Am I addicted?

It can be difficult for someone else to answer that question for you, and if you are actively using, it can be hard for you to answer that question for yourself, but it is important that you do so.

The problem with easy answers is that we're all different. What is true for other people may not be true for you.

Perhaps someone else has expressed their concerns to you, or maybe you've realized that things aren't going the way you'd like them to go, and you've made a connection to drugs or alcohol. You might be trying to decide for yourself whether you are addicted, somewhat addicted, or not addicted at all, or maybe you're worried that you might be moving in the direction of becoming addicted.

While it might be true that some people are born with an inclination or natural tendency to become addicted to drugs or alcohol, they are not generally born addicted. That happens over time, and by degrees, that will differ from one person to another.

Maybe you don't believe that you're addicted yet, but you'd like to stop or at least cut back, but hasn't happened. Probably, you'd like to keep things from getting worse.

There are several tests, or questions that you can ask yourself that might shed more light on the larger question of whether you are addicted.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, more commonly known as DSM-5, lists eleven criteria for addiction:
  1. Taking the substance in larger amounts or for longer than you're meant to;
  2. Wanting to cut down or stop using the substance but not managing to;
  3. Spending a lot of time getting, using, or recovering from use of the substance;
  4. Experiencing cravings and urges to use the substance;
  5. Not managing to do what you should at work, home, or school because of substance use;
  6. Continuing to use the substance, even when it causes problems in relationships;
  7. Giving up important social, occupational, or recreational activities because of substance use;
  8. Using substances again and again, even when it puts you in danger;
  9. Continuing to use the substance, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance;
  10. Needing more of the substance to get the effect you want (tolerance); and
  11. Developing withdrawal symptoms, which can be relieved by taking more of the substance.

The DSM-5 criteria are not yes or no questions, as they are intended to help a professional determine the seriousness
of a patient's misuse of a substance. However, you can easily use them as a way of self-determining the nature of your own problem, although they were not specifically designed for that. How many of the criteria fit?

Misuse disorders can range from mild, to moderate, to severe, depending on how many criteria are met.
  • 2-3: Mild
  • 4-5: Moderate
  • 6-11: Severe

If six or more of these criteria apply to you, you have a more serious problem than if only three of them had applied, and you will have to take a more aggressive approach to resolving the problem.

Keep in mind, also, that addiction is generally progressive. Someone who fits into the moderate classification today isn't necessarily going to remain there.

The International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), is used by some therapists in lieu of the DSM-5. It uses six criteria:
  1. You have a strong desire or sense of compulsion to take the substance.
  2. You have a difficult time controlling your consumption.
  3. You have withdrawal symptoms.
  4. You need to take more to get the same effect.
  5. You tend to stop doing other pleasurable activities.
  6. You persist even though it is clear that your use is harming you, your overall mood, your ability to think straight, and your relationships and work.

Using the ICD-10, if you answered yes to three or more of these criteria, you may be diagnosed as dependent on a substance.

Neither the DSM-5 or the ICD-10 consider that fact that addictive behaviors change the way you feel, and that you like that. If you didn't like the way that the substance made you feel, you wouldn't have used it a second time.

Narcotics Anonymous (NA) has a list of twenty-nine questions, written by recovering addicts, to be considered when considering the possibility that you are addicted. The NA checklist is as follows:
  1. Do you ever use alone?
  2. Have you ever substituted one drug for another, thinking that one particular drug was the problem?
  3. Have you ever manipulated or lied to a doctor to obtain prescription drugs?
  4. Have you ever stolen drugs or stolen to obtain drugs?
  5. Do you regularly use a drug when you wake up or when you go to bed?
  6. Have you ever taken one drug to overcome the effects of another?
  7. Do you avoid people or places that do not approve of you using drugs?
  8. Have you ever used a drug without knowing what it was or what it would do to you?
  9. Has your job or school performance ever suffered from the effects of your drug use?
  10. Have you ever been arrested as a result of using drugs?
  11. Have you ever lied about what or how much you use?
  12. Do you put the purchase of drugs ahead of your financial responsibilities?
  13. Have you ever tried to stop or control your using?
  14. Have you ever been in a jail, hospital, or drug rehabilitation center because of your using?
  15. Does using interfere with your sleeping or eating?
  16. Does the thought of running out of drugs terrify you?
  17. Do you feel it is impossible for you to live without drugs?
  18. Do you ever question your own sanity?
  19. Is your drug use making life at home unhappy?
  20. Have you ever thought you couldn't fit in or have a good time without drugs?
  21. Have you ever felt defensive, guilty, or ashamed about your using?
  22. Do you think a lot about drugs?
  23. Have you had irrational or indefinable fears?
  24. Has using affected your sexual relationships?
  25. Have you ever taken drugs you didn't prefer?
  26. Have you ever used drugs because of emotional pain or stress?
  27. Have you ever overdosed on any drugs?
  28. Do you continue to use despite negative consequences?
  29. Do you think you might have a drug problem?

Are you addicted? While mental health professionals may diagnose, this is a question that you may have to answer for yourself.

Unlike the others, the NA list of questions doesn't require math, as they believe that the actual number of "yes" responses isn't as important as how you felt inside, or how your misuse has affected your life. Some of the NA questions don't even mention drugs because addiction affects all areas of life, even those that don't seem to have a direct connection with drugs.

If you are addicted, you must first admit that you have a problem, and the NA questions are intended to help you realize how your misuse of substances has made your life unmanageable.

In his book, Am I Addicted?, by F. Michler Bishop, Ph.D., another set of criteria are posed:
  1. Addictive behaviors change the way you feel.
  2. They significantly alter your state of consciousness.
  3. You like the results (consequences) in the short run.
  4. You do not like the results (consequences) in the long run.
  5. You are ambivalent about changing.
  6. The behavior is very difficult to change.

These criteria are different from those used in the two major diagnostic manuals that therapists use (DSM-5 and ICD-10), largely because these criteria are intended to be used for self-evaluation, whereas the DSM-5 and the ICD-10 are intended for the use of therapists.

While you're considering whether or not you might be addicted, keep in mind that addiction is not merely a bad habit. In comparison, habits (even bad ones) can be changed fairly easily.

Addiction is a more serious problem, more so for some than for others. The severity of the problem depends on a number of variables, such as the substance that you're addicted to, the length of time that you have been using the substance, the amount of it that you're taking, and a host of individual considerations, many of which have been covered in other posts in this blog.

Not all of the professionals agree, but the National Institute on Drug Abuse defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

Whether you agree that addiction is a disease or not, the problems and solutions are the same.

Addiction can affect relationships, jobs, and health. All too often, it leads to death.

The signs of addiction, according to the National Council on Alcoholism and Drug Dependence, are:
  • A loss of control.
  • Abandoning hobbies and activities.
  • Poor performance at school or work.
  • Unexplained financial problems.

The stages of addiction are:
  • First use: The first step in addiction is trying the substance, which can be as easy as taking your first drink. You may have even used drugs in the past without developing a dependency, but now you have moved on to a more addictive substance.
  • Regular use: When you become a regular user, you begin to display a pattern. You might use only on weekends, or perhaps just at night. The signs of addiction are displayed as the substance becomes more important in your life.
  • Risky use: As use continues, you might begin to exhibit dangerous behavior. This might involve driving while under the influence or frequenting dangerous places while seeking the substance. At this point, there may be a deterioration in relationships.
  • Dependence: At this point, you have developed a tolerance to the substance, and have found that you need to use more of it in order to feel good. Going without the substance for a period of time may bring about withdrawal symptoms. Cravings for the substance may be intense.
  • Substance use disorder: At this point, you can no longer function in daily life without using. This is also the point where your job security may be adversely affected, or you may drop out of school. Homelessness is also a possibility. Despite these negative consequences, you will continue to abuse the substance until you begin the path to recovery.

The earlier you start on this path, the better. While many people have to hit rock bottom before they can accept that they are addicted, recovery doesn't require this. You don't have to wait until you have lost your job, your family, and your home, although help is available to you if you have. Addiction doesn't have to be the end of your dreams.

Some people are able to quit on their own, but most will do better if they avail themselves of the help that is available to them. As you are considering taking that path to recovery, Pir2Peer Recovery Center is a good place to get directions and help.