identifying addiction, diagnosing addiction, what is addiction, defining addiction, dependence

Identifying or being diagnosed

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of consumption]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

The people interviewed for this website describe their alcohol and other drug use in a range of different ways. Some use the word ‘addiction’, others prefer the term ‘dependence’ and several opt for ‘habit’. When asked what prompted them to describe their consumption in these terms, some say they were experiencing symptoms they associate with addiction or dependence (see also What is addiction or dependence?). These include ‘tolerance’ (the need for higher doses after repeated consumption), ‘withdrawal’ (physical symptoms experienced when stopping or cutting down), difficulty stopping, and a strong desire or ‘craving’ for the drug. Several say they thought they had an addiction or dependence because they were devoting a lot of time to consumption or it was disrupting other parts of everyday life such as work and relationships.

While some say they identified an issue themselves or ‘self-diagnosed’, others received a diagnosis from a doctor or other health professional. A few don’t remember receiving a diagnosis, despite consulting a health professional about their consumption. For others it was only when they were prescribed treatment, or referred to an alcohol and other drug service, or advised to cut down or stop their consumption, that they began to think they might have a problem.

For a few having contact with the criminal justice system in relation to alcohol and other drugs prompted them to think they had a dependence or addiction. Others say that family or friends expressed concern about their well-being or encouraged them to seek help and this led them to think they had an issue.

Although the terms ‘dependence’ and ‘addiction’ are widely used in healthcare settings, some of the people interviewed for this website say they don’t see their regular alcohol or other drug use in these terms. They point out that the terms imply that a person is sick or has a problem that needs to be addressed. They say they don’t identify with this idea even though their consumption is regular and occupies a key place in their lives.

Self-identifying addiction or dependence

Experiencing symptoms

Many of our participants say they identified an issue themselves because they were experiencing symptoms they associate with addiction (see also What is addiction or dependence?). These include ‘tolerance’ (the need for higher doses after repeated consumption), ‘withdrawal’ (physical symptoms experienced when stopping or cutting down), difficulty stopping, and a strong desire or ‘craving’ for the drug. Others describe how, when they began taking more and more of a drug daily, or spending a lot of time or money on the drug, this prompted them to think they were dependent on it. As Matthew (M, 49, not working due to illness, cannabis) explains, ‘When you haven’t got any [cannabis] it’s all you think of: where you can get it and you’ve got to go and get it […] It just becomes your main priority […] That’s when I started to feel like it was an addiction’. Some say that it was when their consumption was disrupting everyday activities that they began to think they were experiencing a problem. As Jason (M, 34, studying, ice) puts it, ‘I identified it as a problem […] when I [stopped] going to work [and began] avoiding friends and being more introverted than I would normally be’.

Andrew (M, 41, works in education, cannabis and alcohol) says that he felt a ‘need’ to drink heavily every day, which suggested to him that he had an ‘addiction’ to alcohol.

Part 1

[When I was 19] alcohol was a problem, but it wasn’t an addiction until a couple of years later [from aged] 22 till 32. A ten-year addiction to alcohol.

Part 2

I needed it every day. Like, not during the day so much, but by night I would get drunk. Like, I would drink a bottle of bourbon in a couple of hours and just like the heavy stuff, the Black Label, and just wipe myself out. Lose my memory, black out, but have a good time doing it most of the time […] By the age of 29 it was a real problem.

According to Nick (M, 50, unemployed, heroin), he realised he had a ‘drug habit’ when he started to experience unpleasant physical symptoms when he didn’t take heroin.

About two months after [I started taking heroin] I realised I was doing it every day and I […] didn’t feel right. You know, I was starting to feel sore and I realised that I had got a drug habit […] My stomach, bad stomach cramps. Your legs feel really sore and tired and hot and cold flushes. That’s what done it.

[…]

[I haven’t been diagnosed with drug dependence]. I realised for myself and through other drug users telling me that you’ve got a habit when you are sick like that.

Role of treatment & self-help

Taking part in alcohol and other drug treatment or self-help programs prompted some to see themselves as having a dependence or addiction. For example, Melanie (F, 29, primary carer for her children, ice) says she began to ‘recognise a lot about [her]self’ while in residential rehab: ‘Before coming [to rehab] I didn’t recognise myself as an addict. You know, I just thought I wasn’t an addict. There was nothing wrong with me. Everyone uses drugs, but yeah, the difference between me and everyone else was that they don’t abuse it as I did’.

Bill (M, 43, works in retail, alcohol) says that listening to other people’s experiences in Alcoholics Anonymous made him realise he ‘did have a problem’.

Part 1

I thought I’d ring Alcoholics Anonymous just to see if I could get some sort of help and I rung a bloke and he said, ‘I’ll pick you up after work and take you to this meeting’ […] And I went along and met up with a group of people, probably about 15 or 20 people, I guess […] I actually got up and said, ‘I’m an alcoholic’. But yeah, everyone else sort of shared their experiences. And that’s when sort of the penny dropped, and I realised that I did have a problem. But I got a lot of useful information out of that. And yeah, I just sort of realised that I had a problem at that point. And up until then, I probably was in denial about that. You know, I kind of realised, but you just don’t want to actually […] say, ‘Yeah, I have a problem’ because it’s a hard thing to sort of swallow, I guess. When you see everyone else doing this and they seem to be functioning normally it’s like, ‘Well why am I the one that’s blacking out all the time and why am I the one who’s hurting myself and not getting the most out of myself?’

Part 2

I only actually ever went to one [AA meeting], but as I said, I sort of got the information. I realised that I was an alcoholic at that point and yeah, that I did have a problem.

Contact with the criminal justice system

Some of those interviewed had contact with the criminal justice system in relation to alcohol or other drugs. Several say their experience prompted them to reflect on their consumption and led them to think they had a dependence or addiction. Some of those who had lost custody of their children talk about how these experiences made them think their consumption was a problem.

When Melanie (F, 26, primary carer for her children, ice) lost custody of her children, she began to think her ice use was no longer manageable and had become ‘problematic’. (Played by an actor)

I thought I had [my ice use] all under control. And the majority of the time I’d just stay awake until I had to do what needed to be done. Like, take the kids to school and stuff like that, and then rest while they were at school […] But yeah, it wasn’t manageable […I realised that] when my kids were taken off me.

[…So yeah, I’d been taking ice on and off] since I was 22 […] but I guess it became problematic within the last year […] After my kids were taken, I […] pretty much lost it. And that’s when I started using pretty much every day for about two weeks. Me and my partner were fighting a lot because we were blaming each other. And then yeah, after, like, two weeks of just abusing the drugs […] we realised that we did have to do something about it.

Tiffany (F, 33, works in hospitality, ice) says she realised she had an addiction when she was given a custodial sentence for a drug-related offence. (Played by an actor)

I was really in denial and, you know, I never thought, ‘I’m an addict’ […] And then it got to the point when I hit rock bottom, when I […] ended up in jail. That’s when I surrendered and I said, ‘Oh my God, I’m really an addict. I’ve supplied, I’m in jail, I’ve committed a crime by supply’. I was in jail for one year, that really made me think about my life and, you know, how this is a really big thing that’s affected my life. And yeah, I had been in custody as well [before that…] I couldn’t believe it really. That’s where [ice] took me.

Concern of family & friends

A few say that family or friends expressed concern about their well-being or encouraged them to seek help. Along with noticing what they thought were signs of addiction, the concern of loved ones prompted them to think they had an issue.

When Anika’s (F, 19, studying, cannabis) parents expressed concern about her well-being and she was smoking cannabis every day, she began to think she had an addiction and should cut down. (Played by an actor)

Every day I would wake up and have a cone, wake up and have a cone. And […] my parents would see me and would just be like, ‘What’s wrong with you?’ […And then I started to think I had an addiction to it] when I [was buying] big quantities. I think I would buy an ounce with friends and you know, halve it. You’d have this bowl of weed and […] until that’s gone, you can’t get [on] with life. Like, I don’t know, with me, it’s like if there’s a bowl right beside my bed, I will wake up, I will smoke weed. I’ll have a great day, but at the end of the day you’re like, ‘Okay, tomorrow will be a new day’ but then you just consistently get into a routine of smoking weed every day.

Jim (M, 21, studying, cannabis) started to think he had a habit and sometimes an addiction when others suggested he was smoking cannabis too often. (Played by an actor)

[My marijuana use is] a habit and sometimes an addiction […] It’s just something I do when I don’t have anything else to do, or something that’s kind of familiar for me and I go back to it because it is familiar. And then also maybe addiction, because I’ve done things that I wouldn’t usually do as a person. And I’ve done it to get marijuana or to get high […] I don’t know [when I started to see it this way, probably] when people around me started highlighting it and saying like, ‘You don’t need to do it so often’. Or my girlfriend was saying, like, we’d get high together, but she was never really into it as much as I was. And I would kind of hide weed from her so I could have it when she wasn’t there. And she would find out about it and go, ‘What are you doing?’

Diagnosis

Some of the people interviewed for this website had consulted a health professional about their consumption and were formally diagnosed with alcohol and other drug dependence. For several, the diagnosis confirmed their concerns about their consumption. Others don’t remember receiving a diagnosis but were advised to cut down or stop. This suggested to them that they had a problem.

After consulting his GP about his drinking, Opal (M, 45, primary carer for his children, alcohol and prescription painkillers) was referred to a detox facility where he was diagnosed with ‘chronic alcohol dependence’.

Yeah [I have had a diagnosis of alcohol dependence…] The GP who recommended that I go somewhere and do something about it, start[ed] making some calls to look for a detox facility. Yeah, they actually gave me a diagnosis of chronic alcohol dependence.

[…]

Well, [the diagnosis] didn’t shock me. I knew, because I already knew myself. Well, my mother was an alcoholic […] Some people, they claim, are now more predisposed to be [at] risk of developing a tendency to become an alcoholic versus somebody who’s not. So I don’t know really. It just all happened. I think a lot of it […] stemmed from the anxiety. I was self-medicating a lot and that played a big part in [it].

Some people were diagnosed after they experienced illness or sought treatment for a health issue.

Phoenix’s (M, 48, works in the media, alcohol and prescription painkillers) doctor advised him to cut down on drinking. He says that he ‘knew it was a problem’ but wasn’t aware of the long-term ‘effects’ of heavy drinking. (Note: strong language)

I remember drinking so much alcohol at that point in time that I hadn’t had a solid bowel movement for years. And [I] went and saw a doctor and asked about that, and he sort of said, ‘Well, stop drinking so much alcohol’. And I went, ‘Well, clearly you can’t help me’. Yeah, so I sort of dismissed his help. I knew it was a problem […] Well, I knew that I was doing something bad for me [but I] had no understanding of how bad. [I] had no understanding of the longevity of these effects. Like, [I’m] 48 and still copping shit. It still has effects on my life. Like, had I followed a different path like my siblings, I wouldn’t be here.

Ben (M, 29, works in hospitality, alcohol) thought he had alcohol dependence and his doctor confirmed this when blood tests suggested alcohol-related damage to his liver.

I diagnosed myself with [alcohol dependence] but yes, my GP definitely said the same […] With my GP, it wasn’t so much going there for a diagnosis as such. It was more just for the health check-ups, blood tests, all that sort of stuff […] I’d already [diagnosed it] myself. I knew where I was at, I knew I had a problem. So it wasn’t a big shock to me at all. The biggest shock was some of the results I got back from my liver function [test], which at one point was very scary. That was before I went into rehab the first time. That was close to alcoholic hepatitis, or the next stage after that’s almost cirrhosis of the liver, so that put a scare into me and I just started treating myself well again.

Sophie (F, 38, primary carer for her children, heroin) was diagnosed with dependence when seeking medical help for ‘withdrawal’ from heroin and methadone.

Yeah [I’ve been diagnosed with dependence…] each time I’ve been into hospital. Sometimes I’ve been at home and I’ve been sick because I haven’t picked up my methadone or I haven’t scored. So […] I’ll call the ambulance, I’ll go into hospital. The doctor will ask me what I’m withdrawing from. I have to explain to him, ‘I’m withdrawing from methadone, I’m withdrawing from heroin’. Basically he will either give me a shot of morphine or he’ll give me a shot of methadone. So they always label me as drug dependent. Yeah, so I’m depending on drugs to get by.

Screening & treatment

Although some people had talked to health professionals about their consumption, several were unsure if they have received a diagnosis. Some say they assume they have been diagnosed as dependent because they were prescribed treatment or referred to an alcohol and other drug service. Others don’t remember being diagnosed but do recall being asked a series of questions about how much and how often they consume. This suggested to them they were being screened for dependence.

In order to qualify for drug treatment, Ned (M, 49, not working due to ill health, heroin) was screened and thinks he must have been diagnosed with drug dependence.

Well, I must have [been diagnosed with drug dependence] to have gone into a rehab or detox mustn’t I? […] They take you in and ask you how much you use, how many times a day do you use. What else do they ask you? Have there been any other drugs in your system other than your main drug? […] It’s like applying for a dog licence. You pass the test, get the ticks, and say you’ll do the right thing and, yeah, your dog’s all good. It’s like that, you know? It’s no real qualification for it. You just have to go like that and go, ‘Yeah, I’m a drug addict, see?’

Eva (F, 20, works in the entertainment industry, ice) assumes she has been diagnosed with drug dependence but finds it hard to keep track of the diagnoses she has received. (Note: strong language)

Yeah [I have been diagnosed as drug dependent…] I think I have. I assume I have. I’ve been into my GP […] a number of times asking for Valium (diazepam) so I could stop meth, but they stopped giving me Valium for good reason. In rehab, yeah, I think I was drug dependent. I wasn’t mentally ill, I was just drug dependent […] I’ve been diagnosed with so much shit, hey. I can’t keep up with half the diagnoses they have given me.

Questioning addiction or dependence

Some of the people interviewed for this website resist the ideas and language of addiction and dependence. They point out that the idea of addiction is negative and stigmatising because it implies that a person has an illness or a problem that needs to be addressed. They say that even though their consumption is regular and an important part of their lives, they don’t see it as an issue or an illness that needs to be treated. While others may say they do have an addiction or dependence, they describe their alcohol or other drug use as part of their lifestyle or as a habit that can be broken.

Ted (M, 26, works in the arts, party drugs and cannabis) resists the term ‘addiction’ because it implies an activity that is compulsive and ‘destructive’. (Played by an actor)

I’m a regular drug user, but I’m also, you know […] a citizen of society. I’m not the image of regular drug users that gets painted on the news and I think most regular drug users are people like me […My drug use is] regular, frequent. You could say [it’s a] habit. Of course, I wouldn’t say ‘addiction’. It’s more of, I guess, a vice. But I even hesitate to look at it as a vice because a vice implies there’s something bad about it, but I don’t use drugs because I feel like I need them.

[…I mean] you usually only hear about people being addicted to something [like] drugs or alcohol, or gambling, or sex […] when it’s […] destructive […Like] I think people think of addiction as [in] ‘I need it now, I need it now’.

While Artemis (M, 28, works in education, cannabis and party drugs) says his drug use may meet ‘some of the criteria [for] addiction’, he sees it as part of his lifestyle. (Played by an actor)

I suppose, if I’m strictly honest with myself, I do meet some of the criteria for addiction, and I wouldn’t by choice go without drugs for an extended period of time. But I see my use as fitting well within other aspects of my life and the things that I define as success. So I’d say for me it’s less about a compulsion and more about, you know, chasing new experiences or finding some new way to have fun […So, like, I see it as] a lifestyle. I was going to say ‘habit’, but I don’t really think that’s true. Drugs are a part of my life and part of my lifestyle.