Diagnosing Drug Addiction, Polysubstance Use & 4 Steps to Get a Proper Diagnosis
Sometimes Diagnosing Drug Addiction is as easy as one would imagine, there are conditions that are present at the same time with a substance use disorder, that’s why it is an intricate process.
According to the scientific piece ‘Common Comorbidities with Substance Use Disorders. What are some approaches to diagnosis?’, published by the National Institute on Drug Abuse’, the high rate of comorbidity between drug use disorders and other mental illnesses highlights the need for an integrated approach to intervention that identifies and evaluates each disorder concurrently and provides treatment as appropriate for each patient’s particular constellation of disorders.
Enhanced understanding of the common genetic, neural, and environmental substrates of these disorders can lead to improved treatments for individuals with comorbidities and may help diminish the social stigma that makes some patients reluctant to seek the treatment they need.
The diagnosis and treatment of comorbid substance use disorders and mental illness are complex because it is often difficult to disentangle overlapping symptoms. Comprehensive assessment tools should be used to reduce the chance of a missed diagnosis. Patients who have both a drug use disorder and another mental illness often exhibit symptoms that are more persistent, severe, and resistant to treatment compared with patients who have either disorder alone.
Patients entering treatment for psychiatric illnesses should be screened for substance use disorders and vice versa. Accurate diagnosis is complicated, however, by the similarities between drug addiction symptoms, such as withdrawal, and those of potentially comorbid mental disorders.
Thus, when people who have drug addiction enter into treatment, it may be necessary to observe them after a period of abstinence to distinguish between the effects of substance intoxication or withdrawal and the symptoms of comorbid mental disorders. This practice results in more accurate diagnoses and allows for better-targeted treatment. 
Diagnosing Drug Addiction and Polysubstance Use
Polysubstance use is common, and many people develop multiple comorbid substance use disorders. For example, among people with a heroin use disorder over 66 percent are dependent on nicotine, nearly 25 percent have an alcohol use disorder, and over 20 percent have a cocaine use disorder.
Among people with a cocaine use disorder nearly 60 percent have an alcohol use disorder, approximately 48 percent are dependent on nicotine, and over 21 percent have a marijuana use disorder.
As with single-substance use disorders, the diagnosis and treatment of comorbid substance use disorders and mental illness are complex. The use of multiple substances can further complicate diagnosis and treatment. The National Institute on Drug Abuse, states. 
Dual Diagnosis for Drug Addiction
Dual diagnosis or co-occurring diagnosis, is suffering from both mental health disorders and substance abuse illness. With dual diagnosis, a person has two different illnesses. Each disorder requires its own treatment therapies.
We know that for patients suffering from dual diagnosis:
- When one illness is ignored, the other will likely get worse.
- When both illnesses are given proper treatment, the likelihood for lasting recovery is increased greatly.
The occurrence of combined addiction and mental health disorders is incredibly common. Research shows that mental health illness is strongly associated with alcohol and drug addiction. Dual diagnosis treatment improves recovery outcomes. Providing enhanced opportunities to return to a fulfilling and productive life. 
Drug Addiction Withdrawal
Drug addiction withdrawal is the group of symptoms associated with quitting or decreasing the intake of a drug after developing a dependence. Drug addiction withdrawal may include a combination of physical, mental, and emotional symptoms — some of which can prove dangerous if left unmanaged.
When someone drinks alcohol or uses certain drugs on a repeated basis, their brain adjusts to the presence of this substance. They become physiologically dependent on their substance of choice and utterly reliant on it to function and feel “normal.”
In people who develop significant levels of dependence, withdrawal from drugs is often an inevitable response to the sudden absence of a drug’s declining concentration. Withdrawal symptoms may develop when a substance-dependent person quits a substance “cold turkey” or substantially reduces how much they are using, known as well as drug addiction detox.
During withdrawal, the body is attempting to reach a new state of homeostasis as it dispels the user’s drug of choice. This can result in large fluctuations in brain chemicals and may accompany significant mental and physical health repercussions.
A general overview of certain drugs and their characteristic withdrawal timeline is as follows:
- Short-Acting Opioids (such as heroin and certain prescription painkillers): Short-acting opioid withdrawal symptoms generally begin 8-24 hours after last use and last an average of 4-10 days.
- Longer-acting opioids (such as methadone): For methadone and other longer-acting opioids, it may take 2-4 days for withdrawal symptoms to emerge. Withdrawal will likely fade within a period of 10 days. 
- Benzodiazepines (such as Xanax, Valium, Klonopin, Clonazepam and Ativan): Withdrawal from benzos begins within 1-4 days, peaking in severity in the first 2 weeks. Protracted withdrawal can last months or years without treatment in some cases. 
- Alcohol: The first signs of alcohol withdrawal may appear within several hours after the last drink and peak over the course of 24-48 hours. A risk of seizures may remain high for anywhere from 12 hours to 48 hours after, with certain other risks, such as delirium tremens (DTs), remaining a concern for as long as 3 days after the last drink. 
Steps to follow in order to get a proper Drug Addiction Diagnosis
Step 1: Visit a general practitioner or other medical professional
A doctor will assess general health and perform tests to evaluate drug use. Blood or urine tests can be used to establish levels of illicit substances within the body and to provide an accurate view of how much drug use is occurring. Medical tests cannot diagnose a drug addiction, however; they simply establish drug use. Other blood tests may be performed to check for co-occurring diseases.
A medical professional is a good point of entry for anyone who needs to be evaluated for drug addiction issues. A general practitioner can then refer you to a psychiatrist or other addiction specialist. Clients will likely continue to see a general practitioner throughout the recovery process so general health and drug use can be monitored.
Step 2: Visit a mental health professional
A psychiatrist (a medical doctor specializing in mental health) or a psychologist can diagnose a substance use disorder. A mental health professional will typically begin an evaluation by having a conversation about what substances are being used, and at what frequency and dosages.
Most mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose addiction and other mental conditions.
We Level Up Treatment Center, lists the following DSM-5 criteria for substance use disorders: 
- The individual uses increasingly higher doses or uses the substance with more frequency than intended.
- The person wants to quit, but feels unable to do so.
- A large amount of time is spent getting and using the drug, and recovering from the effects of the substance.
- The person experiences intense urges or cravings for the drug.
- The substance use prevents the individual from meeting obligations and fulfilling responsibilities.
- Substance use continues in spite of negative consequences.
- Social, occupational, and recreational activities are neglected in favor of substance use.
- Use of the substance occurs in dangerous situations, such as before driving.
- The substance is causing physical or psychological harm, but use continues regardless.
- The individual has built up a tolerance to the substance and must use a higher dose to achieve the desired effects.
- The person experiences physical or psychological withdrawal when stopping or cutting back use, and uses the substance to avoid these symptoms.
At least two of these criteria must occur within a 12-month period for a substance use disorder to be diagnosed. DSM-5 includes various diagnoses for substance use disorders, which organize addictive substances into six categories.
SAMHSA lists the following substance use disorders as being included in DSM-5: 
- Alcohol use disorder
- Tobacco use disorder
- Cannabis use disorder
- Stimulant use disorder
- Hallucinogen use disorder
- Opioid use disorder
Addiction can often be diagnosed through an informal conversation with a mental health professional, through which the professional can gather needed information and establish if the person is suffering from a disorder. Sometimes, a more formal assessment is needed, and the psychiatrist or psychologist will use a clinical assessment tool.
Step 3: Undergo a formal assessment
Various assessment instruments can be used to diagnose a substance use disorder. These instruments are often lists of questions the interviewer will ask in order to determine if the person has a substance use disorder, or to determine what kind of disorder is present.
The following is a list of common substance use disorder assessments:
- Alcohol Use Disorders and Associated Disabilities Interview Schedule
- Psychiatric Research Interview for Substance and Mental Disorders
- Semi-Structured Assessment for Drug Dependence and Alcoholism
- Addiction Severity Index
- Composite International Diagnostic Interview
- Structured Clinical Interview for DSM-5
Which assessment the mental health professional uses depends on the professional’s level of training, and which provides the most accurate picture of the specific client’s mental health and drug use. Regardless of what type of assessment is administered, the mental health professional will use the answers to establish whether or not the client meets the criteria for a substance use disorder.
Step 4: Create a treatment plan
Once a substance use disorder has been diagnosed, a treatment plan will be created. The treatment team will often include not only a therapist or counselor but also a psychiatrist and a medical doctor. The appropriate treatment plan will depend on the client’s unique circumstances. The therapist or doctor may recommend inpatient or residential treatment, which requires the client to spend 24 hours a day within a treatment facility for an agreed-upon length of time. A less severe substance use disorder may only require outpatient treatment, in which therapy is provided while the client continues to live at home.
Treatment typically involves individual therapy, group therapy, and sometimes medication. According to SAMHSA, medications are most often used to treat alcohol, tobacco, and opioid dependence. It is important that treatment addresses not only the addiction but also any co-occurring physical or mental health disorders. 
Reclaim Your Life From Drug Addiction
Drug Addiction is a serious disease that should not be taken lightly. We Level Up Treatment Center can provide you, or someone you love, the tools to recover from this condition by Diagnosing Drug Addiction with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
 ‘Common Comorbidities with Substance Use Disorders. What are some approaches to diagnosis?’ – National Institute on Drug Abuse’ (www.drugabuse.gov)
 Elsevier (2017), Opioid Withdrawal Clinical Key.
 Professor C Heather Ashton, DM, FRCP 2004 (2004). Comprehensive Handbook of Drug & Alcohol Addiction 2004.
 Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Substance Abuse and Mental Health Services Administration – (samhsa.gov)