From my understanding of the illness of addiction, according to Dr. Kaplan, the DSM-5 defines a substance use disorder (SUD) for diagnosis when a problematic pattern of use occurs within a 12-month period and at least two or more symptoms are present. It is important to note that the DSM-5 does not require 12 months for all cases. The disorder is considered “persistent” if the problematic pattern lasts at least 12 months, but it can also be diagnosed sooner if criteria are met and symptoms are clinically significant (Kaplin, 2023). In addition, the DSM-5 defines substance use disorders as problems with 10 types of drugs, from alcohol and cannabis to opioids and stimulants. What they all share is the ability to overstimulate the brain’s reward system, which can lead to loss of control, relationship or work problems, risky use, and physical effects like tolerance or withdrawal (American Psychiatric Association, 2013).
Key criteria include:
According to the American Psychiatric Association, 60% of Americans age 12 and older currently use alcohol or drugs. Substance Use Disorder (SUD) is not limited to heavy drugs like heroin or morphine; it can involve pornography, nicotine, sugar, caffeine, or any coping mechanism that disrupts daily functioning. It impacts decision making, memory, learning, and interpersonal relationships. Physiologically, chronic use alters the brain by depleting and then replenishing dopamine, which regulates pleasure, calm, energy, and mood (American Psychiatric Association, 2022).
According to Judy Grisel in a TED-Ed talk, addiction exists on a spectrum, with severe SUD becoming substance addiction. Tolerance from chronic use weakens the effect of drugs or alcohol, leaving individuals unable to cope with reality at baseline. In heroin support groups, “The Dragon” symbolizes the first high so powerful that people spend years chasing it, though it cannot be recaptured. This cycle, combined with intermittent highs and lows, creates chemical dependency that extends into both substance use and relationships (American Psychiatric Association, 2022; Grisel, 2024; Kaplin, 2023).
Recovery involves education, supportive community, and non-judgmental understanding. Judging someone favorably means viewing past choices, often shaped by trauma or complex factors, not as punishment but as opportunities for growth. Multiple screenings exist to identify substance use, and healing also requires addressing the root causes of pain and assuring individuals they are not alone. Accountability from telehealth meetings between medical health providers and clients to treat heavy substance use also has proven effective (Allen LD, 2023).
Allen, L. D. (2023). Navigating the path to effective, equitable, and evidence-based telehealth for opioid use disorder treatment. JAMA Network Open, 6(10), e2336885.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810831
American Psychiatric Association. (2022, February 2). What is addiction? | APA [Video]. YouTube.
https://www.youtube.com/watch?v=Vrb99pSgW7I
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
https://doi.org/10.1176/appi.books.9780890425596
Grisel, J. (2024, March). What causes addiction and why is it so hard to treat? [Video]. YouTube.
https://www.youtube.com/watch?v=hBC7i-vHWsU
Kaplin, D. (2023, February 23). Introduction to substance use disorders with 2023 updates [Video]. YouTube.
https://www.youtube.com/watch?v=P5mucEu4VDg
References