SUBSTANCE USE DISORDERS: A GUIDE FOR WRITERS.
hey i’m a mental health therapist and a writer here on tumblr dot com, back again with another “how to write mental health” guide! this time we’re talking about SUBSTANCE USE DISORDERS! this is MY very specific wheelhouse because i do intensive outpatient work for a substance use disorder treatment agency!
i have seen SO MANY gross mischaracterizations of addictions on tumblr, specifically within the indie roleplay community, from demonizing addicts to misinterpreting addiction to calling their “has a glass of sometimes after work and blacked out once after one night of drinking” little dudes alcoholics. for the purpose of this post, i’m going to try and stick to the CLINICAL side of addiction because there’s a pretty huge addiction recovery/sobriety culture that is incredibly lovely and supportive but it can get convoluted with all the different programs there are out there.
now, let’s start with what makes a substance use disorder a substance use disorder. a substance use disorder is any sort of PROBLEMATIC USE OF A SUBSTANCE THAT INTERFERES WITH DAILY LIFE AND DAILY FUNCTIONS. depending on the specific substance the diagnostic criteria looks a little different but all substance use disorders diagnoses more or less follow the following criteria ( pulled from the opioid use disorder criteria in the DSM-5 ):
a problematic pattern of [drug/alcohol] use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:
[drug/alcohol] are often taken in larger amounts or over a longer period than was intended.
there is a persistent desire or unsuccessful efforts to cut down or control [drug/alcohol] use.
a great deal of time is spent in activities necessary to obtain the [drug/alcohol], use the [drug/alcohol], or recover from its effects.
note: THESE DO NOT JUST INCLUDE ILLEGAL ACTIVITIES. i’ve had clients with alcohol use disorders wake up early and hang around the gas station until it opens at 7am to get their first 12-packs for the day, go through great lengths to hide alcohol from spouses, stash alcohol around their work spaces so they can drink periodically throughout the day, etc. not necessarily illegal, definitely problematic.
craving or a strong desire or urge to use [drug/alcohol].
recurrent [drug/alcohol] use resulting in a failure to fulfill major role obligations at work, school, or home.
continued [drug/alcohol] use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of [drug/alcohol].
note: ask yourself here how your character’s relationships are effected by their drug/alcohol use.
important social, occupational, or recreational activities are given up or reduced because of [drug/alcohol] use.
recurrent [drug/alcohol] in situations in which it is physically hazardous.
continued [drug/alcohol] despite knowledge of having a persistent or recurrent physiological ( physical–think of the body reactions ) or psychological problem that is likely to have been caused or exacerbated by the substance.
tolerance, as defined by either of the following:
a need for markedly increased amounts of [drug/alcohol] to achieve intoxication or desired effect.
a markedly diminished effect with continued use of the same amount of [drug/alcohol].
debunking some common themes i see across the writing community:
SUBSTANCE USE DISORDERS ARE, MORE OFTEN THAN NOT, A RESPONSE TO COMPLEX TRAUMA. i’ve been in this field for 4 years and 99% of the clients i have seen have experienced some degree of trauma. getting absolutely plastered and high is a damn effective way to check out when someone is experiencing chronic trauma and doesn’t want to deal with the overwhelming emotions that come with it.
SUBSTANCE USE DISORDERS ARE, MORE OFTEN THAN NOT, CO-MORBID WITH OTHER MENTAL HEALTH DISORDERS. similar to the above point, checking out with drugs and alcohol is a damn good way to forget how shit your brain is.
THERE IS A DIFFERENCE BETWEEN A SUBSTANCE USE DISORDER/ADDICTION AND CASUAL DRUG AND ALCOHOL USE. if your character smokes weed at the end of the day, or takes prescription pain pills for chronic pain as prescribed, or goes to the occasional party with their friends on the weekends, or drops acid at a rave, and these things are otherwise not interfering with their lives–that’s not an addiction. that’s casual drug and alcohol use and it’s fine. people are allowed to let loose sometimes.
PLEASE TRY TO STRAY AWAY FROM DEMONIZING A CHARACTER WITH A SUBSTANCE USE DISORDER. a big part of treatment is processing the “why” while also acknowledging that your actions related to your substance abuse have affected others. that does not mean people who are struggling with addiction are less deserving of love and compassion. the reality of addiction is that yes, a lot of folks with an addiction do have very strained relationships and have done unsavory things while in their active addiction. if you come at it from the perspective of “this person is dealing with strong internal turmoil” though, how does your portrayal of your character change? how do their internal monologues change?
CONSIDER WHY YOUR CHARACTER IS TRYING TO CHECK OUT WITH DRUGS AND ALCOHOL. what’s going on in the ol’ coconut that they’re struggling to deal with? alternatively or in addition, do they have something going on PHYSICALLY that they’re trying to deal with, like chronic pain? common feelings associated with people who are in their active addiction are anger, anxiety, grief, self-loathing, depression, sadness, fear–i assume you know feeling words if you’re a writer so i’ll stop there.
NOT ALL ADDICTS ENGAGE IN CRIMINAL ACTIVITY AND EVEN IF THEY DO, THEY ARE NO LESS DESERVING OF LOVE AND COMPASSION. i work primarily with court ordered clients with high criminogenic risk factors. i have groups full of felons and they are some of the loveliest, kindest people i have ever met. similar to substance use disorders, criminality can be a response to trauma. a teen who is growing up in a loving stable home isn’t going to turn to gang activity, an adult with healthy relationships and coping skills isn’t going to hold up gas stations or get into dealing drugs. people are just people. similar to the above point, if your character is engaging in criminal activity, ask yourself why they would be and see if that changes the way you portray them.
that’s all i have for now! feel free to reach out to me if you have any questions because again, this is precisely my wheelhouse. it’s what i treat every day.
cheers, and happy writing!