Coming Clean About Substance Use Disorders (SUDs), Part I: Diagnostic Criteria and Root Causes
As I reflected on my topic for this year’s 30 Days of Change, I considered changing things up, but like it or not, addiction is what I know best. I’ve pored over the science of it, sure, but I’ve also lived through it — and changing behaviors begins with empathy, followed by raising awareness and influencing attitudes. I don’t know that anyone is better qualified to tackle a sensitive subject than someone who’s personally experienced it. What else am I going to do with all of this righteous anger? Because despite decades of evidence proving that SUDs are mental disorders involving complex interactions among brain circuits, genetics, the environment and an individual's life experiences, many people still believe they’re a choice, or worse yet, a moral failing. These harmful misconceptions have only exacerbated the stigmas that bar many sufferers from asking for help.
I struggled to distill my thoughts into a single blog post, so I thought to myself, Why do one when I could do several? (Which is precisely the kind of logic that led to my alcohol use disorder in the first place, I know!) Today, I’ll share a bit of my own experience with an SUD, along with breaking down some diagnostic criteria and root causes. Hopefully, by the end of part I, you’ll have a deeper understanding of addiction and empathy for those who suffer from it.
Between Rock Bottom and a Hard Place
In December, I’ll have six alcohol-free years under my belt, but I spent much of my twenties in a dissociated haze. No one really saw my addiction coming. I had a great childhood, but by my high school graduation, I’d also endured a great deal of trauma — and I was too afraid and ashamed to tell a soul. The moment I realized I could buy dissociation by the bottle, it was over. When memories became too terrifying or agonizing to relive, I dove headfirst into oblivion. And instead of healing from my trauma, I inadvertently multiplied it. Time and time again, I put myself in high-risk situations and had no idea how to stop.
My “rock bottom” was showing up at my family’s Christmas party more blacked out than OKC in an ice storm and lashing out at some of the people I love most. However, this wasn’t my lowest point by any stretch. It was just the one that finally brought me to my knees. I think this is important to mention, because my compulsion to keep using the substance that was ruining my life must’ve baffled my friends and family who hadn’t lived through a SUD. It’s not that I didn’t feel remorse over my actions; in fact, it was quite the opposite. And while I knew alcohol was only magnifying the chaos, it was also the only coping mechanism I had. Ultimately, I had to replace it with healthier tools before I could let it go. The same is probably true for anyone you know with a SUD.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are three levels of SUDs, which are determined by how many criteria are met:
- Mild: 2-3 criteria
- Moderate: 4-5 criteria
- Severe: 6+ criteria
The criteria fall under four domains:
1. Impaired Control
- Using more of a substance and/or using it more often than intended
- Wanting to cut down or stop using it but not being able to
- Spending a great deal of time obtaining, using or recovering from the effects
- Experiencing cravings
- Neglecting responsibilities and relationships
- Giving up activities you used to care about because of substance use
- Inability to finish tasks at home, school or work
- Continued use despite significant social & interpersonal problems
- Using substance in risky settings
- Persistent use despite known risks + physical & psychological consequence
- Needing more of the substance to get the same effect (tolerance)
- Experiencing adverse and uncomfortable symptoms when not using (withdrawal)
The Myth of "Moderate" Drinking
As you can see, you don’t have to qualify for the show Intervention to have a SUD. If you’re frequently too hungover to make it to your favorite yoga class on Saturday mornings, you already meet the criteria for a mild one — but you aren’t alone. According to a SAMHSA survey, 40.3 million Americans met the criteria for a SUD in 2020. However, many aren’t even aware of it because heavy drinking is far more socially acceptable than using other substances.
Here's how the CDC actually defines “moderate” drinking:
- Men: 2 (or fewer) drinks a day
- Women: 1 drink (or fewer) in a day
On the other hand, binge drinking means consuming:
- 5 or more drinks on a single occasion (men)
- 4 or more drinks on a single occasion (women)
Now that we’ve established just how common SUDs really are, let’s explore some of their most common root causes. Because addiction is often a symptom of the problem — not the actual problem itself.
Maternal deprivation in early childhood paves the way for various struggles, including addiction. As the book Hungry Ghosts highlights, babies who are deprived of basic human contact suffer from a deficit of essential brain chemicals, including oxytocin, serotonin, norepinephrine and dopamine. Even slight imbalances in these neurotransmitters increase the likelihood of an SUD. Programs like parentPRO, which facilitate attachment and bonding activities, can help combat these pitfalls.
Trauma and Mental Illness
According to SAMHSA, up to 75% of people who have survived abusive or violent traumatic experiences report problematic alcohol use, and adolescent victims of sexual assault are 9 times more likely to develop SUDs. Additionally, based on data from the National Center for PTSD, 1 in 3 veterans who seeks treatment for an SUD also has post-traumatic stress disorder (PTSD). In fact, more than half of Americans with SUDs also have co-occurring mental disorders, according to the National Institute of Mental Health. As a result, they turn to substances to self-medicate their distressing symptoms. Without first acknowledging and addressing these underlying issues, recovery often remains elusive. I wasn’t able to make much progress with my own sobriety until I got professional help for my trauma and mental health issues.
That’s probably enough information for one day, so I’ll stop here. Steps 3 and 4 of behavior change involve changing the behavior, and then the social norm, so I’ll share some tips and resources in part II, along with proven public health policies for addressing this complex issue.
Stay tuned for actionable insights and resources in Part II during 30 Days of Change.