Use, Misuse, Abuse, Dependence: A Road Map to Addiction

With contributions from John Roesch, CASAC-T, CIP 

image by Stefano Pollio

“I’ll stop after the pandemic,” you told yourself a year ago never imagining we would be in this for the long haul. Now you can’t seem to stop. 

The COVID-19 pandemic has seen a spike in substance use, misuse, and abuse. Mental health issues and relapse and overdose rates are soaring. Why do people drink or use substances? Is it recreational or a harmful coping skill? Some have a nightly drink or smoke marijuana to take the edge off after a long day? It may be part of a social interaction - these days a Zoom cocktail gathering. Addiction is a progressive disease and the transition from use or misuse to abuse and dependence, and then to addiction is subtle and long term. We may not think we have an issue with alcohol or substances, but when we try to take a break, we find it harder than we thought to be abstinent for a meaningful period of time or to quit altogether.

So how do we know if we have a problem or if we are addicted? The simple answer is anytime the use of drugs or alcohol negatively interferes with normal life activities, your use most likely has become misuse or abuse and possibly dependence or addiction. You may initially develop a psychological dependence when your mind tells you that you need alcohol or a drug. This is usually followed by a physical dependence, which develops when increased amounts of alcohol or a drug are required to get the same feeling or ‘high’. A person's risk factor is much higher if there is a history of drug or alcohol abuse or chemical dependency in the family. If there is a family history, you must be especially careful, delaying any experimentation or use as long as possible, ideally until adulthood, when the brain is more fully developed.

Signs of chemical dependency: 

•           You have been told by loved ones that drugs or alcohol have become a problem. 

•           You are having problems in your relationships with family and friends. 

•           You fight with people when or the day after using drugs or alcohol. 

•           You are having blackouts and not remembering what you do while using. 

•           You feel sick from using drugs or alcohol but continue using anyway.

•           You lie about use or the amounts of drugs or alcohol used or use in secret. 

•           You need drugs or alcohol to get going or make it through the day. 

•           Your performance at work or in school is suffering because of drug or alcohol use. 

•           You need drugs or alcohol to relate to people or feel comfortable in social situations.

•           You use drugs or alcohol to forget problems.

If you answered yes to any of the above, this is an indication you may have a problem. The longer the misuse of alcohol or use of drugs continues, the greater the problem will become. Is there a roadmap for substance use from misuse to addiction? Let’s take a look.

Use

You use drugs or alcohol for recreation. You take them infrequently and predominantly in social settings. They are not a coping mechanism you turn to when you are anxious, stressed, or angry.

Misuse

You start using alcohol or drugs regularly, in secret or bingeing, often abandoning family and friends in favor of drug use. You become concerned about losing access to drugs or alcohol. 

Drug misuse also may involve not following medical instructions on a prescription drug you take. You may not be looking ‘to get high,’ but you take more than you should. For example, if a  person isn’t able to fall asleep after taking a single sleeping pill, they may take another pill an hour later, thinking, “That will do the job.” Another example would be offering your medication to a friend who is in pain. According to the FDA, these are examples of drug misuse because the person is treating themselves, not following the directions of their health care provider. Prescription drug misuse can include taking the incorrect dose, taking a dose at the wrong time; forgetting to take a dose; or sharing your medication.

Abuse

You continue to use drugs and alcohol even though you know they are harming your health and well-being and relationships. Prescription drug abuse is the use of medication without a prescription in a way other than prescribed or for the intent of getting high.

Dependence

Dependence occurs when you have built up a tolerance to alcohol or a particular drug or drugs and you need to take more and more of the drug to achieve a ‘high.’ As you become dependent on drugs and alcohol, you are unable to function without them. Your physical and mental health deteriorates. Symptoms of tolerance and withdrawal also can characterize dependence.

Withdrawal is defined as a group of physical and mental symptoms that your body experiences when you stop using a substance. These can range from mild (a headache for example if the drug is caffeine) to life-threatening (seizures if the drug is alcohol, prescription drugs, or opioids, etc.). (www.drugabuse.gov)

Dependence versus Addiction

A person can be dependent on a drug, or have a high tolerance to it, without being addicted. While it is possible to have a physical or mental dependence without being addicted, addiction is usually right around the corner. 

Mental dependence is when the use of a substance is a conditioned response to an event or feeling. These are known as ‘triggers.’ Something as simple as the act of driving can trigger a desire to use. These triggers set off biochemical changes in a person’s brain that strongly influence addictive behavior.  

You become physically addicted to drugs as you become more tolerant of their effects and preoccupied with getting them. You may abandon most or all your previous interests and relationships. You cannot stop using drugs or alcohol despite negative consequences.

Continual use leads to even higher tolerance and more of the substance is needed to get the same feeling. This may be soon followed by addiction. With addiction, drugs become the most important part of one’s life. It is more important to drink or take drugs than to participate in the usual activities of life. This includes working or relating to friends and family, which is why addiction is often referred to as a disease of isolation. 

Addiction is a disease where drugs are now needed not just to get high but to feel ‘normal’. The American Society of Addiction Medicine (ASAM) defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases. (ASAM)

Stopping addiction, and even misuse, abuse and dependence, requires outside help from highly-trained and experienced professionals. Whatever your concerns are about your substance use habits, please call Freedom Institute for a consultation. We are here to compassionately discuss your concerns with you. We help people and their families at any stage of examining their relationship with substances. If you think you may be misusing or abusing drugs or alcohol, Freedom Institute’s Exploratory Phase will help give perspective on your relationship with substances so you can decide whether you need to refrain completely or you can manage your use. This is a chance for clients to explore the role substance use plays in their life and whether they wish to change that role. We are here to help and to discuss all options, and we tailor our programs to meet your needs.

Initial Phone Consultation Is Free. We Are Open for Telehealth Services.

Contact us at Freedom Institute or Call us at 212-838-0044 today.