"In 2008, an estimated 20.1 million Americans aged 12 or older used illicit drugs within a month prior to a survey done by The Substance Abuse and Mental Health Administration (SAMSHA). This estimate represents 8.0 percent of the population aged 12 years old or older. During that same time an estimated 22.2 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Of these, 3.1 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.2 million were dependent on or abused alcohol but not illicit drugs. Substance Abuse and Mental Health Services Administration. (2009). A little later we will discuss the distinction between abuse and dependence, but for now, let's just look at why these numbers are so high. Or are they?
In fact I would like to offer the opinion that it is a wonder that the numbers are not much higher. As I point out why, I hope that this will also help to remove judgment from the mind of the reader, in case they are judging themselves or others for having become addicted. The key to the issue is that very first use. Let's take a look at this issue from a practical perspective; Initially drugs (including alcohol and tobacco for the purposes of this article) typically make the user feel better than before ingesting them, and in some cases radically so. Bluntly put, if these substances didn't feel so damn good there wouldn't be a problem. Human beings are hardwired to repeat pleasurable experiences. So, with this understood, does it make sense that once a person uses a drug that they repeat the experience? Of course it does. Repeated use of a substance once a person has experienced the effects of that first use is a simple matter of being human. So there we are, repeatedly using pot, cocaine, alcohol, heroin, or whatever it might be, and what we repeatedly get is a good feeling. All reward, with no consequences. The next fact to establish is that using drugs changes the chemistry of the brain. If the brain chemistry didn't change, then there wouldn't be a pleasant effect. Use enough times and that repeated change of chemistry leads to a change of the structure of the brain. Once that has happened, then a person has typically become chemically dependent. A little bit later we will discuss how you might be able to tell if that has happened to you, if you are not sure.
The effects of a substance induced structural change of the brain means that your choice to use the substance or not has basically been taken from you. The brain of an addict will tell itself that it needs the substance as a priority to all other things, in most cases. It has cross wired the need for the substance into the survival system. So, if you are not addicted, and you want to see what it is like to stop using, from a craving standpoint, to try and go cold turkey off of a substance decide at this moment to not eat for, say, two days. If you have eaten recently you might be able to say that you can do this with some conviction. After a half of a day or so you might reconsider whether you really want to go through with it. About 18 yours you might start to think of all the reasons that you will try it some other time. All the while you have access to food, and let's say nobody would know the difference. Do you see where I'm going with this? Your brain would tell you that your once good idea was no longer a good idea, and you would probably succumb to your hunger before that two days were done. Keep in mind that is only an example of the craving, but often times the addict isn't dealing with only the cravings, but with a host of physiological challenges like sweat, diarrhea, purging, aches, pains, hallucinations, and more, while they are trying to get the drugs out of their system. But the cravings remain, even after the physical withdrawal symptoms are over, for some, their whole lives. How would you like to be hungry your whole life? Fortunately for most people the cravings subside over time.
So then, what about the question "am I addicted?" and/or "am I at risk for becoming addicted?" Most people don't know that there doesn't need to be guesswork, or even an evaluator involved in order to answer that question. To be sure it is probably a good idea to have someone else who is an objective party available to do an assessment, but it isn't absolutely necessary. The criterion is available for anyone to check out. It comes from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) which was mentioned at the beginning of the article. This is the book from which most mental health clinicians derive a diagnosis. Anyone can simply look up the information in this book, or for that matter on the web, and make a determination regarding their chemical health status. Of course it is important to understand that denial is a very real defense mechanism, and might factor into a self-assessment.
You will find that substance abuse is basically continued use despite some negative consequences showing up in your life as a result of your use. Dependence is where we find evidence or symptoms of tolerance, withdrawal and compulsive use related to the substance. Tolerance is where the person needs more of the substance than when they first started taking it to feel the same effect. For example it used to take 3 beers to start feeling it, and now it takes 6. Withdrawal symptoms can be as simple as having a hangover, but most people want to think it is like you see on T.V., with the person going through a horrific ordeal. If you are a coffee drinker and you have tried to stop drinking coffee for a couple of days you probably have had a headache, which is a withdrawal symptom of caffeine. The body adapts to the presence of the substance to the point where the absence of the substance causes problems with your metabolism. The irony of addiction is that the addicted person often times functions better with the substance than without it. Compulsive use is where a person has set limits to their use and then used more than they planned. For example, deciding that you will only have a couple of drinks and ending up having more, perhaps much more. Maybe you have told yourself that you would quit, but didn't. Or maybe you did quit for a time, and feel that you were successful. Perhaps you were, but maybe not if you intended at that time to quit for good. I'm reminded of the quote from Mark Twain "Quitting smoking is easy, I've done it hundreds of times". Another criteria, and good example of compulsive use is when a person uses despite knowing that there will be serious negative results, for example if you have a health issue, like a liver disease.
The good news is that you aren't stuck with addiction, or even with the bitter hassle of struggling in recovery. The even better news; and this is something that my counselors never told me, is that recovery done the right way is better than the best high that there is. I realize why some folks have a hard time hearing that and believing it, especially those who can't remember a time when they were actually happy in the first place. See for a lot of us we never knew what it was like to be genuinely happy, day in and day out. Sure there were those good times, but our baseline without drugs (as a reminder, I include alcohol here) was to have the blahs. But your birthright is to be happy. If you question that notion I invite you to go take a look at any two, three, or four year old child who is being well taken care of, and see what they are like. See if they are not joyous simply being alive! That is your birthright! Yes you can have bills, debt, illness, etcetera, and still have joy in your life day in and day out. You can live without cocaine, pot, alcohol, and all the rest of those drugs and wake up and embrace the new day. I say this as a man who is no longer living in misery. I say this as a counselor, and psychotherapist who has watched this transformation occur in others time and again. I say this because it is true, and it is available to you. I say this because, within you lies a remarkable power and potential for change."
Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD.
About the Author...
Dakota Baker, MA, LPCC, LADC completed his master’s thesis on the neurochemistry of addiction. He worked as a licensed alcohol and drug counselor for close to a decade in Minneapolis and is currently in private practice at the River City Clinic in Saint Paul.