Substance use disorders impact 1 in 10 Americans. Sadly of the nearly 24 million Americans suffering from addiction, only 1 in 10 get treatment. The most common substance use disorder is Alcohol Use Disorders, which account for nearly 80% of all addictions. 

What is Addiction? 

In general, when drug or alcohol use begins to cause negative consequences, keeps the individual from enjoying other aspects of his/her life, or is difficult or impossible to stop when desired, it is very likely that a substance use disorder has developed.


Substance use disorders can cause a wide variety of problems which impact every individual uniquely. In order to standardize and improve the diagnostic reliability and validity 11 specific criteria have been developed to diagnose if someone does or does not have a substance use disorder.


The DSM 5 diagnostic criteria include: 

1) Taking the substance in larger amounts or for longer than the you 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.

What is NOT Addiction? 

You may have noticed (above) that legal problems are not a criteria for a substance use disorder. In fact, legal problems were removed from the diagnosis in the latest update. This is because legal problems may or may not be an indication of a substance use problem.


For example, you could get a DUI the first time you drink alcohol or get arrested for buying an illicit substance before you even tried it. Therefore, legal problems are a potential consequence but not a diagnostic criteria of a substance use disorder. The closest fit would be #8) Using again and again despite danger. A DUI or other drug/alcohol related behavior that may cause legal issues due to being placed in dangerous situations could qualify in that regard. 

How Do you Rate The Severity of Addiction? 

The DSM 5 specifies that the severity of the addiction is based on how many of the 11 symptoms (see above) are identified.

Mild: Two or three symptoms

Moderate: Four or five symptoms

Severe: Six or more symptoms 


Once You Are Diagnosed as Severe are You Always Severe? 

This is an important point to understand. Addictions are a chronic relapsing illness. This means those with more severe symptoms are likely to need lifelong treatment to maintain remission, much the same as those with other chronic illnesses (i.e. high blood pressure or diabetes) need lifelong treatment. However, once someone has achieved three consecutive months of none of the 11 diagnostic criteria, they are said to be “in early remission”. Once an individual has achieved 12 consecutive months with none of the 11 criteria, they are “in sustained remission”. In this light, to avoid stigma and unnecessary shaming, it is important to view an individual's current symptoms, or lack thereof, and not simply a historical diagnosis. 

How Does PHS Help Those Suffering From Addiction? 

Most patients begin their treatment through a brief 10 minute phone call to determine if their goals are a good fit for our practice. The next step is then an in office evaluation to determine what specific diagnosis or diagnoses are present. A treatment plan and recommendations are then formulated to identify what level of care, what types of care and what duration of care will most likely lead to the best possible outcomes. 

Our team provides world-class, evidence-based and cutting edge addiction treatments, including the latest relapse prevention and anti-craving medications. Additional treatments are aimed to address the underlying co-occurring disorders (such as depression, anxiety, trauma or grief) and negative coping strategies (using drugs and alcohol to escape or cope) that often drive addiction and lead to future relapses. 

If a patient needs additional services such as individual or group therapy, monitoring groups, 12-step meetings (or equivalent), our team will match the individual to the specific treatment plan that will help them to achieve their goals and obtain and maintain their sobriety. In the event a patient needs a higher level of care (such as residential treatment) our team will provide recommendations of programs that will most likely be a good fit and provide optimal results.


Additional Resources:

1) Dr. Goldenberg Answers Commonly Asked Questions about Substance Use Disorders

2) Publications about Addiction and Substance Use Disorders by Dr. Goldenberg 

If you would like more information about becoming a patient of Dr. Goldenberg, please contact us or book a free confidential and anonymous 10 minute phone consultation at a time that is most convenient for you.