Understanding Your Substance Use Disorder: 11 Factors of Addiction

PUBLISHED Apr 23rd, 2021 & UPDATED ON Nov 29th, 2022

Addiction is NOT an easy topic to talk about, and it’s certainly not rainbows and unicorns if you’re going through it! And there are many types of addiction, including behaviours, but today we’re going to focus on substance use. You could be addicted to alcohol, drugs, caffeine, or nicotine, and the rewarding effects may make you feel the need to repeat it over and over again — despite some of the not-so-nice consequences.

But you’re defs not alone. Sooo many celebrities have spoken out about their journey with substances, like Zac Efron and Bradley Cooper…even Oprah! It’s also portrayed all over TV shows and movies, from Lip’s alcoholism in Shameless to Rue’s drug addiction in Euphoria. But what causes a substance use disorder, how does it affect us, and can we control it? That’s what we’re here to answer with the help of psychotherapist Dr. Courtney Tracy.

What Is Addiction?

Well, it all starts with using a substance recreationally, which eventually transitions into using it to cope…and then into using it to survive! You can be physically addicted to the point that you experience withdrawal symptoms when you don’t use — like if you miss your daily cup of coffee, you’ll get a nasty headache or maybe start acting a little grumpy.

Other symptoms of withdrawal (not necessarily for coffee) include:

Insomnia
Mood swings
Not being able to control emotions
Cognitive issues (like memory or decision-making)
Anxiety
Depression
Low energy
Inability to manage stress
Trouble with relationships

You can also be psychologically addicted (emotionally or mentally), where you feel that you need that substance to perform — like having a biiiiig presentation and panicking because you didn’t have that cup of coffee! You’ll experience a mix of these symptoms, and find yourself craving the smell of those freshly-ground coffee beans or even missing the ritual of grinding them yourself.

Either way, being addicted is not something you planned. And that whole “addictive personality” concept is actually a myth. So, let’s talk about why it can happen to anyone!

What Causes Addiction?

Some people can use substances occasionally, love the effects, and not feel the need to do it regularly. Meanwhile, someone else might try it for the first time and crave more almost immediately! But how does that happen? Well, to put it bluntly, addiction is a brain disorder (not a personality issue).

There’s a misconception that being selfish, impulsive, or not having life goals for yourself classifies you as having an “addictive personality.” Not very nice, right? This narrative can actually be suuuper harmful, because it perpetuates the idea that you’re not at risk for addiction because you don’t have the “right” personality or, on the other hand, that you’ll never recover because it’s just a part of who you are!

“Addiction is not a moral failing,” says psychotherapist Dr. Courtney Tracy in an episode of the Truth Doctor Podcast. “Addiction is not just for people who have had a fucked up upbringing. Addiction is not just for people who make the choice to become actively addicted….Most people use substances because they’re looking for some type of escape.”

There are biological, psychological, social, and environmental things you could be influenced by. Like genetics, mental health issues, a history of familial use, a bad childhood, and everything in between! And now that we’ve trumped that myth, we can figure out how all of this affects us.

Substance Use Disorders Are Not a Choice

First, let’s re-establish that being addicted to a substance is NOT YOUR FAULT, even if some people in your life may make you think otherwise! It’s something you might be ashamed of, but it’s not a life you chose. Sure, that first sip, that first pill, or that first smoke was up to you, but you couldn’t have predicted the outcome.

Your body gets sucked into the addiction cycle. An emotional trigger makes you fantasize about using, and makes you think using will bring you relief! Then the fantasizing turns into obsession and you start planning when and how you will use. Then you use, hoping for that relief, but instead you lose control of your behaviour. So, you end up facing the consequences, stop using, and allow time to pass (until another emotional trigger just causes the cycle to begin again!).

“It may have been a choice for them to pick up the substance and use it for the first time. But, they didn’t realize that they had a choice not to do that (because of the circumstances of their life),” explains Dr. Tracy. “And maybe the circumstances were struggles, maybe it was peer pressure, maybe it was a lack of education of what the substance would do to their body from the first moment that they took it.”

Think about it this way. Tests have been done on rats to see how likely they are to develop an alcohol use disorder. But when the rat becomes addicted, we don’t call it the rat’s choice. So, why the heck would we say that a human has made the choice to become addicted?

Assessing Severity of Addiction

Severity USED to be classified as either addiction or dependence. But the word “dependence” got a little confusing, because it didn’t include people who may not have a debilitating addiction (but still need help!). The American Psychological Association (APA) has now defined it as a substance use disorder instead, which is categorized as either mild, moderate, or severe. But what exactly does that look like?

Well, if you go to a doctor, chances are they’ll have you fill out an addiction severity index. It’s basically a suuuper long form asking what you use, how much you use, how much you spend, et cetera, et cetera. But for the time being, Dr. Tracy provides this list of 11 criteria that can help you assess your severity!

11 Criteria for a Substance Use Disorder

Like we mentioned earlier, a common symptom of being addicted to a substance is making excuses for why you need it! For example, needing it to socialize, to sleep, or just function in general. But there are many more factors that point towards addiction. So, if you think you may currently be experiencing a substance use disorder, ask yourself these questions!

Hazardous Use: Is my life, or the life of someone else, being put at risk by me using?

Social/Interpersonal Problems: Has substance use caused issues in my relationships?

Neglecting Responsibilities: Do I neglect work or school in order to use instead?

Withdrawal: Do I experience withdrawal symptoms when I stop using?

Tolerance: Do I have to use more and more to get the same effect?

Amount: When I first used, did I expect to use as much, and as often, as I do now?

Control: Have I tried to stop or moderate my use, but just can’t?

Time: How much time do I spend getting substances, using them, and recovering from them?

Related Problems: Do I keep using despite physiological, psychological, or physical problems?

Missing Out: Have I stopped certain activities I once enjoyed in order to use?

Craving: Is my body craving more substance use?

Dr. Tracy breaks it down this way. Checking off 2 to 3 of these boxes indicates a mild substance use disorder, 4 to 5 would be moderate, and 6 or more is classified as severe. But less criteria doesn’t mean less suffering, because someone with 2 boxes can hurt JUST as much as someone with 7!

Brain Changes & Getting Sober

You may have heard this question before: “Is addiction a disease?” And to be frank, it kinda can be! Remember earlier when we talked about how genetics, mental health issues, a history of familial use, or a poor childhood can lead to addiction? Well, ALL of those things point to the disease model of addiction! Aaaand just like a disease, the longer addiction is left untreated, the more life-threatening it gets.

Prolonged use of any substance can also lead to brain changes. We’ll skip the big sciency words, but essentially substances target the parts of your brain that control motivation, reward, memory, impulse control, and judgement. But we’ve got some good news! These things can usually be controlled once the substance use has stopped.

How to Overcome Addiction

It’s a long and hard journey (likely with some pain and withdrawal symptoms), and the road to recovery is almost never linear because relapsing is always a very real possibility. But whether your road is natural recovery, peer-based recovery, or clinical-based recovery, you CAN make it to the other side eventually — even if you’re scared shitless while doing so!

Aside from the pretty difficult physical stuff, you may be afraid to get sober because you don’t quite remember what a sober life feels like. You’ve gotten used to numbing the hard shit in life, and going back to feeling ALLLL the pain can feel like the scariest thing in the world! But the important thing to remember is — just like the cause of addiction lies in toxic environments, hatred and isolation — the cure for addiction lies in supportive environments, love, and community.

If you are struggling with substance use, try turning to friends, family, or whoever you trust most. We also recommend seeing a professional. They’ll be able to help you wean off of the substance to curb your physical dependence, or help you create new thoughts and behaviours to stomp that psychological dependence.

You can also call an addiction helpline at 1-800-565-8603 (Drug and Alcohol Helpline, Canada) or 1-866-698-0672 (American Addiction Centers, US).

For more information on substance use disorder, tune into the “No B.S. Break Down: Addiction” episode of the Truth Doctor Podcast.