A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
There are several ways to know if you have an addiction (or if someone you love does). For a simple, informal diagnosis, we refer you to the article entitled, "What is addiction?" In this section, we review the formal method of determining if someone has an addiction. Professionals call this the diagnostic process, or simply diagnosis.
The diagnostic process in most developed countries follows a predictable sequence. First, the clinician performs an evaluation. The evaluation identifies symptoms. Then, the clinician uses this information to make a diagnosis (or several diagnoses). We might say a diagnosis is a label that summarizes a set of symptoms. In some cases, a diagnosis may also point to the cause of that set symptoms. Once the clinician makes a diagnosis, a treatment plan is then developed. The purpose of the treatment plan is to eliminate or diminish troubling symptoms. Some clinical models rest on the assumption that the reduction of symptoms leads to improved health and well-being. However, other models do not assume that symptom reduction leads to improvement. Instead, the focus is on improving the quality of life. From this perspective, improving the quality of life results in symptom reduction. This type of model is called psychiatric rehabilitation.
Diagnostic labels also serve another useful purpose. Healthcare providers use these labels to bill insurance companies or other funding sources. In the United States, there are two primary funding streams for addiction treatment: 1) public healthcare services (funded by the United States government) and 2) private health insurance (usually funded by employers). Many people seeking addiction treatment do not have private health insurance. This is because private health insurance is usually provided through employers. In advanced stages of addiction, it is usually difficult to maintain full-time employment. Furthermore, health insurance companies share information with each other. As such, many people with addictions are reluctant to use private insurance. It creates a lasting record of the addiction.
The person seeking treatment must meet the diagnostic criteria to be eligible for reimbursement. This intuitively makes sense. No one should receive "treatment" if there is nothing wrong that requires treatment. The most common diagnostic method for addiction follows the American Psychiatric Association (APA) guidelines. The APA publishes these guidelines in the Diagnostic and Statistical Manual of Mental Disorders, commonly called DSM-5 (APA, 2013).
When a credentialed and/or licensed treatment provider determines a person meets the diagnostic criteria they assign a diagnosis. Then, treatment services can begin. In the United States, private healthcare insurance pays for treatment services for people with insurance. For people without insurance, each state delivers treatment services. Usually these services are provided by the public mental health service delivery system in each state. Although each state's services vary, the federal government pays for these services to some degree. You can find and locate federally-funded treatment services here.
The DSM-5 provides a description of symptoms. Together, these symptoms form the basis for a diagnosis. The specific causes of addiction and treatment methods are not included. However, DSM-5 briefly mentions the biological causes of addiction such as the brain's reward system, and mentions the relationship between cravings and classical conditioning.
Diagnostic categories describe symptoms; not people with those symptoms. For this reason, we strive to avoid the use of the term "addict." This term labels and defines someone according to a diagnosis. A person is not an addict. A person is someone with an addiction. In fact, the DSM-5 avoided the use of the term "addiction" altogether. The authors of DSM-5 thought the word "addiction" could have a potentially negative connotation. Therefore, they chose to use the term Substance Use Disorder instead. The authors believed this to be a more neutral term. We have chosen to use the word addiction because it is a widely recognized term. We have previously provided our definition of this term.
Although the DSM-5 (APA, 2013) is the most frequently used method for diagnosing addictive disorders, there is no law that requires its use. There are other (but less well-known) approaches to diagnosis and treatment. Despite this fact, the DSM remains the unofficial standard for diagnosing addictions. Consequently, DSM- 5categories form the organizational structure for addiction research. Thus, although there are many valid disagreements about the DSM, its role within the health care system is without competition (Bentall, 2006).
A diagnostic assessment begins by collecting information from many different sources. This may include clinical interviews, questionnaires, laboratory findings, and medical records. Ideally, it also includes input from friends, family members, and romantic partners. Factors considered in the assessment include: the number and type of substances being used; the routes of administration (e.g. inhalation, injection); the frequency of use; the psychological and physical symptoms; family history; any co-occurring mental or physical disorders; prior treatment attempts; and life circumstances (including child care responsibilities, pregnancy, work schedules, social environment, traumas, etc.). Clinicians gather this information to make a proper diagnosis. This information also helps to develop a treatment plan.
Ideally, clinicians conduct a complete bio-psycho-social-spiritual assessment. A thorough assessment of this type is more helpful than a simple diagnostic code. Furthermore, a bio-psycho-social-spiritual assessment is the foundation for an individualized treatment plan.
Most addictions fall into the DSM-5 category called Substance-Related and Addictive Disorders (APA, 2013). Other addictions that do not have specific DSM-5 diagnostic criteria are discussed in the section on activity addictions.
Within the Substance-Related and Addictive Disorders category are two sub-types: 1) substance use disorders, and 2) substance-induced disorders. With respect to addiction, the most common category is the substance use disorders. We discuss the basic diagnostic criteria for substance use disorders and substance-induced disorders in the following sections.