This seems like a simple question, doesn’t it? So let’s start with the most simple answer: If you think you have a problem, it’s likely you do. But it’s not so simple after all, because addiction is probably the only disease that manifests by making you think you don’t have a disease. Denial is a hallmark of addiction, and that makes things tricky.
Because addiction is a disease, it has specific signs and symptoms that doctors recognize. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, classifies addictions based primarily on the severity of the problem. Less severe cases of addiction are called Substance Abuse, while more severe cases are called Substance Dependence.
The DSM defines Substance Abuse as a pattern of use that leads to significant impairment or distress. What they call impairment or distress might be failing to fulfill major obligations at work, at school or at home because you are drinking or using drugs. It might be using while you’re doing something dangerous, such as driving. It might be getting into legal trouble because of your substance abuse. It might be continuing to use even though your substance abuse is causing social or interpersonal problems. The DSM doesn’t say a substance abuser has all of these problems–just one is enough to diagnose the disease.
What about the more severe Substance Dependence? The DSM also defines it as a pattern of use that leads to significant impairment or distress, but the consequences are more serious and include physical problems as well as social and emotional ones. The physical consequences are tolerance (the need to use more and more just to get the same effect), and withdrawal symptoms if you cut down or stop using your substance of choice. As a result, you might take the substance in larger amounts or over a longer period of time than you had originally intended. The social consequences are that you spend a huge amount of your time getting drugs or alcohol, using them, and dealing with the hangovers. You give up social, work and recreational activities that you used to enjoy, because your habit is taking up so much of your time and energy. One emotional consequence is that you know your using is making things worse–making you more depressed, more unhealthy–but you still keep using. Another is that you sometimes wish you could cut down or even stop using, but the wishing just doesn’t make it so.
Again, the DSM doesn’t say you must be having all these problems to be diagnosed with Substance Dependence–any three is enough.
That’s how the doctors define it. But there are some other things to think about as well. If you have trouble living your everyday life sober, you have a problem. If you try to cut down on how much you drink or use drugs and you find that you’re obsessing about using or can’t cut down, you have a problem. If your habit of choice is causing trouble in your life–relationships, physical, financial–but you still can’t stop, you have a problem. If you do or say things under the influence that you would never do while sober, perhaps even hurting people you care about, you have a problem. If you find yourself lying about the substances you use, how often you use them and how you get them, you have a problem. If you rearrange your life to avoid things that might stop you from using or drinking, you have a problem.
Even if you don’t want to see it, even if you feel like screaming that it isn’t so, remember that a big part of addiction is denial. If what I’ve described here sounds like your life–even a part of your life–it might be time to stop denying your addiction.
Remeber, the disease of addiction is the only disease that tries to convince you that you don’t have one.