Alcohol & Substance Abuse Diagnosis

How do the experts make the distinction between mild substance 'Abuse' and more severe substance 'Dependence'? The answer depends largely on whether or not the addicted person experiences Tolerance and Withdrawal.

Tolerance is the name given to the case when, over time, a drug or alcohol user requires more and more substance to get the same amount of 'high' effect they are seeking. Typically, the more a person takes drugs or alcohol, the more that he or she will become tolerant to its effects, requiring more and more of the substance to get the same effect. Tolerance, then, is what is happening when someone starts needing to drink six drinks to get the same 'buzz' that they used to get by only drinking three drinks.

Withdrawal is the name given to the negative experiences and cravings that a drug or alcohol user may have when they stop taking using drugs or alcohol. For example, an alcoholic who stops drinking abruptly may experience one or more of the following negative symptoms: anxiety, sweating, increased heart rate, hand tremor, insomnia, vomiting, agitation, hallucinations, and even seizures. A drug or alcohol user in withdrawal becomes highly motivated to get and take more drugs or alcohol, as this relieves their feelings of sickness. As one might figure, an alcoholic who experiences such an array of negative symptoms even once, will be highly motivated to remain drunk so as to avoid ever having to experience them again.

A person must be experiencing significant social, relationship, family and/or occupational difficulty due to their substance use in order to qualify for a Substance Abuse diagnosis, but they need not have ever experienced Tolerance or Withdrawal. A diagnosis of Substance Dependence, however, cannot be made if Tolerance or Withdrawal is not present.

Diagnosis is important in general because it helps doctors to know how to treat a problem. The diagnosis of a substance use problem (abuse or dependence) is important because it helps justify getting an addicted person into treatment.

Getting an addict to the point where a substance abuse or dependence diagnosis can be made is often a difficult task. People with drug and alcohol problems are often secretive about their use, or blind to the idea that a problem exists. It is helpful then to have a list of behaviors that one can look for that, when present, may suggest that someone has a substance use problem.

Behaviors to look for include:

• A repeating failure to meet social, occupational or familial duties:
• Repeated lateness or absence
• Poor work performance
• Neglect of children, etc.
• Bizarre or lame excuses for social, occupational or family failures
• Borrowing (or stealing) money without good reasons.
• Uncharacteristic mood or personality changes

Physical signs may include:

• Puncture marks, or long thin lines along the arms or legs (IV drug use such as heroin)
• Skin Infections
• Nose and throat problems (snorted drugs such as cocaine)
• Bloody nose
• Nasal and/or sinus infections
• Coughing
• Loss of the sense of smell
• Drowsiness, or loss of coordination (depressant drugs such as alcohol)
• 'Pinned' (tiny, constricted) pupils in the eye (secondary to opioid abuse)
• Eye movement disturbances:
• Nystagmus: back and forth eye movements during an extreme lateral gaze (secondary to alcohol abuse)
• Red or bloodshot eyes (secondary to smoking marijuana)
• Drug-related smells on clothing (drugs that are smoked)
• Drug-related paraphernalia (pipes, 'works', pill bottles, small plastic bags or vials, lighters, etc.)
• Medical signs (only apparent upon formal testing) may include:
• Positive findings of drug related metabolic (break-down) byproducts in the urine, blood or hair.
• Hypertension (High Blood Pressure) (may point to alcoholism)
• Elevated levels of the liver enzyme 'delta-glutamic transferase' (GGT) (may point to alcoholism)
• Enlarged red blood cells (may point to alcoholism)