Alcohol & Drug Addiction - Other Person Diagnosis

If you think you may be affected by a friend, co-worker, or family member with an alcohol or other drug problem, the following test can help you determine if your suspicions are founded. Answer each question with a "yes" or "no."

• Are you ever afraid to be around the person when he or she is drinking or using drugs because of the possibility of verbal or physical abuse?
  
• Do you worry about the person's drinking or drug use?
  
• Has the person broken promises to control or stop his/her drinking or drug use?
  
• Have you ever made excuses for the way the person behaved while drinking or using?
  
• Do you feel guilty about the person's drinking or drug use?
  
• Do you feel anxious or tense around the person because of his or her drinking or drug use?
  
• Are you afraid to ride with the person after he or she has been drinking or using?
  
• Have you ever lied to anyone else about the person's drinking or drug use?
  
• Have you ever helped the person "cover up" for a drinking or using episode by calling his or her employer, or telling others that he or she is feeling "sick"?
  
• Have you ever been embarrassed by the person's drinking or drug use?
  

If you answered "yes" to three or more of these questions, then there is a good chance that the person you care about has a drinking or drug problem. If you answered "yes" to any five, the chance is even greater. And if you answered "yes" to seven or more, you can feel safe in assuming that the person you care about needs help.

We have compiled a mixture of references from the internet and other sources that give some insight into the addictive personality, the disease of addiction, diagnosis references, and some research. As you will notice, the addiction is in the person, and the behaviour/drug/chemical, seem to be the symptom, the evidence rather than the cause. We need to intervene with the addiction. Recovery is allot more than just stopping, and just stopping with out skilled help is an unrealistic target.

Alcoholism

NCADD

"Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial."

"Primary" refers to the nature of alcoholism as a disease entity in addition to and separate from other pathophysiologic states which may be associated with it. "Primary" suggests that alcoholism, as an addiction, is not a symptom of an underlying disease state.

"Disease" means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage.

"Often progressive and fatal" means that the disease persists over time and that physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

"Impaired control" means the inability to limit alcohol use or to consistently limit on any drinking occasion the duration of the episode, the quantity consumed, and/or the behavioural consequences of drinking.

"Preoccupation" in association with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The relative value thus assigned to alcohol by the individual often leads to a diversion of energies away from important life concerns.

"Adverse consequences" are alcohol-related problems or impairments in such areas as: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anaemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behaviour); interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships); occupational functioning (e.g., scholastic or job problems); and legal, financial, or spiritual problems.

"Denial" is used here not only in the psychoanalytic sense of a single psychological de fence mechanism disavowing the significance of events, but more broadly to include a range of psychological man oeuvres designed to reduce awareness of the fact that alcohol use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery.

Approved by the Boards of Directors of the National Council on Alcoholism and Drug Dependence, Inc. (February 3, 1990) and the American Society of Addiction Medicine (February 25, 1990).

This definition was prepared by the Joint Committee to Study the Definition and Criteria for the Diagnosis of Alcoholism of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine:

Conveners: Robert M. Morse, MD, Joint Committee Chairman; Daniel K. Flavin, MD, NCADD Medical/Scientific Director

Members: Daniel J. Anderson, PhD; Margaret Bean-Bayog, MD; Henri Begleiter MD, PhD; Sheila B. Blume, MD, CAC; Jean Forest, MD; Stanley E. Gitlow, MD; Enoch Gordis, MD; James E. Kelsey, MD; Nancy K. Mello, PhD; Roger E. Meyer, MD; Robert G. Niven, MD; Ann Noll; Barton Pakull, MD; Katherine K. Pike; Lucy Barry Robe; Max A. Schneider, MD; Marc Schuckit, MD; David E. Smith, MD; Emanuel M. Steindler; Boris Tabakoff, PhD; George Vaillant, MD

Members Ex-Officio: James Callahan, DPA; Jasper Chen-See, MD; Robert D. Sparks, MD

Emeritus Consultant: Frank A. Seixas, MD

Bulimia

Bulimia: Also called bulimia nervosa. An eating disorder characterized by episodes of secretive excessive eating (binge-eating) followed by inappropriate methods of weight control, such as self-induced vomiting (purging), abuse of laxatives and diuretics, or excessive exercise. The insatiable appetite of bulimia is often interrupted by periods of anorexia.

bulimia is generally thought to be a psychological eating disorder. It is another condition that goes beyond out-of-control dieting. The cycle of overeating and purging can quickly become an obsession similar to an addiction to drugs or other substances. Although bulimia has been widely considered to be psychological and sociocultural in origin, not everyone is susceptible to developing bulimia.

There is now a substantial literature showing that bulimia is strongly familial and that the pronounced familial nature of bulimia is due largely to the additive effects of a number of genes. One bulimia susceptibility gene is known to be linked to chromosome 10p (the short arm of chromosome 10). Another susceptibility gene for bulimia may be on chromosome 14.

Drug Addiction

Drug addict, junkie, smack head. invariably references to heroin. This misses the point by a mile, and condemns many to a miserable existence. Addiction is the condition. The drugs are the symptom. Many drugs offer a wide variety of specific conditions, but all come from the same problem point. The addictive use of them. Pot, speed, crack, cocaine, valium diazepam, benzo's, etc etc the list is endless, but the addiction to them is easy to diagnose.

Diagnostic Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of the substance.

(2) Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the substance

b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

(3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control).

(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control).

(5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation).

(6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).

(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. (adverse consequences).

Eating Disorder

The most common element surrounding ALL Eating Disorders is the inherent presence of a low self esteem

Having an "Eating Disorder not Otherwise Specified" can mean a number of things... It can mean the individual suffers from Anorexia but still gets their period; It can mean they may still be an "average healthy weight" but be suffering Anorexia; It can mean the sufferer equally participates in some Anorexic as well as Bulimic behaviours (sometimes referred to as being Bulimirexic).

Just as it is important to remember that doctors can make mistakes, it is also important to keep in mind that it has only been until very recently (in the last 10 years) that awareness on the subject Eating Disorders has really begun to surface. People are frequently confused (including doctors) about the real differences between Anorexia and Bulimia (Anorexia essentially being self-starvation, and Bulimia being defined as going through binge and purge cycles - simply put), and often times know nothing at all about Binge-Eating Disorder.

For example, a doctor relies completely on his diagnostic manuals and reads the criteria to diagnose an individual as having Anorexia. He finds that his patient has regularly practiced self-starvation techniques, thinks of herself unrealistically as overweight, and seems to be hard on herself... BUT she still has her monthly period (the diagnostic criteria states that there must be loss of monthly menstrual cycles). He may technically diagnose the patient as having "An Eating Disorder not Otherwise Specified".

Another example would be that of a person suffering through binge and purge cycles once a week, who feels that they are overweight and who feels depressed. (The diagnostic criteria states that the sufferer must binge and purge, on average, at least twice a week.)

Practically speaking, in the first example the person suffers from Anorexia and the second suffers from Bulimia. Clinically speaking, according to the "text book" they would suffer from "An Eating Disorder not Otherwise Specified". In either case, both people are suffering with an Eating Disorder, both are in danger of potentially deadly physical complications, and both need to make a choice for recovery.

The most important thing to remember is that Eating Disorders, Anorexia, Bulimia, Compulsive Overeating, Binge-Eating Disorder, any combination of them, (or any that fall into the clinical category of EDNOS), are ALL psychological illnesses, none less or more serious than the next. They all have their physical dangers and complications, they all present themselves through an array of disordered eating patterns in one way or another, and they all stem from emotional turmoil such as a low self-esteem, a need to forget feelings and/or stress, a need to block pain, anger and/or people out, and most of all, a need to cope. The bottom line is that we are ALL suffering. If you find you suffer from any Eating Disorder then it's time to reach in to yourself.


Diagnostic Criteria
The following is considered the "text book" definition of an Eating Disorder Not Otherwise Specified, to assist doctors in making a clinical diagnosis... it is in no way representative of what a sufferer feels or experiences in living with an Eating Disorder. It is important to note that this is a Clinical definition, and is in no way meant to say that any sufferer does not struggle, and that the condition is not serious. It is not meant to say you do not have Anorexia or Bulimia (or a combination of both sometimes known as Bulimirexia). This is a clinical category of disordered eating meant for those who suffer but do not meet all the diagnostic criteria for another specific disorder.

Examples Include:

1. All of the criteria for Anorexia Nervosa are met except the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for a duration of less than 3 months.
4. An individual of normal body weight who regularly engages in inappropriate compensatory behaviour after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
5. An individual who repeatedly chews and spits out, but does not swallow, large amounts of food.
6. Binge eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviours characteristic of bulimia nervosa.

Information compiled from the something fishy website

Gambling

Gamblers Anonymous will ask

• Did you every lose time from work or school due to gambling?
• Has gambling ever made your home life unhappy?
• Did gambling affect your reputation?
• Have you ever felt remorse after gambling?
• Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
• Did gambling cause a decrease in your ambition or efficiency?
• After losing did you feel you must return as soon as possible and win back your losses?
• After a win did you have a strong urge to return and win more?
• Did you often gamble until your last dollar was gone?
• Did you ever borrow to finance your gambling?
• Have you ever sold anything to finance gambling?
• Were you reluctant to use "gambling money" for normal expenditures?
• Did gambling make you careless of the welfare of your family?
• Did you ever gamble longer than you had planned?
• Have you ever gambled to escape worry or trouble?
• Have you ever committed, or considered committing, an illegal act to finance gambling?
• Did gambling cause you to have difficulty in sleeping?
• Do arguments, disappointments or frustrations create within you an urge to gamble?
• Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
• Have you ever considered self destruction as a result of your gambling?

Most compulsive gamblers will answer yes to at least seven of these questions.

The premier example of an Impulse-control disorder listed in the DSM-IV is Pathological Gambling (DSM-IV, p.618):

Table 2: Diagnostic criteria for Pathologic Gambling

A persistent and recurrent maladaptive gambling behaviour as indicated by five (or more) of the following:

(1) is preoccupied with gambling (preoccupation).

(2) needs to gamble with increasing amounts of money in order to achieve the desired excitement. (tolerance)

(3) has repeated unsuccessful efforts to control, cut back, or stop gambling (loss of control).

(4) is restless or irritable when attempting to cut down or stop gambling (withdrawal symptoms).

(5) gambles as a way of escaping from problems or of relieving a dysphoric mood (preoccupation).

(6) after losing money gambling, often returns another day to get even ["chasing" one's losses] (loss of control)

(7) lies to family members, therapist, or others to conceal the extent of involvement with gambling (continues despite adverse consequences)

(8) has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling (adverse consequences).

(9) has jeopardized or loss a significant relationship, job, or educational or career opportunity because of gambling (adverse consequences).

(10) relies on others to provide money to relieve a desperate financial situation caused by gambling (adverse consequences).

After each criterion we have appended what we consider the essential element which may be associated with an addictive disorder. It is instructive to compare this list with the DSM-IV criteria for a substance-related disorder (DSM-IV, p.181):

Internet

Ten Symptoms of Computer Addiction (by James Fearing, Ph.D.)

• A demonstrated "loss of control" when trying to stop or limit the amount of time on the computer. (Breaking promises to self or others. Promising to quit or cut down and not being able to do so)
• Being dishonest or minimizing the extent of the time you stay on the computer, or covering up or being dishonest about what activities you participate in when on the computer.
• Negative consequences experienced by the computer user or his/her friends or family as a direct result of time or activities spent on the computer.
• Participation in high risk or normally unacceptable behaviours when using the computer. Compromising your morals and values based on the opportunity to remain anonymous and protected on the computer. (a good test for this is to ask yourself if your spouse, partner or family would approve of what you were doing on the computer)
• An overdeveloped sense of importance for the computer in ones life. Defending your right to use the computer as much as desired, regardless of the fact that people in your life are feeling left out and neglected. (denial of the problem and justification; not being able to hear or feel what the other people are saying regarding your computer behaviour)
• Mixed feelings of euphoria (a "rush"), combined with feelings of guilt brought on by either the inordinate amount of time spent on the computer or the abnormal behaviour acted out while using the computer.
• Feelings of depression or anxiety when something or someone shortens your time or interrupts your plans to use the computer.
• Preoccupation with the computer and computer activities when you are not using the computer (thinking about the computer and its activities when doing something else; i.e. having a family dinner, working on project deadline etc.)
• Finding yourself using the computer at times when you are feeling uncomfortable, irritated, or sad about something happening in your life. ( feeling uncomfortable in your relationship, so you will self medicate and "hide out" on the computer) Using time on the computer to become externally focused outside yourself as a way to avoid facing what is happening in your life, and avoiding feeling the appropriate feelings inside yourself. (self medicating)
• Experiencing financial concerns or problems in your life as a result of money being spent on computer hardware, computer on-line charges, or any other costs associated with computers. (Spending money on computer related items which should have been allocated to other normal living expenses)

If you said yes to one question you may have a problem with computer addiction. If you said yes to two questions, there is a good chance you do have a problem with computer addiction. If you answered yes to three or more, you are demonstrating a pattern of behaviour which would suggest that you are addicted to your computer and/or the activities on it.

This questionnaire was developed by James Fearing, Ph.D., at the National Counseling Centre in Minneapolis, MN.