27 ,Dec, 2018

Addicted…..Yes or No?


Ticking boxes provided by the DSM5 (The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) or Victorian Governments  SELF COMPLETE INITIAL SCREEN FOR ALCOHOL AND OTHER DRUG PROBLEMS. is a guide to assist Psychologists and Counsellors as to a client’s dependence/addiction to a substance but it should never be regarded as a definitive reason for declaring a client has become addicted/dependent to a substance.


A recent 21Renew client illustrates this.


Case Study Michael (his name has been changed)

Michael was a middle aged business man who had attended 3 residential rehabs in 2017/18 and had been diagnosed at each facility as being addicted to alcohol and cocaine.


Using the 11 criteria of the DSM5

  1. Taking the substance in larger amounts or for longer than you’re meant to.
  2. Wanting to cut down or stop using the substance but not managing to.
  3. Spending a lot of time getting, using, or recovering from use of the substance.
  4. Cravings and urges to use the substance.
  5. Not managing to do what you should at work, home, or school because of substance use.
  6. Continuing to use, even when it causes problems in relationships.
  7. Giving up important social, occupational, or recreational activities because of substance use.
  8. Using substances again and again, even when it puts you in danger.
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
  10. Needing more of the substance to get the effect you want (tolerance).
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.


Michael ticked Yes to all of the criteria (apart from 9 and 11) and similar outcomes were seen following his completion of the Victorian Governments  SELF COMPLETE INITIAL SCREEN FOR ALCOHOL AND OTHER DRUG PROBLEMS.


Despite all of the above findings I was not convinced Michael was addicted to alcohol or cocaine nor was I convinced he had become dependent. During his residential stay at 21Renew I had several one on one sessions with Michael and during these sessions several facts emerged.


Michael had started his own business at the age of 22 and everyone told him it would never work and he would go broke. He also married at a young age and commenced a family. He was determined to prove everyone was wrong about his decision to buy a business and worked 60-70 hours a week for the next 15 years. He was rarely home on the weekends and when he was home he was constantly thinking about work.


Driven to succeed Michael proved his detractors wrong and built a very successful business and with this came all the trappings of success, better home, better car and a more affluent style of living.


After 15 years of relentless dedication and focus Michael was mentally and physically worn out. The enjoyment in going to work ceased and Michael felt his commitment to building the business had seen him miss out on life. In short he had a midlife crisis.


What followed were several years of extremely erratic behaviour including excessive use of alcohol and towards the end of this period frequent use of cocaine.


At 21renew one of the questions we always seek to find an answer to is, Why did the client start drinking or using drugs.?  The answer to this question is vital for a number of reasons and in Michaels’s case it explained why his drinking dramatically escalated and why he started using cocaine.


Physically and mentally Michael was burnt out. 15 years of relentless 60-70 hour weeks had taken its toll.


Mentally Michael had to deal with three major issues. The first issue was his identity had been defined by his success in building the business. As each year passed and the business became more successful so to did Michael’s identity of who he was become more cemented to the success of his business.  When the midlife crisis hit and he fell out of love with his business he also fell out of love with who he was. He needed to redefine who he was and what he stood for.


The second issue was the need for Michael to understand his erratic behaviour was a direct result of his midlife crisis. After 15 years of continuous 60-70 hour weeks he had literally blown up his engine. His abuse of alcohol and cocaine were directly traceable to his midlife crisis.


The third issue Michael needed to address was to come to the realisation that while he needed constant challenges in his life he also needed to look after his physical and mental well-being. I used the analogy of car with Michael and explained to him he had been in overdrive for 15 years and blown up his engine. From this point on he needed to use mental gears and make sure he throttled back into neutral on a regular basis.


Following these discussions and reviewing his Assessment we came to the conclusion Michael was not addicted to alcohol. That said his abuse of alcohol had reached a point where if he continued drinking at the same levels he currently was then there was every chance he would cross the line into addiction/dependence. Michael put into place a simple plan. He would have a drink if there was a reason to have a drink and would set limits around this.


His use of cocaine had reached the stage where it was only a short walk into addiction/dependence and Michael agreed with this. After giving the issue a great deal of thought Michael agreed he needed to implement an abstinence approach to the use of cocaine (and any drugs).


It is now 6 months since Michael left 21renew. He has got his personal and business life back on track. He is living a more balance life style and making sure he is taking time out. He has a drink when there is an occasion, has remained abstinent from cocaine and is following the plan he put into place during his stay at 21renew.


If you would like to know more about 21renew then please email me on graeme@graemealford.com.au or ring 1800 300 813.