More than 40 million Americans are living with a substance use disorder (SUD) according to the 2020 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) – just 11% of these people in need receive any kind of treatment.
Just what defines a substance use disorder? The standard on which diagnoses are based is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). “If substance use causes significant problems in someone’s life, such as health issues, disability, and/or not meeting responsibilities at work, home, or school, they may have a substance use disorder.”
Criteria for Substance Use Disorder
Substance use disorders are classified as mild, moderate, or severe, depending on how many of the diagnostic criteria a person meets. The DSM-5 criteria for a substance use disorder are:
- Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, ex: overdosed, driven while under the influence, or blacked out.
- Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.
- Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.
- Withdrawal: When you stop using the substance, you experience withdrawal symptoms.
- Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.
- Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.
- Repeated attempts to control use or quit: You’ve tried to cut back or quit entirely but haven’t been successful.
- Much time spent using: You spend a lot of your time using the substance.
- Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.
- Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.
- Craving: You have experienced cravings for the substance.
In order to be diagnosed with a substance use disorder, you must meet two or more of these criteria within a 12-month period. If you meet two or three of the criteria, you have a mild substance use disorder. Four to five is considered moderate, and if you meet six or more criteria, you have a severe substance use disorder.
What is High-Functioning Addiction?
Many of those affected, including nearly 20% of all alcoholics, do not fit the stereotypical image of an addict — they are able to maintain their job, they may have spouses and children, and often enjoy busy social lives. Many professionals who abuse alcohol or other drugs are able to maintain a façade of normalcy, at least for some time.
With high functioning professionals who suffer from alcohol and substance use disorders, the consequences of their drinking or using are not always obvious to the casual observer — at least for a while. The high-functioning addict may face hangovers and other physical problems related to their substance abuse, but are able to hide the effects, or may attribute them to other causes (e.g., sickness, stress, lack of sleep) to prevent others from taking notice.
While the negative impact of drugs and/or alcohol may be subtle in professionals who suffer from addiction, there are a few signs that may identify an alcohol or substance use disorder, including:
- A high volume of consumption.
- Using drinking as a reward.
- Using drinking to cope:
- Socializing always involves drinking or drugs.
- Cancellations of non-drinking social engagements.
- Many rough mornings.
- A loss of interest in sports or hobbies.
While some addicts rapidly spiral out of control, experiencing dramatic turmoil and upheaval in their lives, high-functioning professionals with addiction tend to keep their problems well-hidden, sometimes for years.
Unfortunately, while they are managing to “keep it together,” high-functioning professionals are less likely to seek treatment for their addictions and related problems. Asking for help might not even be part of their lexicon, because they may be accustomed to success and controlling all areas of their life. Accepting that they need help with addiction may be a foreign concept. In many cases, the highest functioning professionals do not seek help until they reach a crisis point, such as facing job loss or deteriorating health.
Because they seek to hide their addiction for as long as possible before bottoming out, many high-functioning addicts are grappling with relatively advanced behavioral, mental wellness, and physical issues by the time they come to treatment. In short, their disease is often more advanced than it is for others who may seek treatment earlier.
Ketamine for Addiction: What to Know
Ketamine has been linked with better outcomes in substance misuse treatment when used along with behavioral and motivational therapy.
Two clinical trials — one looking at cocaine addiction and the other at alcohol dependency — showed that people who were prescribed ketamine, alongside therapy, had a better outcome than those who had therapy without ketamine treatment.
The people who had cocaine addictions got ketamine through an IV for 5 days, in addition to 5 weeks of mindfulness relapse prevention therapy.
The people who were dependent on alcohol got ketamine through an IV during the second week of a 5-week motivational enhancement therapy session.
In both studies, the researchers concluded that ketamine lowered the chances of restarting or relapsing into addiction.
More research on how ketamine affects addiction is needed, but it may change how your brain deals with cravings, motivation to quit a drug, and controlling behavioral reactions. Ketamine treatment might also make behavioral therapy more effective, which is a big part of overcoming addiction.
For ketamine to be helpful in addiction treatment, the current best practice is that it be used in conjunction with other addiction therapies. Intravenous ketamine therapy must be used under the close care of medical professionals. Recreational use could lead to addiction and other dangerous effects.
2 Matthew Goldenberg D.O. double Board Certified in Psychiatry and Addiction Psychiatry
3 WebMD May 2021