What Is Addiction?

A clinician explains what it means to actually have a substance use disorder.

Posted Feb 18, 2020

Maks Golikov/Shutterstock
Source: Maks Golikov/Shutterstock

Either you or someone you know has been touched by addiction at some point. In fact, recent estimates suggest that nearly 30% of individuals will report an alcohol use disorder at some point in their life and nearly 14% will report having an alcohol use disorder in the past year (Grant et al., 2015).

Estimates are less for other drugs with an estimated nearly 10% reporting a drug use disorder at some point in their life and approximately 4% in the past year (Grant et al., 2016). 

Despite these staggering statistics, many are uncertain of what actually makes up an addiction clinically speaking. This article is intended for those who have friends or family struggling with addiction and are not sure whether they have an addiction. Or, perhaps it is for the person reading this, as people may have told you that you have a “problem” and wonder whether that is true. 

First of all, let’s define the word “addiction.” Addiction is a more colloquial term used to describe what clinicians diagnose as a substance use disorder.  A substance use disorder can be more specifically broken down into an Alcohol Use Disorder, Stimulant Use Disorder, Cannabis Use Disorders, Opioid Use Disorder, etc.  

Regardless of the specific use disorder that one has, there are eleven areas that a clinician examines to determine the presence/absence as well as the severity of the use disorder. When an individual endorses experiencing 2-3 of the symptoms, we call that a “mild” substance use disorder. The presence of four to five symptoms is a “moderate” substance use disorder and six or more symptoms is a “severe” substance use disorder.

So what are these 11 criteria? Examine the following questions:

  1. Do you take the substance in larger amounts or for longer than you're meant to?
  2. Have you tried to cut down or stop using the substance but have not managed to do it?
  3. Do you spend a lot of time getting, using, or recovering from use of the substance?
  4. Do you have cravings and urges to use the substance?
  5. Do you not manage to do what you should at work, home, or school because of substance use?
  6. Do you continue to use, even when it causes problems in relationships?
  7. Have you given up important social, occupational, or recreational activities because of substance use?
  8. Do you use substances again and again, even when it puts you in danger?
  9. Do you continue to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance?
  10. Have you needed more of the substance to get the effect you want (tolerance)?
  11. Have you developed withdrawal symptoms when you have stopped taking the substance, which can be relieved by taking more of the substance?

I list the diagnostic criteria and questions as guides for your own thinking and not as ways to pressure your loved one into telling them that they have an “addiction” for X, Y, or Z reasons. It is always recommended to consult with a psychologist or mental health professional about these areas. 

Whether you have found yourself down the rabbit hole of a substance or whether you know someone who has, it is undoubtedly a difficult place to be for all parties involved. From the perspective of the person with the substance use disorder, they can often recognize their current life as just a shadow of what it used to be and things just being “different.” From the perspective of the loved one, the person recognizes the difference and wants to help but either is not sure how or feels powerless in their efforts. 

As I mentioned, it is always important to consult a mental health professional if you are struggling or know of someone struggling with a substance. Additionally, there are always AA/CA/NA meetings as well as al-anon for those who are looking for ways to deal with your loved one who may have a problem. I recognize that abstinence may not always be the most immediate, practical solution for some, so it is important to search for harm reduction programs in your community. By starting from any of the places mentioned above or some unique options in your own community, you can begin to put yourself on the journey towards recovery. 

Dr. Rubin Khoddam is a Clinical Psychologist currently working in private practice in Los Angeles, CA as well as at the West Los Angeles VA as the Team Lead in the residential rehabilitation program for individuals dealing with issues related to substance use and homelessness. Dr. Khoddam currently provides individual, couples and family therapy, as well as group therapy. He also runs the IMPROVE: Outpatient Substance Use Treatment Program, a low-demand, harm reduction substance use treatment program for individuals hoping to decrease their substance use or examine the impact of their substance use in their life. For more information, visit his site and follow him on Facebook, Instagram, and Twitter