In my private practice I see individuals in recovery; those who have relapsed and are looking for support to get back on the wagon; those who are “evaluating” whether or not they are ready to begin a life of recovery; those who have been arrested for DWI or a drug related charge; parents and partners who are concerned about their loved one’s use and abuse; and those who have grown up in an alcoholic household and are now dealing with the ramifications of that experience. I try to understand what is your motivation to get better and always use that as the starting point. People recover every day and it is worth the effort.
Use, Abuse & Dependence: How are They Different?
What is the difference between someone using alcohol and drugs, abusing them and being dependent on them? People throughout recorded history have always found a way to chemically escape the routine of day-to-day life, or to seek an altered state of consciousness. To expect that we will ever completely wipe out this desire is foolish. However, there are customs, traditions and laws that attempt to govern the use of substances so that a minimum of harm is brought to individuals and society. As with most individual decisions about things that can potentially bring us harm, free will is an important component of one’s decision to use alcohol and drugs.
Because of the anesthetic properties of alcohol and drugs, they often become an easy target for abuse by someone who may be experiencing emotional and psychological difficulties. This does not necessarily mean that the individual is dependent on them. It could be a time limited abuse pattern that may or may not disappear whenever the difficulties are behind him/her. Abuse can often occur developmentally, i.e. as a way of fitting in during adolescence, or a means of easing some of the difficult challenges that growing up often provides. An example of this is often seen on college campuses where a style of drinking alcohol may be considered “alcoholic drinking”, yet once the students are out of that setting, they find that they can give up drinking altogether, or cut down on their drinking behavior considerably without any difficulty. This would be seen as a temporary pattern of abuse. Can abuse lead to dependence? I believe so. I have seen this happen many times, even when there does not appear to be a family history of alcoholism.
Even though the new DSM-V manual no longer differentiates between abuse and dependence, preferring to call it substance use disorder, substance DEPENDENCE is defined in the American Psychiatric Association’s diagnostic manual (DSM-IV) as a pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same 12-month period:
- Tolerance, as defined by either of the following:
- a need for markedly increased amounts of the substance to achieve intoxication or the desired effect
- markedly diminished effect with continued use of the same amount of the substance
- Withdrawal, as manifested by either of the following:
- the characteristic withdrawal syndrome for that particular substance (e.g. with alcohol withdrawal: sweating or pulse rate greater than 100, increased hand tremor, nausea or vomiting, anxiety, seizures, hallucinations, etc.)
- the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
- the substance is often taken in large amounts or over a longer period than was intended
- there is a persistent desire or unsuccessful efforts to cut down or control substance use
- a great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances) use the substance (e.g. chain smoking), or recover from its effects
- important social, occupational or recreational activities are given up or reduced because of substance use
- the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
Because denial is always one of the largest symptoms of substance abuse, it is almost impossible for someone who is physically dependent to self-diagnose. Most substance abusers will only get help because they have to. And the three biggest reasons are pressure from family (threat of separation or divorce), employer (threat of job loss) and/or the courts (DWI).
“My experience with Tom has been outstanding.
He assisted me in my addiction to alcohol. Without his guidance I would most likely have lost my job and would still be battling the “insanity” that my life had become. Without hesitation I have recommended Tom to several co-workers struggling with work & personal problems and he has always been receptive in a timely manner. Thank you for everything you do.”
How Do I Know if My Child is Using Alcohol and Drugs?
This is a common question for which I get a lot of calls from very concerned parents. Every situation is different and I am glad to meet with you and your child to help provide an accurate assessment of the situation.
Most teenagers will have some experience with alcohol and other drugs. Most will experiment and stop, or continue to use casually without significant problems. Some will use regularly, with varying degrees of physical, emotional and social problems. Some will develop a dependency and be destructive to themselves and others for many years. Some will die, and some will cause others to die.
Some people grow out of their use of alcohol and other drugs. But since there is no certain way to predict which teenagers will develop serious problems, all use should be considered dangerous. Saying no is often part of the solution, but “just saying no” is seldom enough.
Some teenagers are more at risk than others to develop alcohol and other drug-related problems. Highest on the list are those teenagers with a family history of substance abuse problems. Legally available products include alcohol (over 21) and tobacco (over a certain age), prescribed medications, inhalants and over-the-counter cough, cold, sleep and diet medications. Illegal drugs include marijuana, cocaine/crack, LSD, PCP, opioids, heroin and “designer drugs.”
Those who begin to smoke or drink during their early teens are at particularly high risk. These substances (nicotine and alcohol) are the typical “gateway drugs” which can lead to cannabis, and then to other illegal drugs.
Warning signs of teenage drug abuse may include:
- Physical: lasting fatigue, repeated health complaints, red and dull eyes, and a steady cough.
- Emotional: personality change, sudden mood changes, irresponsible behavior, low self-esteem, depression, and a general lack of interest.
- School: drop in grades, many absences, discipline problems.
- Social problems: new friends who are less interested in standard home and school activities, scrapes with the law, and changes to less conventional styles in dress and music.
Some of the warning signs listed above can also be signs of other problems. Parents may recognize signs of trouble but should not be expected to make the diagnosis. An effective way for parents to show care and concern for their teenager is to honestly discuss the use and abuse of alcohol and other drugs with them.
Consulting a physician to rule out physical causes of the warning signs is a good first step. This should often be followed or accompanied by a comprehensive evaluation by a child and adolescent psychiatrist or licensed substance abuse counselor, psychologist or social worker.
—Photo credit: Kristina Tripkovic on Unsplash