The substance use-abuse-dependency process

17 years ago

    The use of alcohol and other drugs in our society and communities is common and widespread. Thankfully, use of a substance does not constitute abuse or dependency, nor does it necessarily lead to dysfunction and impairment in meeting day-to-day responsibilities. But any use does include some level of risk. The level of risk is impacted by many things such as age, substance used, quantity, frequency and the individual’s biology.     The issues related to substance use are ageless. I have a Currier and Ives picture in my office, dated 1864, depicting “The Drunkard’s Progress”. The picture shows a nine-step process from first use to the grave. The first few steps show some of the perceived benefits of drinking, but as time, quantity, and frequency increase, the negative social and physical impact is clear, ending in premature death. The risk associated with the use of alcohol and drugs is real and often leads to confusion, physical and emotional pain, and destroyed lives. We all know this to be true and we all see this daily in our families, friends and communities.
    So why do we continue to use? Just as we all know people in our lives that are challenged with the use of substances, we also know people who use alcohol and other drugs and are not negatively impacted by the use. In fact, the use can be seen and experienced as a positive thing in their lives. Just as the 1864 picture represents, use-to-dependency takes time. It is a process usually of small but perceptible changes that lead from use-to-abuse-to-dependency. The process is protracted, and as the person moves closer to dependency their ability to clearly perceive the changes in their behavior and life become more and more difficult and they are unable to accept that alcohol and drugs are now negatively impacting their life.
    So what should we do? Youth should not use alcohol and other drugs. Studies clearly show that the younger a person starts drinking alcohol or using other drugs the greater the likelihood that the individual will develop dependency. This is due to the fact that the drug adversely impacts the youth’s physical and structural brain development and the incorporation of thoughts and behaviors that support use. It is important to note that adults are also impacted by the same.
    As a community we need to clearly communicate that we do not support the use of substances by youth or the excessive/harmful use by adults. Not because people who use are “bad,” but because use is bad for developing minds and bodies and clearly any use is harmful.
    Regardless of age, whether young or old — quantity plus frequency plus biology equals your risk. This equation is the process from use, abuse to dependency. Depending on the drug used, the quantity used, the frequency of use, and your biology, these factors will clearly impact how and if you will progress through the process from use to dependency. For some drugs, and for some people, this process may be lengthy. For others, a very short exposure to the drug may lead to dependency. I have seen both types of individuals in my work. Some people drank or used for years before experiencing health and social problems related to their use. I have also worked with people who report dependent use almost from the very beginning, skipping the abuse stage.
    Abuse of a substance is categorized as a pattern of use that leads to social, legal and functional problems. There is often a component of substance use involving dangerous practices, such as driving a car under the influence. At this stage there is no physical dependency on the chemical.
    Dependency to alcohol or another drug is evident by having tolerance for the drug. The slide to Dependency is a process, for most it does not happen over night, but creeps up quietly. No one plans to become dependent on a drug. This generally shows up when the person can drink or use and still continue to function with out obvious significant impairment. Dependency is also marked by a loss of control where the person can not consistently predict the amount of use or outcome once use starts. Withdrawal is also a result of dependency when the individual experiences noticeable physical and physiological discomfort when the drug is taken away. Often a similar drug may be used to lessen the impact of the withdrawal by the person. Dependency also includes social or legal issues related to the use of the drug.
    If you find yourself, a friend or loved one somewhere in the substance use-abuse-dependence process and are concerned, find the courage to take action. Decreasing the quantity and frequency of use is the first place to start and may be enough arrest your progression towards dependency. If you can’t do this, you definitely need help. Talk to a friend, adult, parent, pastor or a local mental health counselor for help. Taking this step starts another process, the process of recovery and creating a new life for yourself, your family and your friends.
    This article was written by Peter G. McCorison, LADC, LCSW, director of substance abuse services at AMHC. The article was brought to you by Aroostook Substance Abuse Prevention. For more information about ASAP and its prevention efforts contact Clare Desrosiers, project director 521-2408.