Substance Abuse Disorder or Who Me? A Junkie?

Posted by in Louise Behiel, mental health | 44 comments

In the thirties, when the founders of Alcoholics Anonymous concluded that alcoholism was a disease, people were outraged. Everyone knew it was a moral weakness and nothing more. How times have changed.

Today Substance Abuse Disorder is considered a mental illness. The DSM-V defines it as “A maladaptive pattern of substance use leading to clinically significant impairment or distress”.

To put it into simpler language: Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain – they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.

According to the DSM –V, to be diagnosed, a person must have at least two of the following symptoms:

  1.  Recurring substance abuse which interferes with work, social or family life and play.
  2. Using in situations which are physically hazardous (e.g. Drunk driving)
  3. Continued use in spite of problems made worse by using.
  4. Increased tolerance: i.e. it takes a lot more of the stuff to get high.
  5. Withdrawal: lack of use causes pain and discomfort.
  6. Heavier use than intended.
  7. Persistent desire and unsuccessful attempts to cut down or moderate usage
  8. Much time and effort is put into securing the substance, using and recovering from it.
  9. Important personal activities and goals are given up or reduced for substance use.
  10. Substance use is continued in spite of knowledge of its detrimental effects.
  11. Craving for the substance is present.


Causes of Substance Abuse Disorder As with so many issues manifesting in the brain, there is little hard evidence about the causes of this disorder. Two people coming from the same gene pool and with the same early family life will often end up with vastly different results (see earlier posts on family roles). But that doesn’t change certain facts:

Alcoholics and drug addicts are more likely to have an addicted parent.

Greater likelihood to have grown up in emotionally barren families

Lack of parental attachment

Socialization factors in early life may also be considered:

• Extremely shy or aggressive classroom behaviour

• Poor coping skills

• Poor school performance

• Isolated from peers or association with an inappropriate peer group

• Perception that drug-use behaviour is acceptable.

What is the difference between a bad habit and an addiction? The primary difference between these two is the matter of choice. People choose a habit, but addicts have lost the freedom to choose whether or not to use. This is probably the hardest element for others to understand: the addict does not have a choice. The chemical of choice becomes as necessary as breathing. From the outside we can see the destructiveness of the individual’s choices, but as with all mental illnesses, the patient lacks the insight to see their own behaviour and its outcomes in the way that the rest of the world sees it. So if something critical comes along, a person can give up a bad habit, but that’s not as likely with an addiction. In spite of all his/her best intentions, the addict is unable to quit on their own.

Common addictive substances include:

• Alcohol

• Amphetamines

• Caffeine

Courtesy of Catie Rhodes, via wana commons on flick

• Cannabis• cocaine

• hallucinogens

• inhalants

• nicotine

• opioids

• phencyclidine (PCP)

• sedative-, hypnotic-, or anxiolytics

We can become addicted to almost anything. Prescription medications are one of the fastest growing categories of drug addiction. This feeds another fast growing abuse of drugs by teenagers who steal their parents prescribed medications and combine them with other pills and/or booze to create a high. Unfortunately, such combinations are often lethal and the kids don’t know enough to tell the difference between a friend who’s high and one who’s dying.

All of the above named chemicals pass through the blood/brain barrier and impact the structure and functioning of the brain. When we abuse our gray matter over periods of time, we risk our very survival. Babies are often born drug addicted. And many are born with Fetal Alcohol Spectrum Disorder, which includes low birth weight and decreased muscle tone, as well as delayed development in the major areas of thinking, speech, movement and/or social skills.

Outside of the DSM, gambling, internet, sexual activities and a variety of other actions are also recognized as addicting. And recently, food has also been added to the list of addictive chemicals. (This is my substance of choice. I’m grateful to have been abstinent from sugar and between-meal snacking for almost thirty-two years, but that’s a post for another day.)

Addiction is a difficult medical problem, for people with this disorder often aren’t aware enough (or honest enough) to admit to what they’re doing and how much they’re using. But in the meantime, they’re tearing apart families, ruining their reputations and behaving in ways that shorten their life. If a person comes to me as a client wondering if a loved one has an addiction, I usually tell them to guess at how much that person is using and then double it and double it again. Remember, addicts are very good at pulling the wool over the eyes of their loved ones.

As with every mental illness, the symptoms are behavioral. Families need to remember they didn’t cause it, they can’t control it and they can’t cure it. But they don’t need to enable the disease either.

Details, fact checking and lots of great information can be found at these sites:



  1. I appologize. My struggle with distraction has been going on like forever. For a long time I was not even diagnosed and now im just strarting to find out how I can manage my symptoms. On a good day I just suffer from lack of concentration, but if I havent had enough support I can easily start to get really irritable and even depressed. Most of the time I just feel unfocused.
    My workmate says im better now compared with last year, but i put that down to therapy. Alcohol will rip appart any chance of succes in your path. If you dont quit you will see the consequenses to physical and mental health. My self control depends a lot on knowing that the care for my pet is making the right impression.

    • totally agree. nothing outside of us is a solution for the long haul.

      good luck

  2. Best advice I’ve ever heard on addiction: “As with every mental illness, the symptoms are behavioral. Families need to remember they didn’t cause it, they can’t control it and they can’t cure it. But they don’t need to enable the disease either.”

    Thanks Louise. 🙂

    • thx Kourtney. I appreciate you stopping by

  3. It was fun reading you and Heidi’s posts today. A nice dose of “know yourself”. Good pragmatics and facts. Love xoxox

    • thanks…glad you enjoyed. I really need to post again. i’m very lazy about blogging right now

  4. What if the person just decided that they couldn’t cope with something in their life and wanted something to just “make it all go away”? And then they became addicted because they didn’t want the feeling of it all going away to stop? Does their lying and being dishonest and destroying their own life, while telling everyone else they’ve stopped using, still count as an actual addiction? Or not, because its their choice to keep taking? He stopped at one point and was clean but decided he didn’t like being clean. Withdrawals were over and everything. I’m curious, because it has nothing to do with his gene pool…

    • Yes, it still counts as an actual addiction. A person without an addiction would not risk their lives/health/relationships to ‘make it all go away’. People without an addiction cope with life on life’s terms. We don’t try to make it go away. Yes, it’s uncomfortable and painful and sometimes downright ugly but it’s life.

      In the addiction world, this is called a ‘self-justified return to using’, and it’s common. The user knows he has to come up with a reason to justify his choice and he does (or she does). That doesn’t make it less of an addiction.
      If this person were taking arsenic, a little bit a day, just because he wanted to, we’d know there was a mental illness present. Sane people do not ingest a toxic chemical because they don’t like life. They get help to deal with life. For an addict, the toxic chemical is the addictive substance.
      Additionally, addiction never goes away. We know that once you’ve crossed that line, you can never safely use again, because after the first ‘hit’ or two, all the addiction responses in the mind and body are awakened. Usually the slide to hell is faster the second time and much harder to climb out from. I know people who have quit three, four five times and gone back. Once an addict, always an addict. It is the great lie that tells us ‘this time’ we can use the chemical to manage our feelings and our world without getting into the trouble it causes. Many people follow it to the gates of insanity and death.
      My friend’s husband had quit numerous times. But he always went back. He ended up in full blown cirrhosis and still he drank. His excuse was the pain was so awful he needed booze to kill it. He died shortly afterward.
      It’s tragic how far addicts will go to ensure they get their stuff, even though it’s killing them. So a justified return to using is still addiction. things will get worse quicker this time. It’s very sad.

  5. Very well laid out explanation. Thanks Louise for another informative post.

  6. Louise, this post likely touched everyone who has read it. So many people abuse one substance or another. I have wondered if part of the reason for addition is our modern lifestyle. In the past, there weren’t as many choices of things to be addicted to and there was plenty of physical work to do in order to survive. I know there were addictions to drugs and alcohol in the past, but it seems like fewer people had problems. Do you think that’s true or am I guilty of “the past is greener” type of thinking?

  7. Sugar free for 32 years? I am waiting for that post, Louise! Good on you for taking care of your body. I always try to read your posts as it might pertain to a character in a novel, but end up thinking of someone I know. I have to say, the information here was very enlightening. I’ve always thought the addiction was something akin to a choice, but that’s not the case at all. Makes me a little more sympathetic to a hard-core alcoholic I know. It still hurts to see this person destroying their life.
    Tameri Etherton recently posted..Giving A Little Love to the Romantic SuspenseMy Profile

    • Tameri, it is very hard to see the people we love killing themselves with alcohol or other substances. It looks like a choice but it isn’t…not really. I’m glad you’re learning something here. that’s always good.

  8. While he was getting his bachelor’s degree in Criminal Justice, my husband read a really interesting study about the connection between substance abuse in member of the military returning from combat deployment and the constant stress-high they’re on while they’re overseas. Apparently, alcohol connects with the same receptors in their brains as was filled by their constant need for hyper-alertness. It’s their way of dealing with the withdrawal they feel from chemicals their bodies were naturally generating. Many of them become alcoholics because they never learn to deal with life back in North America. It was very enlightening because my husband hadn’t been a drinker before he went, didn’t drink much while on deployment, but started drinking WAY more than he should when he returned. He, thankfully, was lucky and got a handle on it. He’s never had a problem with drinking since.
    Marcy Kennedy recently posted..What Lord of the Rings Character Are You?My Profile

    • You and he, are very lucky he got control of it. And yes, alcohol abuse is a very common outcome of military service. But it is also common with people who have PTSD, and those are so very often returning service men. He’s so bright – very few people can see their behavior with the detachment needed to get and stay well. Well done. and thanks for sharing.

  9. I always think of drugs and alcohol as inducing an addiction. Very enlightening post Louise!

    • Susie, so many things trigger the pleasure centers in the brain and if we overdo, we’re in trouble.

  10. A wonderfully informative post, Louise. Thanks so much for always sharing your vast knowledge on these sensitive topics.

    • thanks for stopping by Sheila. be well

  11. Can you be addicted to good things? Or is that called healthy living? Or is there a fine line between being healthy and being addicted?
    Joan Leacott recently posted..Shots in the LanewayMy Profile

    • Research on this topic is just starting. But for example, there is pretty clear proof that exercise can be addictive. we create ‘feel good’ chemicals when we work out and people get hooked. It’s often in combination with bulimia but it is as addictive as anything. Ironically (and typically of addicts) if an exercise addict cuts back, they feel crummy. they can’t handle the ‘stress’ of living and they’re grumpy. To them, it’s because they’re not burning off their stress, but to a professional it’s because they’re not getting their ‘fix’. ditto for food – especially sugar, grains and fats. So yes, I think we can become addicted to good stuff. Remember addiction means we no longer have a choice in what we do. so then it looks good on the outside but isn’t good for us on the inside.

  12. It’s so amazing that we have this wonderful brain that most folks can’t even begin to imagine how awesome it is and they do such destructive things to it. Seems like our brains, above everything else in our bodies, should be the most protected organ. And yet, I’d say just about everyone, forgets that fact.

    I am guilty of abusing my brain on occasion, but I have no tendencies toward addiction. There is not one single thing that I can think of, except air and water, that I cannot live without. Sure, I love my tea and my evening glass of wine, and my afternoon Hersey’s kiss or two, but I could live without them. I have a hard time understanding addiction. I know it’s real and it’s harmful and I have addicts in my family, but I just don’t – get – it.

    Thanks for sharing such important information with the blogging world.

    Patricia Rickrode
    w/a Jansen Schmidt
    Patricia recently posted..“I’m Watching That!”My Profile

    • It is a hard thing to understand, Patricia. but it is real for those people who have that reaction in their brain to certain chemicals and activities.

  13. Wonderful post, Louise! Thank you for providing great information about such an important topic.

    • Rhonda, I’m so glad you stopped by. thanks

  14. Louise, this was amazing to read. Can people have addictive personalities?

    • There’s no research to back up that theory but from a personal perspective it’s very common for people to get off one thing and on to another. so they quit booze and start drinking coffee and eating donuts. or they become fitness nuts. or…well you get the picture. It just seems some people have to be vigilant. So I have never gambled. I’ve always known that would hook me hard and fast.

      • As a toddler and preschooler, my daughter would often eat only one food, for days at a time, as often as she was allowed to have it. When she finally tired of one food, she’d move to another, and another. We had to set firm limits, one hotdog a week, one bowl of cereal per day, etc, to keep her from eating whatever she was fixated on exclusively.

        The behavior continued through to early adulthood, when alcohol came along. Alcohol was replaced by pot, and then other drugs. Today, at 25, she still shows the same behavior with food and beverages. She doesn’t drink a great deal of alcohol, thankfully, but she is addicted to narcotics.

        Looking back, I have to wonder if those early fixations on particular foods might have been early indicators of an addictive personality.

        • Certainly your suggestion of early addiction is possilbe. One of the key signs of addiction is ‘all or nothing’ thinking. We tend to jump in with both feet or run away quickly, often without rhyme nor reason to other people. So it’s possible. There is also a big genetic component to addiction so if there’s some history in her history, it may have played out early in her life. I’m going to have to do some research now and see what I can find.

  15. Thanks for the really informative post on addictions. The list of symptoms was estremely helpful as was the info on the difference between habits and additions. It aways takes over the whole family in ways both physical and mental so the more we know the better we are.

    • You are absolutely right, Karly – the whole family becomes involved. I’m going to do some posts on that aspect of these illnesses but after I’m done looking at the issues of the patient/client. take care

  16. I find myself fascinated with addiction TV shows. Maybe it’s because I know too many people that have struggled with it. The one thing that stands out for me–the addict’s skill at deception with loved ones. When someone is family, it is far too easy to want to believe them.
    Thanks for the information Louise!
    Coleen Patrick recently posted..A Food Reunion: My Big Fat Gluten-Filled WeekMy Profile

    • Coleen, I think a number of things happen with families. We all want to believe our loved ones. But as a matter of practice we tend to believe or not believe what people say, rather than comparing their words to their behaviors. If we did that (and didn’t feel like such a terrible person) there would be a lot less addiction and many fewer problems in our world.

      Additionally, believing them means we have hope. Somehow for many people, looking at actions seems to be unkind or blasphemous. It’s not – it’s realistic and necessary when we’re talking to someone else. as we learn that their behavior matches their words, then we can back off on the observation. But we are loath to do that.

  17. Louise– I appreciate your list of common addictive substances at the beginning of the post. So many people take the attitude that addiction means drugs or alcohol. Period. This is a really helpful post.

    “Addiction is a difficult medical problem, for people with this disorder often aren’t aware enough (or honest enough) to admit to what they’re doing and how much they’re using”

    I lied to everyone about my alcohol consumption. I mostly drank at home. It was, therefore, easy to lie to myself since I hadn’t experienced much in the way of penalties for my consumption. No symptoms? No problem! When I had to face blackouts, I finally knew something was wrong, but I still was in denial for a long time.

    Thank you for the information about how to assess addiction. We lie. We do. Sometimes we don’t even really know we’re doing it until we get into recovery and start to see reality. Yes, double it, double it.

    Of those whom I deceived, I was first in line.

    • Boy isn’t that the truth, Heidi. Put me first in my line as well for deceiving myself. You are so lucky you got off the stuff, given how you were using alone. It’s a miracle. Celebrate that and give yourself a hug from me.

  18. A good and informative post, Louise.

    • Thanks Gerri

  19. My husband and I recently lost good friends because of their actions while drunk. Both husband and wife are alcoholics; the wife is also into Rx meds. Both their kids have been heroin addicts, but are both clean atm. It seems everyone is addicted to something – me, caffeine, for sure!
    Jennette Marie Powell recently posted..Misfit Monday: Left Out?My Profile

    • It is tragic to lose friends to this disorder but it is wise for you to protect yourself. wonderful the kids are off the stuff. well done. Me? I always chuckle at the intervention shows where mom and/or dad are sitting there, so fat they can hardly breathe, whining that they don’t know why their kid ended up addicted to >>>>>> (fill in the blank). Addiction is addiction. And as long as you can control your caffeine intake, you haven’t crossed the line yet. LOL

  20. Informative and enlightening, Louise! Thanks for sharing this information.

    • thx for stopping by. glad you enjoyed

  21. Such an insightful post, thank you for explaining and exploring the difference between habit and addiction. I have often wondered if patterns or ways of thinking, are addictions or habits. It seems we can get addicted there too…? Good reminder about the symptoms being behavioral and the three c’s.

    Yes, the wool being pulled over our eyes, that is a good way of stating it. Some are sooooo good at it you’d think they were sheep herders! 🙂
    Resilient Heart recently posted..Creepy: It’s Not Just For Halloween Anymore…My Profile

    • I like that…they’re sheepherders. It’s so true but of course I have to be a willing participant in that process. The day I take off my blinders and look at the world, then I’m free. Thank heavens for that truth.

  22. We saw two of our children turn to drugs and fall into more and more dangerous areas and behaviors. It is heartbreaking to do all you can with raising your children and seeing them change and do such destructive things. With one daughter we stepped in and removed her 4 yr old daughter who was non verbal,emotionally and physically abused. Our daughter had kept disappearing and we did not know how truly bad things were or we would have stepped in sooner. At least we had some success there. With time and lots of counseling. That daughter also turned her life around and is working while finishing her college degree. But we still have a daughter lost to drugs, who has had children removed at birth because they were born addicted. It took a lot of couseling and prayer for me to know I had done all I could and give up the guilt I felt that there must have been something more I could do. I have contact with two of her children since each adoptive family were made aware early that when they wished to tell the children about the adoption we would be pleased to be part of their lives if the wished. We are forging bonds of love which means so much to me.

    • good for you Shirley, for stepping in with one child and being involved with the others. it is not your fault. We all do the best we can and some people are just not able to get beyond the highs or the lows of using drugs. prayer is good for all ofus in this situations.


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