We’ve all heard the terms “alcoholic,” “addiction,” and “addict.” In recent years, there has been a move away from these labels toward more clinical terms like “substance use disorders.” There are good reasons to shift from labels that can be stigmatizing to more neutral terms, but the change can be confusing, too. Some people struggle to understand what a substance use disorder is and if they, or someone they know, may meet the criteria. This blog explores why the labels changed, what that means, and how to make sense of substance use disorder in plain, easy-to-understand language.
Why have addiction labels changed?
The short answer to this question is simply because of stigma. The longer answer is that substance use disorder (abbreviated to SUD) is one of the most stigmatized mental health conditions in the world.
Research shows that the labels we use to describe people with substance use disorders, like “addict,” “substance abuser,” or “junkie,” while empowering to some people in recovery, often convey negative stereotypes that can lead to discrimination.
In particular, researchers found that these labels are associated with stigmatizing views that they are less likely to benefit from treatment and more likely to benefit from punishment. This stigma also views SUD as a moral failure and a lack of willpower. Many medical providers and folks in society at large believe that people with substance use disorder are to blame for substance-related difficulties rather than a brain disorder that impacts their ability to control substance use despite negative consequences.
While I’m not here to police the language people in recovery use, I am pointing to the fact that, when used by providers or outside of the rooms of 12-step meetings, this stigma can prevent people from seeking treatment, and it can impact the quality of care received.
The move towards more person-centered language includes terms like person with a substance use disorder, people who engage in heavy use of a substance (instead of abuser), and returning to use (instead of relapse). You can find out more about labels and language to use at the Recovery Research Institute, which has an Addictionary of person-centered language.
Is getting a diagnosis good or bad?
Whether getting a diagnosis is good or bad is very much a matter of personal perspective. Some people don’t want a diagnosis. They may feel labeled or judged by it, or they may feel that (despite meeting the criteria) it doesn’t really apply to them. But there are reasons why you might benefit from having a diagnosis:
- Self-knowledge: Learning more about ourselves is helpful. When we know the reasons why we’re feeling or behaving in certain ways, we can also get a clearer view of our path forward.
- Insurance: There are treatment programs and medications that insurance will cover … but only if you have the necessary diagnosis.
- Protection from discrimination: The Americans With Disabilities Act (ADA) offers some protection from discrimination for those of us with substance use disorder. If you need to rely on this protection, it may support your case to have an official diagnosis. Note that the ADA does not protect us from the consequences of using illicit substances nor from misconduct caused by substance use.
What are the diagnostic criteria for substance use disorders?
“Substance use disorder” is the umbrella term to describe what you may know as addiction. The diagnostic criteria are the list of symptoms that, taken together, may reach the threshold for substance use disorder. As you look at the list below, you’ll see that the diagnostic criteria are mostly about how your substance use is affecting you. SUD occurs on a spectrum from mild (two to three symptoms), moderate (four to five symptoms), and severe (six or more symptoms).
When considering your drug use, including alcohol, over the last 12 months:
- Have you taken more of the substance, or for longer periods, than you intended? For example, intending to go out for one drink but drank the whole bottle of wine.
- Did you try to cut down your substance use, but couldn’t? For example, did you promise not to use cannabis during the week, but were only able to refrain for one night?
- Do you spend a lot of time taking drugs, drinking, or recovering from using them?
- Do you experience intense cravings or urges to use the substance?
- Does your drug or alcohol use impact your ability to meet your responsibilities, like going to work or taking your kids to school?
- Do you continue to use substances despite them causing problems in your life or relationships?
- Have you given up other hobbies or interests you once found enjoyable to use substances instead?
- Has your substance use led to risky behavior, like driving while under the influence?
- Have you continued to use substances despite their adverse effects on your physical and mental health?
- Do you need to take more of the substance to have the same effect? Like needing to take three pills to get the same high as you used to get with just one?
- Do you experience withdrawal symptoms, like shaking, nausea, sweating, or feeling anxious if you stop taking the substance? Do those symptoms go away when you retake the substance?
Notes
This list is a summary of diagnostic criteria contained within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is called the DSM-5 for short. When providers make a diagnosis, they will specify which substance is under consideration. For example, “alcohol use disorder,” “opioid use disorder,” or “stimulant use disorder” (amphetamines).
If you think you may have a substance use disorder, it’s important to seek support from a trained mental health professional. They can make a diagnosis and inform you of treatment options and additional resources.