Addiction is a powerful thing. Addiction is a habitual need to keep doing something despite negative outcomes for the taste of a positive reinforcer. Ironically addiction can be almost anything in excess in life. It can pertain to an action, such as gambling, gaming, or even sex and sexual acts. Usually addiction is correlated with substances, food, or drugs. In this blog, we will focus on substance abuse disorders and eating disorders described in the DSM-V-TR and review diagnosis and etiology of these disorders.
Please also review AIHCP’s Substance Abuse Practitioner Certification Program.
Substance Abuse
Substance use is the involvement and partaking of a particular substance. Substance use within itself does not entail a disorder. It can lead to a dangerous outcome or a lesson learned due to a onetime DUI or fine, or severe hangover to never be repeated. In this case, substance abuse occurred, but a disorder was not existent (Barlow, et al., 2023). Substance abuse is usually associated with substance intoxication in which the levels of the substance exceed safe and social norms of it. Obviously some substances within moderation are legal, while other substances are illegal even in moderation. Unfortunately, substance abuse even once can be a life altering choice when it harms oneself or others.
Substance Abuse Disorders
The DSM-V-TR lists 10 separate classes of substances and drugs with subcategories. Within these categories include, alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants and tobacco (2022). In addition the disorders include the behavioral and psychological craving of the substance, intoxication of the substance and the withdraw of the substance (DSM-V-TR, 2022).
Addiction in general to these substances involves a general and universal footprint that transects the various substances. Within this general diagnostic criteria, the DSM-V-TR lays out these guidelines for a Substance Abuse Disorder
A. A problematic pattern that leads to significant impairment with at least 2 of the following occurring within a 12 month period.
- substance is ingested in larger amounts that intended
- unsuccessful efforts to control or limit intake
- great deal of time and energy to obtain substance
- cravings or strong desires or urges to use substance
- recurrent uses of substance resulting in failure to fulfill obligations at home, work or school
- continued use despite negative personal, legal and social issues
- reduction of occupational or recreational activities in place of substance use
- recurrent use in hazardous situations
- continued use of substance despite knowledge of the physical and physiological problem
- presence of tolerance
- presence of withdrawal
The disorder can be specified as mild if 2 or 3 symptoms are present, moderate if 4 to 5 symptoms and severe if 6 or more symptoms present (DSM-V-T, 2022).
This presents the basic blueprint for all addiction with substances. Intoxication or withdrawal differ from substance to substance. For purposes of brevity, we will just review a few substances and encourage those with particular interests to review particular substances in the DSM-V-TR.
Alcohol Intoxication
With recent ingestion of alcohol (depressant), clinical problematic behavioral and psychological changes include inappropriate sexual or aggressive behavior, mood lability, and impaired judgement. Physical symptoms include one or more of the following, slurred speech, incoordination, unsteady gait, nystagmus, poor attention and poor memory, and stupor or coma (DSM-V-TR).
Alcohol Withdrawal
Two or more of the following issues develop after cessation of heavy and prolonged drinking. Autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory illusions, psychomotor agitation, anxiety and generalized tonic-clonic seizures (DSM-V-TR, 2022).
Cannabis Intoxication
With recent ingestion of cannabis, clinical problematic behavioral and psychological changes include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, and social withdrawal. Two or more of the following symptoms can manifest including conjunctival injection, increased appetite, dry mouth and tachycardia (DSM-V-TR, 2022)
Cannabis Withdrawal
Three or more of the following issues develop after 1 week of heavy or prolonged use of cannabis. They can include irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, or at least one physical symptom of abdominal pain, tremors, sweating, fever, chills or headaches (DSM-V-TR, 2022).
Opioid Intoxication
Common Opioids- Heroin, hydrocodone, oxycodone, fentanyl (Barlow, et al, 2022)
With recent ingestion of opioids, clinical problematic behavioral and psychological changes include initial euphoria followed by apathy, dysphoria, psychomotor agitation, retardation and impaired judgement. Pupillary restriction can occur. In addition drowsiness, or coma, slurred speech and impairment to attention and memory (DSM-V-TR, 2022).
Opioid Withdrawal
Three or more of the following issues develop after cessation of heavy or prolonged opioid use. These include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea (tears or runny nose), pupillary dilation, sweating, diarrhea, yawning, fever or insomnia (DSM-V-TR, 2022).
Stimulant Intoxication
Common Stimulants- Amphetamines ( crystalized-Methamphetamine), Cocaine (Crack in crystal form) (Barlow, et al, 2022)
With recent ingestion of stimulants, clinical behavioral and psychological include euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, and impaired judgment. Two or more symptoms include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, nausea or vomiting, weight loss, psycho motor agitation, muscular weakness, respiratory depression, chest pain, confusion, seizures or coma (DSM-V-TR, 2022).
Stimulant Withdrawl
Two or more of the following issues develop after cessation or reduction of prolonged amphetamine use that include fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation (DSM-V-TR, 2022).
Tobacco Withdrawal
Tobacco withdrawal can occur after daily use for at least several weeks and with abrupt cessation include irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood and insomnia (DSM-V-TR, 2022).
Hallucinogen Intoxication
Common Hallucinogen- Phencyclidine or Angel Dust, LCD or Acid (Barlow, et al., 2023).
With recent ingestion of hallucinogens clinical behavioral and psychological changes include belligerence, impulsiveness, unpredictability, psychomotor agitation, and impaired judgement. Symptoms include two or more of the following within an hour such as vertical or horizontal nystagmus, hypertension, numbness, ataxia (Uncoordinated motor movement, dysarthria (impaired speech), muscle rigidity, seizures or coma, hyperacusis (hearing). (DSM-V-TR, 2022).
Eating Disorders
Substance misuse can also include how one eats and what one consumes. In ways, it can become a impulse and compulsion as well due to anxiety, or poor self concept that leads individuals to eat certain ways or binge eat, or to starve oneself or attempt to control one’s weight through purging. These disorders are very dangerous to overall nutrition and health but also have deep psychological issues. Among the numerous eating disorders listed by the DSM-V-TR, there are Pica or the eating of nonnutritive or nonfood substances, rumination disorders, binge eating, as well as the most common Anorexia Nervosa and Bulimia Nervosa disorders. These disorders usually are tied to control issues, anxiety, low-self esteem, and body dysmorphia (Barlow, et al. 2022).
In regards to the BSM-V-TR, Anorexia Nervosa meets these diagnostic criteria
A. Restriction of energy intake leading to significant body weight loss.
B. Intense fear of gaining weight or becoming fat and behavior that interferes with weight gain
C. Lack of recognition of the severe loss of weight.
Specifiers include restrictive type in which one has not binge ate or purged within the last 3 months but has severely dieted, exercised or fasted. The second specifier is binge-eating/purging type in which the person within the last 3 months has self induced vomiting or utilized laxatives, diuretics or enemas (DSM-V-TR, 2022). Based on one’s weight loss determines mild, moderate, severe or extreme.
Bulimia Nervosa
The DSM-V-TR points out that diagnosis of Bulimia does not occur exclusively during episodes of anorexia nervosa. In addition, many individuals with bulimia do are average weight and do not appear thin or weakly (Barlow, et al., 2022). The DSM-V-TR lists these criteria:
A. Recurrent episodes of binge eating which include eating within a certain 2 hour period of time of an amount of food that is larger than most individuals would eat and a sense of lack of control during that period
B. Recurrent and inappropriate measures to prevent weight gain through self-induced vomiting, laxatives, diuretics or other medications and excessive measures.
C. These behavior occur at least on average at least once a week for a three month period
D. Self evaluation of the body is unduly founded regarding shape and weight
Specifiers can include mild, moderate, severe or extreme (DSM-V-TR, 2022).
Binge Eating
Binge eating is recurrent episodes of eating large quantities of food to find some type of reduction of anxiety or comfort. These recurrent binges are defined by the DSM-V-TR within the following parameters.
A. Eating in a discrete period of time within a 2 hour period of an amount of food larger than what would be consider appropriate with a sense of lack of control.
B. The binge eating is associated with three or more of the following feelings
- eating more rapid than normal
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone because embarrassed for others to see the amount consumed
- feeling disgusted, depressed and guilty with oneself after consuming the meal
C. Marked distress regarding binge eating is present
D. The binge eating occurs once a week for three months
E. The binge eating is not associating with Bulimia or Anorexia
The specifiers include mild, moderate, severe and extreme (DSM-V-TR, 2022)
The Problem and Etiology of Addiction
Addiction looks for quick fixes. It looks for pleasure in place of happiness. The dopamine high is sought at the expense of the serotonin stability of life. Many are looking to escape life’s problems and maladaptively cope via escapism. This coincides also with more than stressors and problems but also comorbidity with other mental disorders such as depression and anxiety (McRay, et al., 2016). In addition, addiction is many times tied to impulse control disorders as well (Barlow, et. al, 2023).
In addition, the activation of genetic and biological markers are passed down from generation to generation. Individuals can face more than merely a psychological and mental addiction but also develop a physical addiction and disease. Obviously some substances are more objectively addictive, but for some, genetic predispositions play a key role in whether someone can become addicted to a certain substance (Barlow, et al., 2023).
One reality is addiction is not always about substances, albeit the DSM-V-TR only lists gambling as a disorder, but addiction can take the form of many things if one considers actions to be repeated for purpose of positive reinforcement but with negative consequences. All three qualities must be present for an addiction. Hence, one can include activities that exceed moderation and in some way become harmful. This could include gaming, pornography, or any type of obsession that takes away from quality of life. Balance and temperance are key factors in maintaining healthy outlooks on things we do in life.
Addiction Treatment
Addiction treatment depends on a person’s willingness and the level of addiction itself. For many it is a life long cross that involves will power, peer support, avoidance of the substance and its occasions, as well as developing better coping strategies for stressors, as well as anxiety and depression. For some, it also involves finding deeper meaning in life and finding a spiritual anchor. AA utilizes a spiritual based plan that holds one accountable to a higher power (Barlow, et al., 2023).
Conclusion
Whether addiction is a substance or a practice, it involves maladaptive coping to face life and issues. It involves a habitual need to engage or indulge oneself in something that has negative consequences for the small price of brief positive reinforcers. For some addiction is mental and behavioral, but for others it can be inherited and activated. It is important to never allow something to become so powerful over oneself as to destroy everything in one’s life. Addiction is not fast, it is insidious and slowly seduces and entraps the victim but individuals can escape it with a strong will and peer support. Finding meaning in something greater than oneself is key to overcoming habitual vice and addiction.
Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals.
Additional Blogs
12 Steps of AA Video blog: Access here
Dopamine and Serotonin in Addiction Process: Access here
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.
Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th ed.). Cengage Learning
McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic
Additional Resources
Addiction and Substance Abuse Disorders. APA. Access here
Drug Addiction. Mayo Clinic. Access here
Substance Use Disorder (SUD). Cleveland Clinic. Access here
Hartney, E. (2026). “DSM 5 Criteria for Substance Use Disorders”. VeryWellMind. Access here