In many cases, it is a family member or very good friend who raises concern about the patient’s behavior (rather than the patient himself/herself doing so).
The first port of call is usually a GP (general practitioner, primary care physician, family doctor). The doctor will ask several questions, including how often the substance is consumed, whether the substance use has been criticized by other people, and whether the patient feels he/she may have a problem. If the doctor suspects there is an addiction problem, the patient will be referred to a specialist.
In cases of nicotine addiction, establishing whether or not there is an addiction is done at the GP-patient level. With more powerful substances there is usually an evaluation by a specialized addiction counselor, psychologist or psychiatrist.
Blood test - this may be ordered to determine whether the substance is still in the blood (whether the substance has been taken recently). It is not used to diagnose addiction.
DSM criteria for substance dependence - a patient diagnosed with substance dependence (an addiction) must meet criteria laid out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), a manual published by the American Psychiatric Association.
The criteria for drug dependence that causes significant problems must include three of the following:
- Tolerance - the substance has less effect on the patient because their body has developed tolerance. They need more and more of it to get the same pleasure.
- There are physical/psychological withdrawal symptoms, or the patient takes the substance to avoid experiencing withdrawal, or the patient takes a similar substance to avoid experiencing withdrawal.
- The patient frequently takes higher-than-intended doses of the substance.
- The patient often tries to quit or cut down.
- More and more time is spent getting hold of the substance, using it, or recovering from its effects.
- The patient’s drug use causes him/her to give up social, occupational or recreational activities.
- Even though patients know it causes psychological/physical problems, they continue taking it.