In many family law cases, addiction -- or at least, an accusation of addition -- can be an issue. How do you determine who is an addict?
AddictionThe DSM-V talks about substance abuse disorder. For the purposes of litigation, we need to determine whether or not a person is suffering from an addiction or a situational problem. Impaired control and chronic use are hallmarks of addiction. There is a physical component and a psychological component. Impaired control is also a component. There needs to be a problematic pattern of use that causes significant impairment or distress. Ironically, one of the items dropped as a benchmark between DSM-IV and DSM-V is that the addiction causes legal problems as statistically, that component did not help in diagnosing the patient.
Abuse. Use. No Use.A new criterion has been added to substance use disorder under DSM-V: craving or a strong desire or urge to use a substance. How to measure whether you cross the threshold from use to abuse? Is there alcohol dependence? Women and men metabolize alcohol differently. For men, no more than 4 in a day and 14 drinks in a week reaches problem territory. For women, no more than 3 per day and 7 drinks in a week is problem territory. Under the CAGE assessment, physicians will ask the following:
Have you ever felt you should CUT down on your drinking?
Have people ANNOYED you by criticizing your drinking?
Have you ever felt bad of GUILTY about your drinking?
Have you ever had a drink as an EYE-opener first thing in the morning to steady your nerves or to help a hang-over?
Other Definitions of AddictionNational Institute of Drug Abuse (NIDA) --"a chronic, relapsing disease characterized by compulsive drug seeking and abuse by long-lasting chemical changes in the brain."
American Society of Addiction Medicine (ASAM) -- "primary, chronic, neurobiologic disease, with a genetic, psychosocial, and environmental factors influencing its development and manifestations. ASAM notes that addiction is "characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, and continued use despite harm, craving."
Signs of Substance Abuse Disorder per DSM V include at least 2 of the following criterion over a 12 month period:
* use in larger amounts or over longer period than intended
* unsuccessful efforts to cut down or control
* lots of time devoted to obtain, use or recover from use
* Substance craving
* Failure to fulfill major role obligations
* Continued use in spite of consistent social/interpersonal problems
* Social, occupational or recreational activities that are given up or reduced
* Recurrent use in physically hazardous situations
* Continued use despite negative physical effects or psychological effects
Whose Troubled?By way of example: 15-18% of attorneys abuse alcohol or drugs, according to the American Bar Association Commission on Lawyer Assistance Programs. 32% of investment bankers engage in heavy drinking at least one day per week, according to Catalyst Strategies Group. Almost 5 million Americans are dependent on prescription painkillers. NIDA Infofacts: Prescription Pain and Other Medications 2005.