening symptoms for loved ones to observe. They seem the obvious risks and dangers and don’t understand why their addicted loved one doesn’t take heed. It may very well be that the addict also sees the risks and dangers, but that compulsion has overtaken them. Such dangers and risks can
include a wide range, such as driving under the influence, associating with dangerous people, going into unsafe situations, having unprotected sex, etc.
Despite Apparent Problems…
The next symptom is continuing to use despite knowing there is a psychological or physical problem caused or made worse by using. This clearly says that even when we are aware substance use causes health problems, we feel compelled to continue to use. Many people with this symptom are highly conflicted and feel helpless and hopeless to do anything to improve their situations. Some even decide that no one else can help them either because they feel so locked into self-destructive and compulsive behavior.
When the Body and Brain Want More…
A Substance Disorder is characterized by the building of a greater tolerance for the substance over time. As the brain and body adjust to an addictive substance, one typically needs to increase the dosage to get the desired effect.
When the Body and Brain Object…
Withdrawal symptoms are the body and brain’s loud objection to a lowered dose or discontinued use. Distress signals go out to say more of the addictive substance is needed for all to return to status quo. Of course, status quo may be a seriously addicted state. However, once a level of addiction is established, it is the ‘normal’ and any less substance use will feel uncomfortable, even distressful.
Assessing the Severity of a Substance Disorder
When the standard medical criteria given above is used, the severity of the Substance Use Disorder is determined by how many of those symptoms are present in a 12-month period. If 2-3 symptoms have occurred, the disorder is considered mild. If 4-5 have occurred, it is a moderate condition, and if 6 or more have been present, it is considered severe.
Typically, an addictive illness runs a course. There are fewer symptoms early on, and more as time progresses. Consequently, without abstinence, a Substance Disorder can be expected to run its course from mild to moderate, and eventually to severe.
Remission of a Substance Use Disorder
Many consider an addictive illness to never be cured, although that is changing, and some now believe that will can cure our addictions. More generally, the view is that an addictive illness can go into remission., and the symptoms disappear. It is also commonly thought that complete abstinence from substance use is needed for remission.
Consequently, withdrawal and detox are thought to be the first steps in putting an addictive illness into remission. After that process is completed, sustaining abstinence—gathering more sober time—is key. And, because the compulsion to use is so strong, it is most beneficial to seek professional help to withdraw and detox. It is also the most judicious plan because many need supervision and support when in withdrawal in order to be safe and comfortable enough to complete this first significant phase of treatment.
If You Have a Substance Disorder, or Your Loved One Does…
If you or a loved one have a Substance Use Disorder, help is available. As you know, willpower and desire are not always enough to correct the problem. You have to stop the use of addictive substances to begin healing, and if you are like most of us, you need help to stop.
A treatment program can provide you the support, monitoring, and guidance you need to safely navigate withdrawal and detox. A program also surrounds you with the time and space to focus on regaining your physical and mental health. Addiction’s effects are pervasive and it takes time, trained professionals and support to prepare you for a sober life. Not only do you need time to be physically better, but you also need to process emotions related to your illness, and to learn healthier coping strategies.
The best relapse prevention plan is a holistic one, and with the help of trained professionals in a structured rehab program, you can address all the pertinent areas of concern. You can also learn and rehearse the skills you will need when you leave rehab. If you are sick and tired of being sick and tired, perhaps it is your time. Reach out to us for a free consultation. We will help you clarify your needs and make appropriate recommendations.