Written by: Arin Lee
Edited by: Eastlyn Zhou
For as long as drugs, alcohol, and other substances have been in existence, there has always been the looming threat of substance use disorder. However, there is a popular but harmful misconception that substance use disorder is in the hands of the individual, and that everything is within the user’s control. There are several reasons why this understanding of substance use disorders is both faulty and damaging.
The Diagnostic and Statistical Manual of Mental Disorders states that the word “addiction” is not used as a diagnostic term because of its negative connotation, and instead the more neutral term “substance use disorder” is used to generally diagnose a wide plethora of more specific disorders and symptoms (American Psychiatric Association, 2013). The word “addiction” itself also implies that the individual has possession or control of the substance that they are using and its enduring effects, contributing to the belief that substance use disorders are a result of poor morals or weak character (Hill, 2021). On the contrary, substance use disorders are defined by four important criteria, the most relevant of which being impaired control (American Psychiatric Association, 2013). There are several behaviors that fall under the broader impaired control criterion: taking a substance in larger amounts/longer than intended (1), the persistent desire to stop use of a substance with reports of unsuccessful attempts to stop use of the substance (2), spending a significant amount of time obtaining/using/recovering from the effects of the substance (3), and craving which is defined as an intense desire or urge to indulge in a substance (4) (American Psychiatric Association, 2013). Psychologically, those with substance use disorders are not able to control the way their bodies react to a drug’s effects and frequently experience a crippling sense of shame and self-blame that is intensified by social and familial rejection.
There is also a common misconception that the individual oftentimes purposefully chose to take addictive substances; however, this is just not the case. Many individuals living with a substance use disorder came to be as a result of being prescribed potentially addictive painkillers and other prescription drugs. Due to compliance with a doctor’s prescription, many people grow unwillingly and unwittingly dependent on medications such as oxycodone or codeine (American Psychiatric Association, 2013; Smith, 2018). The reality of substance abuse is that the detriments extend much further than internal turmoil and in fact severely impede social cognition. Some behaviors that may arise from social impairment are lying, cheating, stealing, and anger outbursts, all of which the individual may have little to no control over (American Psychiatric Association, 2013; Hill, 2021). In addition to these socially detrimental behaviors, there are also underlying chemical reactions that the individual has little to no control over, hence the label of the criterion for substance use disorder being “impaired control” (American Psychiatric Association).
These misconceptions about substance use disorder contribute heavily to the large amounts of stigma that surround the disease and the term “addiction”, and can thus indirectly and directly harm individuals who live with disease. Without the support of others to help fuel an individual’s route to recovery, the individual is even more prone to suicidal ideation and attempts. Merely living with substance use disorder, especially opioid use disorder, is associated with higher risk for suicide attempts and completed suicides (American Psychiatric Association, 2013). Compassion and understanding is paramount for successful treatment and recovery from substance use disorder. The misconceptions about substance use disorders and the individuals living with them can lead to detrimental, and even fatal, consequences.
References:
American Psychiatric Association. (2013). Cautionary statement for forensic use of DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.CautionaryStatement
Hill, T. (2021, September 13). Is addiction a choice?. Mental Health First Aid. https://www.mentalhealthfirstaid.org/external/2019/03/is-addiction-a-choice/.
Smith, A. (2022, June 29). Disease or choice? the debate surrounding the origin of addiction. HCRC. https://www.hcrcenters.com/blog/disease-or-choice-the-debate-surrounding-the-origin-of-addiction/.
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