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When Does Alcohol or Recreational Drug Use Cross the Line into Substance Abuse?

By:  Kristen Carothers, MSW, LCSW

 

When has recreational use crossed the invisible line into substance abuse?  Do any of these professions sound familiar, either as something you say or hear from a friend, colleague or family member?  Pot is not addictive.  I only have 2 glasses of wine in the evening – how can that  be a problem? I need Adderall for my ADHD.  I haven’t been evaluated for it, but my doctor prescribed it and it really helps me get things done. My internist prescribed these drugs for anxiety and sleep.  Every once in a while, not too often, I need to take some extra but it’s prescribed for me, so it’s no big deal.  These kids drive me crazy.  Sometimes I just have to have a drink or two to get by.  I could stop anytime I want.  If you had my stress, you would drink or use meds too!  I don’t drink or use more than anybody else.

Do you question the acceptability of substance use by yourself or someone else?  Generally, if there is cause to question the frequency, pattern, amount, or consequences of use by yourself or someone else, it is worthwhile to consider how the substance is impacting your life or the life of the other person.  In a court proceeding involving custody or visitation of children, such concerns can trigger the appointment of a guardian ad Litem (a lawyer to represent the best interests of the child or children and/or a substance abuse evaluation by a highly specialized professional.  Either of these can be expensive, but are well worth it where the welfare of child may be at risk.

Most people think of individuals who are adversely affected by substance abuse as being easily identifiable.  It’s the drunk who is wildly inappropriate at the family or office Christmas party, the homeless man that you see on your way to the gym, the folks on the A&E show Intervention, or the disheveled celebrity in the mug shot that is all over the internet..  In fact, addiction and Substance Use Disorder affect people of all races, ages, genders, and socioeconomic classes.  Most of the people living with alcohol or drug addiction are very functional.  Some comfort themselves by saying, “I have a good job and I’m in good health so I can’t have a problem.”  In fact, Substance Use Disorder affects 10% of our population.  That means one of every ten of the people you know personally are impaired and you can’t see it.   Of course, drugs have a place in our society.  They serve as treatment for many ailments:  there is no such thing as a “bad” drug: opioid pain killers are effective at controlling severe pain for a short time and medical cannabis has been shown to have positive effects in the treatment of some chronic health issues.  Even alcohol, used in moderation, can be an enjoyable and effective social lubricant.  It is not the substance itself, but the way that a particular person relates to the substance that becomes problematic.

Do you or your loved one use alcohol or drugs to manage your emotions by regulating or generating a mood?  To regulate your mood or generate a mood? Do you continue to use despite relational or other consequences?

The causes for Substance Use Disorders can be called “the perfect storm.”  The perfect storm includes preexisting conditions and situations that frequently lead to substance abuse and addiction, including:  genetic predisposition, age of first use, frequency of use, trauma, and a lack of true intimacy or connection in relationships.

Genetic predisposition to alcohol or drug abuse may be indicated by a family history of addiction or compulsive disorders.  This family history does not have to be just within the nuclear family.  Evidence of the genetic potential for addiction can be further down the family tree in grandparents, great grandparents, aunts, or uncles.   Also, certain cultural heritages are more at risk for addiction, such as those of American Indian, Irish, Russian, and German descent.

Studies show that the younger the age of first substance use, the greater chance of a problem developing.  Similarly, the more frequent the use of alcohol or drugs in adolescence, the greater the potential issues of abuse and addiction.  For example, people who have their first social drink of alcohol by age fourteen are four times more likely to develop an alcohol use problem than individuals who do not drink until they are adults.

Trauma can be as severe as childhood abuse or neglect, or less obviously traumatic issues such as frequent moves, bullying, divorce or separation, or childhood illness.  In addition, recent studies have shown that a feeling of less connection and belonging to family, friends and community leads to disconnection and alienation.  This in turn can lead to isolation and a lower ability to regulate emotions, thus leading to a desire to turn to external substances like alcohol and drugs for warmth and comfort.

We now know that substance abuse typically runs on a continuum with a very predictable pattern from use, to abuse, to disorder, to addiction.  Current thought regarding treatment is that an individual need not automatically follow the progression through abuse to and legal, emotional, and relational issues addiction – arresting the disorder in earlier stages can help save a person from the legal, emotional, and relational issues as well as the health consequences of addiction.   One way to think about it is this:  if someone is diagnosed with Stage 1 Cancer, doesn’t it make sense to treat it before it progresses to Stage 4?

Here are some warning signs that recreational use of drugs or alcohol may have crossed the line into Substance Use Disorder:

 

  1. Substance use has resulted in the failure to complete obligations at work, school or home.
  2. Substance use has resulted in physically dangerous situations.
  3. Substance use has continued despite relationship problems with family, friends or co-workers.
  4. More of the substance needed to achieve the desired level of intoxication and/or diminished effects with continued use of the same amount of the same substance.
  5. Withdrawal symptoms when substance use is stopped (anxiety, shaking, hangover, cravings, trouble sleeping, concentration problems, nausea, or vomiting).
  6. The drug is taken for longer periods of time or in larger doses than prescribed.
  7. The individual has a persistent desire or unsuccessful attempts to cut down or stop use, including making promises or compromises, i.e. “I’ll only use on the weekends.”
  8. The substitution of one kind of substance for another, i.e. “I’ll only drink wine, beer, light, or dark liquors.”
  9. The individual devotes a significant amount of time and energy to planning to use or obtaining the substance.
  10. Social, work, and recreational activities are sacrificed in order to use, or avoidance places that do not allow usage.
  11. Cravings to use the substance

According to the Diagnostic and Statistical Manual (DSM-5), from the American Psychiatric Association, when two or more of these criteria are seen within a period of one year, a diagnosis of Substance Use Disorder may be made.  As Substance Use Disorder progresses,  the brain’s pleasure center is hijacked and the person is unable to consistently abstain, and the person experiences impairment in behavioral control, cravings, diminished recognition of significant problems, and a dysfunctional emotional response.  The brain begins to “need” the substance in order to feel normal. The person who crosses the line into Substance Use Disorder is not “weak,” “undisciplined,” or “selfish” and is unable to “just stop.”   Rather, the person has developed a chronic brain disease that in most cases requires treatment to be able to stop.

If you or your loved one needs help, reach out just as you would for any other chronic, progressive, relapsing disease.  It is worth multiple attempts to arrest the disease at an earlier stage to prevent some of the devastating consequences to your emotional and physical health or that of your family member.

 

 

 

 

Kristen Carothers, MSW, LCSW brings twenty years of experience specializing in aiding and guiding children, adolescents and adults.  Her areas of focus include:  substance abuse, addiction and recovery, codependency, bipolar disorder, depression and anxiety, parenting and child behavioral issues, trauma, grief, and crisis intervention.  Kristen is known for her direct, open, and compassionate communication style.  She works with each client to gain a productive yet empathetic relationship structured for therapeutic success.