Compulsive Disorder Criteria

This episode includes a description of Alcohol Use Disorder with the criteria to determine mild, moderate and severe use levels from the DSM-V-TR diagnostic criteria.  A behavioral or process addiction follows a similar course of neurochemical changes in the brain's reward system that closely resembles the Substance Use Disorders.  The main neurochemical involved in compulsive and addictive behaviors is dopamine, which is experienced as enhanced pleasure.  The episode is designed to educate families and individuals with the DSM-V-TR diagnostic criteria so they can make an informed decision as to the level of use and severity along with an ability to consider treatment and recovery options.  

Resources:  "Diagnostic and Statistical Manual of Mental Disorders" Fifth Edition 
American Psychiatric Association Publishing   Copyright 2013.  

"Recover To Live"  Christopher Kennedy Lawford, BenBella Books Inc. Dallas Texas, Copyright 2013

Restoration Family is a recovery and healing educational podcast for individuals and families that have a loved one that struggles with mental health and/or substance use disorders combined. Restoration family teaches Biblical principles, recovery steps, counseling and marriage and family interventions. I am a Licensed Mental Health therapist, a Psy. D. in Counseling, a Master level addiction professional and a trained pastor and chaplain.

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Transcript

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Today I am gonna do a new podcast and we're gonna talk about substance abuse disorders and also behavioral disorders, or you could call them compulsions. You look at the signs and symptoms of these disorders and it helps you understand. If you have a problem that might be mild, moderate, or severe. That's how the criteria is measured, particularly in the DSM five that's the Diagnostic Statistical Manual for Mental Health disorders. If you have two or three of the criteria, that's usually considered a mild case of a substance use disorder. If you have. Four to five, that can be moderate. And anything from six and above that's called severe. So as an example, I'm going to use alcohol use disorder because that's so common, this can be applied pretty much in the same way. If you had a behavioral addiction like gambling or pornography or compulsive spending, workaholism, things like that, a lot of the signs and symptoms would look very similar. And the brain chemistry can function very similar with the neurotransmitters. So I'm gonna describe these signs and symptoms and then you can look at it and, apply it to your life and try to get a good idea of what you're dealing with or someone you care about, a family member or a friend. One of the first criteria you look at with alcohol use disorder is alcohol is often taken in larger amounts or over a longer period of time than was intended. So you would see this. If someone went to a bar or nightclub and they were driving and saying, well, I'm only gonna have, two drinks and dinner. But that didn't happen. They ended up, eating and then having a lot more drinks where they went, above the legal limit which isn't that high in a lot of states. Point zero eight in Florida, depending on your weight, that's not that many drinks, so that could be a problem you ended up drinking or using a substance, or could be maybe even engaging in gambling. Gambling a lot more money, a lot more time than he had planned on doing. The second criteria is persistent desire or unsuccessful efforts to cut down or control the alcohol use Could be efforts. To control or cut down on gambling, or substance use, it could be drugs, but you're trying to stop something and cut down and it's not working. So you go on to the third criteria. A great deal of time is spent in activities. Necessary to obtain alcohol, use alcohol, or recover from its effect. And I had seen this with a lot of people I knew growing up, is that a lot of the social network and structure was built around alcohol use. Maybe going to bars or football games or parties, friends. And your social and cultural network was built around the use of alcohol. And in some places it would've been drugs or could have been gambling, could have been high risk behavior, like driving cars very fast. That could be a compulsive behavior. You'll see that you're gonna have a lot of friends that are doing the simmer. Similar type of activity. Then there's a craving or a strong desire or urge to use alcohol. Cravings are often triggered. Physiologically, you don't feel okay over time. If you're getting more and more, driven or compelled into the substance use disorder or behavior, you don't feel good without using the behavior. And particularly if you develop tolerance, you're gonna have more and more need for more and more of the substance. If it's has state of withdrawal, you almost don't feel normal unless you're using the substance. When you're not using the substance, you start to feel withdrawal effects, which generally speaking is the opposite of what the substance or behavior did for you in the first place. So if you drank, you might have felt calm or at ease, or you could go to a bar and dance and feel less inhibited. You would get the opposite effect of all those behaviors and emotional states when you're getting a withdraw effect. The next criteria you're looking at is recurrent alcohol use, resulting in a failure to fulfill major role requirements. So when you look at this, you'd start to see, well, my work is starting to suffer. I'm missing days at work. I'm hung over. Maybe your health is bad. You're not spending time with your family. You're sleeping late on your days off, maybe you're hung over and your weekends are spent trying to recover, or you're just not doing anything with your family, your children, and your friends, because you're recovering from a lot of the alcohol use. It affects your work and your ability to produce in life. You would continue with alcohol use despite having persistent or recurrent social or interpersonal problems cause or exacerbated by the effects of the alcohol. So over time, this would cost a lot of problems with your family. You might have some marriage problems. You might start spending time with your friends and not being there for your children or your wife. A famous actress described drinking and substance use disorders as you start out with them and you're kind of having fun with it. And then over time you're having fun, but now you're starting to have some problems too. And then farther down the road. All you're doing is you're having problems with it. So a lot of people start using drugs and alcohol and gambling for, some type of payoff. It might be excitement escape from reality, you don't feel pain or you block out emotional states. But over time, with a state of tolerance and withdrawal, you're gonna have to use more and more of the substance. Or the behavior, and then you don't feel normal without it. So it starts to take control over your life and all of the domains of your life. Substance abuse disorders and addiction can become what's called the primary drive. A primary drive becomes. More important than everything in your life, and that includes more important than your health could be more important than legal problems. Your safety finances, job and career, children, family, and relationships. Because now the substance use disorder, the addiction itself, you're moving in a state of loss of control and compulsive use. Where it really comes first in your life, and people didn't really plan on this happening. They might have started it for a payoff of maybe escape from reality or a feel good or some euphoria on some level. But over time, the substance use disorders will take over your life and the domains of your life. The next criteria that we can talk about is important. Social, occupational, and recreational activities are given up or reduced because of the alcohol use. So over time you might have a hobby where maybe you ran or you lifted weights or you went swimming or scuba diving, or you took the dog for a walk. You went to your kids' soccer games. A lot of things you're gonna start giving up because the alcohol use is going to become more important than these other life domains that you used to do and have fun in. So that's where it starts to take over and control things in your life that used to be enjoyable and bring you joy and pleasure. This is why they refer to addictions as loss of control and compulsive use, meaning I have to do this, or I'm driven to do this. A lot of people will try to control someone with an addiction. But they're trying to control someone that has a definition of what is called a loss of control and compulsive state that doesn't work very well We're gonna have to go get help to go to treatment, go to recovery until we can heal physiologically, our environment might be needed to be enhanced for recovery. Our social network, people, places, and things. All these things you have to change and recover with so that you're not being controlled by alcohol use and other substances. The next criteria we talk about, you would be using alcohol or substances in situations that are physically hazardous. The primary one here we think of is people driving, using, machinery at work or you get a DUI, most of the research will show that if someone has 1D UI, there's approximately 50 other times that they could have had a DUI where they were driving under the influence above the legal limit. So this is another sign that. You have to really be honest about, and a big part of recover and healing is you being honest and truthful with yourself and other people that want to help you. The bottom line is you're responsible for your recovery. You might have. A genetic predisposition, grown up in a bad environment. Been stressed or abused, but you still have to make the decision and the choice to go into recovery for yourself and do the right thing. That's where individual. Responsibility has to take over. Then, once again, we're looking at the tolerance where you have to get more and more of the behavior or substance to get the same effect and a diminished effect if you don't get more. Withdraw state is where you start to feel the symptoms from alcohol use withdrawal, which could be anxiety, depression. And also you would have other emotional states. People that drink heavily, they don't sleep well. They usually suffer with their nutrition because the alcohol starts to become the primary source for food or intake. That's on a level of severity. So when you look at these signs and symptoms, be honest with yourself. Tell yourself the truth and look at, do I have two or three of these signs and symptoms? Four or five, which would be moderate, or six and above. Be truthful with yourself because it's very difficult to overcome a substance use disorder or a behavioral. Disorder. If you continue to distort the reality and the truth, and some of the common defense mechanisms that we have that deny and distort reality are, one, we deny the state of what we're actually going on within life, deny that it's a problem. Then sometime we project it onto other people and then you can minimize it. Well, I'm not really drinking that much and it's just affecting me, not other people. When you look at research, substance use disorders and behavioral disorders, they affect usually at least six or seven other people in your family circle. So look at this criteria and I'll have some resources for you to follow, but you want to be honest with yourself look at what you need to do to get better. When people have a state of loss of control, they need to get help from other people and go into treatment, and they start working a recovery program. They don't try to do their own program. Their own program got them to where they are right now. So a lot of people get better when they do recovery and follow up with aftercare. The rate of recovery goes well above 90%, but you have to do the work and continue to do the work then your life can get really good healthy and happy again. So that's it for me now thank you and God bless.