Why Substance Use Disorder and Not Addict?

I often use different words to describe Substance Use Disorders or Addictive Disorders, namely words like Addiction (this blog has the word addiction in the title)

If you’ve ever wondered why I interchange the words it’s down to the fact that the word addiction can be very off-putting for those are affected by drugs or alcohol.

I work with a vast range of people who partake in some form of substance use that has an impact on their lives.  From Alcohol to Zopiclone, people’s relationship with each substance can be very different and sometimes unique. Some people will totally unwittingly get their life enmeshed with a substance at some point. Through taking medications or just drinking socially, their disorder may start to take over their life and become a rampant pathological force that has an immense impact of all aspects of their being.

The word addict is very weighted, I by no means want to deprive anyone of using that as a helpful tag to remind themselves of their primary illness, but for some people it can be very off-putting for treatment. 

In The United Kingdom

In the United Kingdom, the word Substance Misuse is often used to describe addiction, but this may also not be true of the type of drug that someone is using. Some people may be using a substance as they should but still effectively have an addictive disorder. The word substance misuse is also part of the legal frame work of language, as in the UK the criminalization of drugs is the Substance Misuse Act.

Substance Abuse implies that someone is willful in their actions of their usage.   If we consider the American Society of Addiction Medicine definition of addiction to be that, addiction is characterized by the following:

  1. Inability to consistently Abstain
  2. Impairment in Behavioral control
  3. Craving, or increased “hunger” for drugs or rewarding experiences
  4. Diminished recognition of significant problems with one’s behaviors and interpersonal relationships 
  5. A dysfunctional Emotional response.  

https://www.asam.org/resources/definition-of-addiction

We can see that addiction is not a willful act when a person becomes an addict, they have diminished recognition that they have lost control.

The American Psychiatric Association (APA)  in 2013 released the 5th edition of the Diagnostic Statistical Manual which updated the words “Substance Abuse” and “Substance Dependence” to single substance use disorders specific to each individual drug. The APA also removed the term “poly-substance”, individual substances must be specified – as that make a lot more sense, mixing LSD and cannabis is much more different than mixing cocaine and heroin. 

The APA still use the term dependence.  In my field of work, I would state anecdotally that 50% of my clients are not dependent of a substance or alcohol. The other 50% of clients who come to see me are irregular users of a substance, some have the ability to stop for several weeks at a time. There can be a confusion for these people to identify as an addict or alcoholic at times, nor should they feel that they have to “fake it to make it”.

For those having difficulty identifying with the label of addict or alcoholic I often describe the criteria for SUD or Alcohol Use Disorder (AUD), rarely do I encounter a client who state they do not fit that criteria (I am a Certified Substance Abuse Therapist). The clients often feel much less resistant to accepting that they have a SUD or AUD. They clearly identify they have a disordered relationship with a substance, but often they do not know to what extent. 

Playing into Their Denial

I’ve had it said to me many times that using words outside of “addict” or “alcoholic” plays into the person’s denial system, there is certainly a risk of that. However, the counterpoint to this is that resistance is a force that is ubiquitous in counseling on Health behavior change. Rolling with resistance plays a big part of motivation interviewing (Health Beahviour Change – Butler, Mason, Rollnick 1999). The idea is to roll with some of the denial, not play into it or collude with it.  Getting a client to identify the aspects of their SUD can be a big part of confronting denial as opposed to fighting them to surrender to the tag of addict or alcoholic.

Primary Illness

I’m sure plenty of people will have different opinions on the matter and this isn’t a new rule for people on how to practice. If you believe the tag of addict or alcoholic has served you well then by all means continue to call yourself that.

A Substance Use Disorder or Addiction, is a often a primary illness. Meaning that if a person fails to treat that first then they will not be able to deal with any issues that may have a co-morbidity with that such as:

  • Depression
  • Anxiety
  • Psychosis
  • Personality Disorder

If you developed a diabetes or another condition related to diet, would you be happy being called a sugar abuser? Or Hamburger Addict? Or pudding misuse? Probably not, there may even be genetic reasons why you would develop those conditions. So why should those who have a Substance Use Disorder or Alcohol Use Disorder be subjected to the same labeling?

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