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Disease Characteristics of Substance Use Disorders

Max Liles, Senior Director, The Counseling Center

After visiting the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AKA the DSM5, we start to get a clearer picture about what it means to have a substance use disorder.

Rather than using certain drugs; or certain means of consumption; or a certain number of days a week; or whatever my own definition of “having a problem” is – the DSM breaks it all down fairly simply.

11 criteria – symptoms of the disease.

While these 11 criteria are a good place to get started, I am of the firm belief that most folks who experience substance use disorders also have a tinge of some other personality related stuff that is going on.

Alcoholics Anonymous would tell us, “Selfishness and self-centeredness! That, we think, is the root of our trouble.”

Narcotics Anonymous diagnosis of the addict is of the person trying to live up to the “terminally hip and fatally cool” portrayal.

…and of course, the DSM5 has an entire subsection of personality disorders that we can diagnose ourselves with if we read over them enough (my MSW grads and students know what I am talking about).

There has been much work done to streamline and refine what diagnosis are included in the DSM; how those diagnosis are derived; and what all is included within the informational sections about various disorders, other than the criteria themselves, to pack as much information as possible into the literature the field uses to guide diagnosing. With that being said, I think there are some specific notes that should be taken about substance use disorders.

DISEASE CHARACTERISTICS

**PRIMARY**
Often, people will look for the cause of a person’s excessive drinking or using – “He’s going through a lot right now.”

Sometimes, people will use their circumstances to justify their excessive drinking or using – “If you had my life, you’d drink, too!” (and you would).

Rather – substance use disorders are not inherently caused by anything else; that’s what PRIMARY means.

Can people be predisposed to the development of an SUD based on heredity? Yes.
Can people behave in their drinking and using that develops an SUD? Absolutely.
Can a person’s environment contribute to the likelihood of developing an SUD? Sure.

But with all that being said, that’s all it takes: a person and the substance. Nothing has to “cause” the disorder – it can present by itself.

**PROGRESSIVE**
Flo will not be doing a car insurance commercial, although I am plugged in the Sherman-Kricker (shop local).

SUD’s themselves get worse – especially without treatment interventions… ESPECIALLY if a person is continuing to use it.

If someone has an assessment at the age of 24 and is diagnosed with a moderate substance use disorder (meeting 4-5 criteria), and doesn’t engage in a recommended treatment program, it is likely that they are going to present later in their lives for another assessment where they will be diagnosed as a severe substance use disorder case (meeting 6 or more criteria).

What PROGRESSIVE means is, the disease gets worse.
Point blank, people don’t use forever: they either get clean or they die.

**CHRONIC**
And not the beloved Dr. Dre Album (1992 or 2001), nor are we talking high-grade devils lettuce.

CHRONIC means that a condition is persistent; permanent; long-lasting. It’s not going anywhere.

This is why long term treatment, at appropriate levels of structure and dosage are important. As a general rule of thumb, the longer a person can stay connected to suitable treatment based on their assessed needs the more likely they are to get into and remain in sustained remission of their SUD. My rule of thumb is 1 year (AKA Max Liles 1 Year plan for your life), give or take 3 to 6 months either way based on the severity of the case.
Treatment works. We do recover.

**FATAL**
This is the most dangerous characteristic of a substance use disorder, and we’ve already touched on it – BUT to REALLY drive this point home… it can kill you.

Harm Reduction Ohio cities that drug overdose deaths have surpassed over 3,000 since 2015. That number jumped to over 4,000 in 2016, 2017, and 2019. That is terrifying.

If you are a person that actively uses, PLEASE don’t use alone and get a hold of some Narcan. If you don’t know how to get a hold of it – reach out to The Counseling Center.

**TREATABLE**
If #4 totally wigged you out – we’ve got some good news…

You don’t have to die in the perils of active addiction. Help is available and we want to be one of the connecting pieces to you getting your life back. Treatment is more accessible than ever before: through service improvements and growth within our own agency and the surrounding area; by way of Medicaid Expansion (Thanks Obama); with increased community collaborations and partnerships.

If you or someone you love is struggling, please reach out to us at 740.354.6685. We’re waiting on you.

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