How do you know when use of alcohol
and other drugs has become a problem? Some people appear to become
addicted almost immediately, while others may use for years without
apparent consequences. The question is critical for individuals
wondering about their own use -- and the families, friends and employers
who care about them.
We know that certain clear characteristics mark the progression
from first use to full-blown chemical dependency. Drug and alcohol
professionals usually divide the process into four stages: experimentation,
regular use, misuse and addiction/dependency.
In the experimentation phase, people limit the use of a substance
to five times or less in their lifetime. This is the stage where
many of us, usually in our teens or 20s, may have tried a drug out
of curiosity, media or peer pressure -- or just to find out what
it does to us. It's sometimes been described like a first date.
Some people we like, some we're indifferent to, and some rub us
the wrong way from the beginning. Experimenters either forget about
the drug or move into the next stage.
In the second, or "user" stage, people are able to use their drug
of choice now and then, even going long periods without it. They'll
sometimes choose parties because they know drugs will be available,
but they're never preoccupied with whether they'll get high. They
may use alcohol or even marijuana regularly. They're in control
of their consumption and experience few, if any, significant consequences
with their jobs, relationships with others, or the law.
Significant controversy has developed around whether people can
actually use certain drugs, especially marijuana, methamphetamine,
crack or heroin, without moving into misuse or dependency. With
some drugs, like alcohol, it seems that most people can stay in
the "user" stage -- only about 20% appear to develop a more dependent
relationship. A larger percentage of marijuana users (as many as
25%) become more dependent if they use the drug regularly over time.
And a very high percentage (85% or more) of the people who use drugs
like cocaine, heroin, and methamphetamine eventually enter the much
more damaging stages of dependency.
People in the third stage, termed "misusers," usually develop a
tolerance for their drug of choice. Because of physiological changes
that come from regular use, there is a growing reliance on the drug
to change the user's mood --but it takes more to produce the desired
effect. Misusers become preoccupied with the drug and think frequently
about when they will use again. Parties are often chosen for whether
or not the drug of choice will be present. There is some level of
discomfort if the drug is not available, and another drug, often
alcohol, may be substituted.
Other indicators of misuse include:
- High levels of conflict with with spouse or other primary relationship
- Family concerns with use
- Patterns of isolation
- Irritability, restlessness or discontentment
- Unpredictable mood swings
- Legal problems
- Financial problems, including growing debt
- Job-related problems, including chronic absenteeism or lateness
People living a pattern of alcohol and other drug misuse can also
have significant health problems. Many misused substances are highly
toxic, leading to weight loss, hair and tooth loss, acne, lesions
and life-threatening liver problems. General levels of stress tend
to be very high, creating additional problems of their own.
In the fourth stage, the "chemically dependent" or "addicted" person
continues to misuse substances despite continued consequences. Almost
always preoccupied with the next drink, smoke, or fix, these people
spend a significant amount of their time, money and energy avoiding
the emotional and physical discomfort of not using. Addicts usually
do not see that the consequences they're experiencing are a result
of the misuse; rather, they feel that their life is such that they
need alcohol and other drugs to cope with life's problems. ("You'd
drink too, if you were married to my spouse/had my job" etc.) They
have an overwhelming desire to recreate the physical sensation and
emotions that the drug gives them. The combination of physiological
craving and psychological need is one of the hallmarks of addiction.
Ironically, chemically dependent people commonly see themselves
only as regular users. Then, when they misuse and experience some
consequences, they attempt to control their intake for a time. Then
they misuse again. This back and forth pattern is a common symptom
of the last stage. All the while, each symptom found in misusers
becomes more serious.
It is very important to note that people can't stay in addiction
without significant assistance from the people around them. In case
after case, chemically dependent people have relied on the financial
and emotional support of family members, patience of friends or
employers, even handouts on the street to continue their addictions.
Ultimately, well- meaning people can actually keep the addict from
the "precipitating crisis" -- threat of arrest or jail, separation
or divorce, loss of child custody, loss of yet another job or other
financial distress -- that makes them willing to make real changes.
It is extremely difficult, if not impossible, to arrest chemical
dependency without such a crisis. But knowing the warning signs
can make it possible for users and the people who care about them
to take action -- before addiction destroys their lives.
The opinions expressed in this column are those of the writer