Working with Substance Abuse Disorders
I met with a client some years ago who was struggling with cannabis use. When I first began meeting them they used cannabis a few times a month. They did not consider this problematic and said they just smoked for fun. As we continued to meet, this client started using more frequently. After a month or so they were smoking every week.
As their use progressed, they refused to see that anything was wrong. Even as they began smoking at school every day, the client would still tell me that they could stop at any time. After more time passed they had a difficult time coming to sessions if they were not high and they clearly became agitated when they were sober.
Over the course of a year I watched as this client progressed through all four stages of addiction. During our time together I did everything I possibly could to get this client more help. I tried harm reduction approaches, cognitive behavioral strategies, and a lot of compassion. Although it took some patience on my part, this client did eventually get treatment for addiction and is now living a happy and sober life.
The Four Stages of Addiction
- Regular Use
- Risky Use
- Dependence and Addiction
Many people think that they will know the moment when they become addicted to something. However, more often people move slowly through the stages of addiction and don’t realize the signs as they are happening. It is important to check in with a mental health care professional if you see signs of the later stages in yourself or a loved one.
The first stage of addiction is experimentation. This phase is characterized by relatively harmless drug or alochol use. In order for it to be considered experimentation the substance can only be taken one or two times; anything more than that is considered regular use.
There are many reasons that people experiment with drugs and they are not always bad. People sometimes used because they want to feel better, have a spiritual experience, are curious, feel pressures, feel stressed, and many more. It is important to note that not everyone who experiments with drugs will go on to progress through the stages of addiction.
Signs of Experimentation
- Trying substances for the first time
- Using substances only once or twice
- Long periods of time between instances of substance use
- Very little or no consequences from using substances
- Ability to refuse substances
2. Regular Use
Regular use is the second stage of addiction. If someone is in this phase they will often use substances with more frequency than the first stage. People who use regularly might begin using substances every weekend at first. Some people enter this stage without every progressing to the second two stages. In some cases people can use regularly and then have no problem stopping when they need to.
However, regular use greatly increases the risk of becoming addicted to a substance. Additionally regular use during a time of stress or life transitions has also been linked to higher rates of addiction.
Signs of Regular Use
- Using substances on a weekly basis
- Looking forward to substance use
- Minor consequences of substance use
- Increased feelings of depression or anxiety
- Peer relationships based on substance use
- Seeking out social situations where substances will be available
3. Risky Use
The third stage of addiction is risky use. This is the point where someone’s substance use becomes concerning because it can easily progress to addiction. There is a thin boundary between regular use and risky use so it is important to be able to distinguish the signs. The biggest difference is that with risky use someone continues to use substances despite negative consequences.
Additionally, someone in this phase might use drugs or alcohol in situations that are potentially physically hazardous. For example someone might drive while intoxicated or they might put themselves in a dangerous situation in order to obtain drugs.
Signs of Risky Use
- Using substances despite negative social, occupational, or family consequences
- Increased feelings of depression and anxiety
- Putting oneself in potentially dangerous situations in order to use or obtain substances
- Using on a regular basis
- Preoccupation with using substances
- Denial about problems from substance use
- Peer relationships and social activities revolve around substance use
- Going to work or school while intoxicated
4. Dependence and Addiction
The final stage of this four part model is dependence and addiction. This phase is characterized by the same social and emotional consequences that are found in risky use. The difference between addiction and risky use is that at this stage someone is physically and psychologically dependent on the drug.
In order to someone to be considered dependent on substances they must meet the criteria for both tolerance and withdrawal. Tolerance is defined as needing to take more of a substance in order to get the desire effect. If you are interested in learning more about tolerance you can visit this page from the National Institute of Health. Withdrawal is defined as having adverse psychological and physical symptoms when the substance is removed.
Signs of Dependence
- Taking more of the substance in order to get the desire affect
- Symptoms of withdrawal when the substance is removed
- Feelings of depression and anxiety
- Preoccupation with using and obtaining substances
- Using on a regular basis
- Physical, psychological, social, familial, and occupational consequences from using
- Failure to meet regular obligations
- Anger or agitation
What can you get Addicted to?
Many people who I work with with say that there is no way that they are addicted because you cannot be addicted to cannabis. The truth is that you can absolutely become addicted to cannabis the same way you can become addicted to heroin. Additionally, you can also become addicted to food, sex, or gambling.
Just because something is not considered as dangerous or habit forming as some other thing does not mean it is harmless. In my clinical opinion, you can become addicted to just about anything that causes your brain to release dopamine. Dopamine is neurotransmitter that enables us to feel pleasure. When dopamine is released your brain naturally seeks more of it.
So if your brain releases a rush of dopamine every time you eat a bite of cake then it is likely that you will want to eat more cake. Of course, we do not get addicted to everything that makes our brains release dopamine. However, we have the potential to get addicted to many of these things if we use them regularly. This is especially true if we use them with the intention to reduce anxiety or other unpleasant feelings.
It is crucial that if someone is struggling with addiction that they get help. Often the course of treatment includes inpatient residential treatment. This is commonly known as “drug rehab”. These types of facilities are equipped to handle the physical and psychological symptoms someone might experience while coming of of drugs.
It is not easy to find the right treatment and it is important to work with a licensed mental health professional in order to find the right place. If you are in need of addiction treatment for yourself or someone you care about please feel free to contact me at Elizabeth@OneMindTherapy.com or (707) 780-3003.
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