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People become addicted to an incredibly wide variety of substances and behaviors. What do they all have in common, and how do these common features allow doctors to make a diagnosis of addiction?

Perhaps you're concerned that you or a loved-one has fallen victim to addiction and are wondering what happens when people approach a primary care doctor or psychologist for help — or perhaps you're just curious. Either way, "how does a doctor diagnose addiction?" is an incredibly broad question. 

People become addicted to all sorts of things, after all.

Some addicts are abusing substances that most people would believe to fall into the "never a good idea, in any circumstances" category. They'd probably include cocaine, crack, heroin, LSD, MDMA, glue, and believe it or not, even other household items like hair spray and gasoline. Some addicts are abusing substances many would consider to be OK in moderation or under certain conditions, like alcohol, marijuana, or prescription painkillers. Cigarettes, which are extremely addictive but still socially acceptable in many places, feature on the list as well.

Others aren't addicted to substances, but to behaviors. Gambling is an activity well-recognized to hold addictive potential, but not all behaviors research has established to become addictions in some people are diagnostic categories. Sex, work, food (and fatty, processed food to be specific), internet use, gaming, shopping, and exercise are just some of the things that become addictions for some. 

Addiction is a huge spectrum, then — so how do doctors deal with that? Is there one diagnostic checklist for just "addiction"? Let's explore that a bit further. 

Is there a universally-accepted definition of addiction?

Not exactly. The American Society of Addiction Medicine's definitions are quite widely used, however, and ASAN emphasizes that addiction is a chronic disease that changes the brain's mechanisms of reward and motivation. Like many other chronic diseases, addiction is often not only chronic, but also progressive. There may be periods of remission and relapse. (The ASAN doesn't say, but it's true nonetheless, that just like with many other chronic diseases, patients may engage in behaviors that increase their risk of developing the disease — but it's not their fault, exactly, when they develop it.)

The American Society for Addiction Medicine goes on to describe the risk factors, brain processes, and characteristics associated with addiction in detail, and that's worth a read for people who want to find out more. Most addictions recognized in the diagnostic and statistical manual of mental disorders (DSM-5) come with similar diagnostic criteria, however, and here, we'll take a look at the symptoms common to various substance and behavioral addictions:

  • Addicts use the substance or engage in the behavior more often and for longer than they planned to or wanted to. 
  • Many addicts try to stop or reduce their use or engagement but find they can't. 
  • Addicts spend a lot of time engaging in their addiction, trying to get the substance or get to the behavior (like sex or gambling), getting money to fuel their addictions, or recovering from their use or engagement. 
  • When they don't have access to their substance or behavior, addicts crave it and become anxious. It may get so bad they can't think about anything else until their addictive needs are met.
  • Addicts continue engaging in the substance or behavior even when it has negative health consequences (high blood pressure, weight gain, chronic obstructive pulmonary disease, hepatitis C, etc) or negative social or mental health consequences (job loss, divorce, loss of friends, trouble with the law, depression, etc). 

This basically sums it up. Addicts' lives are, in one way or another, dominated by their addictions. The addiction has negative consequences, but they're in its grip and can't get loose on their own. Even if they want to, cravings, anxious thoughts, and withdrawal symptoms may set in, and these compel the addict to return to the behavior or substance. Some substance addictions lead to physical dependence and sometimes very dangerous withdrawal symptoms (think delirium tremens), but this is not required for something to "qualify" as an addiction. 

How do doctors diagnose addiction?

A medical doctor, psychologist, psychiatrist, or counselor will look at the diagnostic criteria for the relevant addiction if the addiction is a diagnosable category. Not all are — shopping and sex, for instance — but many will still be widely studied and reported in the scientific literature. In this case, your doctor may already be familiar with the characteristics of such addictions, or they may need to research them. 

To determine if a person meets these diagnostic criteria, they'll ask a lot of questions. Many of these will be the list above, but in question form, for example:

  • Does your drinking ever interfere with your ability to work?
  • How much time do you spend smoking weed and recovering from its effects?
  • Do you ever skip social obligations so that you can gamble?
  • When you can't shop, how does it make you feel?

This process can sure be intimidating, but addicts should do their very best to answer all the questions fully and honestly — this will enable them to get the help they need.

In the case that an addiction has the potential to have caused physical health consequences, a physical exam is also recommended. This may include anything from liver function tests to tests to check for communicable diseases or high cholesterol. If the addiction is one that leads to physical dependence, detox may be recommended under medical supervision, on an outpatient or inpatient basis. 

Keep in mind that you — or your loved one — can receive help for an addiction even if it's not yet officially diagnosable as such, something that applies to many behavioral addictions. Cognitive behavioral therapy, other forms of talk therapy, and self-help or 12-step programs are much more inclusive than diagnostic criteria! Rehab programs are available for many behavioral addictions not currently included in diagnostic manuals. 

If you need help, or someone you care for does, talking to a family doctor is often a good first step. This is because they can perform the initial screening, offer physical exams where relevant, are familiar with community resources that can help addicts, and can refer addicts to programs or therapists. 

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