Substance Abuse

“Understanding Addiction”

A commonly held definition of alcoholism is an inability to say no to that second drink. What most people fail to acknowledge is that addiction is not a moral failing, but a recognised and diagnosable disease. We are dealing not with bad people trying to become good people, but sick people who wish to get well.

Addiction is not a diagnostic or clinical term in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Rather, diagnoses fall under either “substance abuse” or “substance dependence”. Many would argue that the criteria listed in the DSM are not difficult to meet. This is for the simple reason that today, substance use in its various forms is normalised by society, leading to social down-playing of the magnitude of this problem.

The DSM lists the following criteria for substance dependence:

  • Tolerance (marked increase in the amount of the substance taken, as well as a marked decrease in the substance’s effect).
  • Characteristic Withdrawal Symptoms, with the substance being taken to relieve or avoid these negative effects.
  • Persistent desire or repeated unsuccessful attempts to quit
  • Much time and activity dedicated to obtaining, using and recovering
  • Important social, occupational or recreational activities reduced or given up altogether
  • Use continues despite knowledge of adverse consequences (use when physically hazardous, failure to fulfil role obligations, etc.)

A workable definition of addiction can be described as follows:

A pathological relationship with a substance which becomes the primary relationship in the person’s life. This understanding of addiction can be extended beyond substances and can therefore also include relationships with food, shopping, pornography or gambling. The relationship is indicated by the individual defining the parameters of their relationship, and attempts to control amounts or frequency (“I only use on weekends” and other similar excuses).