By The MotherMind Doctor
I remember my mother being fearful of me having ‘an alcohol problem’ when I was at university.
On my graduation day, she witnessed me start with champagne at brunch and continue drinking through the day and then being able to go out at night to drink more.
This certainly fits a criteria for tolerance, which is one of the 11 required for a diagnosis.
But we need to consider the whole picture before we jump to conclusions.
Criteria for a substance use disorder:
The eleven criteria from the DSM-5-TR (the diagnostic and statistical manual of mental disorders, fifth edition, text revision) can be grouped into four categories:
1. Physical dependence
2. Risky use
3. Social problems and
4. Impaired control.
The first criteria relates to taking larger amounts of a substance for longer than you’re meant to (applies to my graduation day). The second one relates to cutting down or stopping the substance use but not managing to. (I would say the next hangover was a good way to stop me from using again for a while) and additional criteria talk about how much time is spent getting using or recovering from the use of a substance (in this case, alcohol). Cravings and urges to use this substance and not managing to do other activities because of that substance are all important indicators of a substance disorder. (thankfully, these criteria were not fulfilled).
What my mother was concerned about (and many parents for their own children) was that I seemed to be able to drink a lot and be able to keep drinking without significant effect, called the degree of tolerance (disclaimer: this was a special occasion and I apparently successfully managed to ‘pace’ myself that day). But I didn’t go on to continue to use, which resulting physical or psychological consequences, including withdrawals that can only be relieved by taking more of the substance (like ‘hair of the dog’).
However, it is important to state that not all 11 criteria need to be met in order to qualify for a substance use disorder. As two or three symptoms qualify as mild severity (I met 2 as per my account). Six or seven symptoms indicate a severe level of substance use disorder.
Types of substance use disorders:
There are 10 separate classes of drugs outlined in the DSM-5-TR that mostly cover psychoactive substances such as hallucinogens, opioids, stimulants, and other legal drugs such as caffeine, tobacco and alcohol.
Interestingly, gaming has made it into the DSM-5-TR, As Internet gaming disorder. It is included in the section recommending conditions for further research along with caffeine use disorder.
However, there is no clinical agreement on the meaning of ‘food addiction’, Although similar neurobiological pathways are found in binge eating disorder and substance use disorder. Animal models show behaviours in rodents that are addiction-like after some weeks of intermittent access to sugar. There appears to be some parallels such as (tolerance, withdrawal, large amounts used, unable to cut down, etc in binge eating) but also discrepancies that need to be further explored (such as physically hazardous use, failure to fulfil various obligations).
Exercise addiction has been coined as a term and is characterised as dysfunctional behaviour with loss of control over exercise, with negative life consequences. Research in this area is growing but it is not yet recognised in the DSM-5-TR due to the lack of sufficient evidence for consistency.
Substance use in families:
It is long been known that addictions tend to run in families (are heritable), which is why a family history is part of an assessment substance use. My family has alcohol use on both sides which is why my mother was so vigilant in looking for it. My uncle also used cannabis and, although I was too young to diagnose him, his life was severely impacted by his habit.
As recently as 2023, studies identified common genes across addiction disorders (regardless of substance of choice) and showed that the combination of genes underlying addiction is associated with the regulation of dopamine.
Instead of a pleasurable surge of dopamine, substances of abuse can cause a ‘flood’ to the reward pathway (ten times the natural reward), The brain remembers the surge and creates the association with the substance. Chronic use means the brain is less sensitive to dopamine to more is then needed to elicit the response.
Addicted to Love?
Dopamine is a neurotransmitter that is part of the reward system as well as associated with movement, attention, learning and pleasure. Experts link the happy hormone so common in the early stages of love to addictive relationship behaviours. Romantic love is considered a ‘natural addiction’ that mellows over time to a more stable, lasting love. But one-sided love or a breakup can reveal the addictive qualities of love.
Habit or Choice?
Addiction can also cause problems with focus, memory and learning, not to mention decision-making and judgement. So the ‘drug seeking’ is habitual rather than a rational decision and is considered a ‘psychological disease’. Medication based treatments have been shown to be the most effective treatment when combined with therapy/counselling/support.
Environmental factors also relate to substance use disorders. Access to substances, lack of social support, social media interactions, parenting styles and mental health issues can all play a part in developing a substance use problem.
If you or anyone you know are concerns, speak to a health professional such as your GP to see what supports are available.
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