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Dr. Steve Frisch, Psy.D. is a clinical psychologist in private practice in
Chicago, Illinois and Northfield, Illinois.

You can contact Dr. Frisch, Psy.D. at
(847) 498-5611.

Learn how to prevent and recover from chemical dependency as well as the aftereffects of chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of Recovery books.


How Does Alcohol and Other Drug Use Progress from Social Use to Dependence?


D
ear Dr. Steve:

I don’t know what’s happened to me. One minute I’m sixteen and drinking three beers to fit in with my new fraternity brothers and fifteen years later, my drinking and drugging has gotten totally out of control. This doesn’t seem real. This isn’t how it was suppose to be for me. I was the golden boy. I was going places. But I’m thirty-two years old and my life is falling apart all around me. I just lost my driver’s license for three years thanks to my third DWI. A few months ago I lost yet another job. I can’t fool myself anymore. It was because of my drinking and drugging. I came in late, left early, or didn’t come in at all. Most of the time I was either too hung over to focus on my work or too preoccupied trying to figure out when and how I was going to get to my dealer. You have no idea what it takes out of you juggling the logistics of it all—keeping up with the lies, juggling the money, the meaningless affairs, and living with the fear of being caught and found out. I feel like I’m thirty-two going on sixty. My nose is burned out from the coke. My stomach has begun rotting out from the booze. My mind is so fried from the binging and the running and the wheeling and dealing.

As for my home life, we’re broke thanks to me. My wife looks at me with disgust and pity. Her contempt for me grows by the day. The lies and the cheating and drugging and the money problems have us so buried that it will take years for us to put things back together—that is if she is of a mind to stick with me. As I said, I don’t know how things wound up like this. One day I was a party boy and seemingly the next day I’m a drug addict. It’s all a blur to me now but I know that I didn’t intend for things to wind up like this.  

Nobody starts to drink and drug with the intention of becoming addicted. Unfortunately, for a percentage of people who begin to drink and drug recreationally, a combination of biological, psychological, and social factors affect the progression from recreational use to abuse and/or dependency.

Although considerable effort has been aimed at understanding how one becomes an alcoholic and/or drug addict, no conclusive answer or explanation has been found that applies to all persons and circumstances. Alcoholism and drug addiction are complex and multi-faceted. The most widely embraced model for understanding and treating alcoholism and drug addiction is what is known as a biopsychosocial model. What this means is that there is no single factor that makes a person an alcoholic or addict. Rather, there are biological, psychological, and social factors that contribute to an individual's initiation and continuation of alcohol and other drug use.

Most people initially use alcohol and other drugs with the intention of using only occasionally or for specific purposes—and many people are able to maintain that practice. Experimental use usually occurs during the adolescent years. Typically an adolescent begins with experimentation with tobacco, alcohol, and/or marijuana. During this experimental period, the use of drugs is intermittent. While experimenting with alcohol and other drugs, the adolescent may not experience any adverse consequences from such use. As their experimentation continues, they may begin to use other drugs as well.

However, for some people, their use of alcohol and other drugs progresses from experimental use to abusing alcohol and other drugs and, for some, dependency on their drug(s) of choice. The transitional timeline from experimental use to abuse and dependency varies from individual to individual. Biological/physiological, psychological, or social factors influence the timeline significantly. The pharmacological effect of certain drugs can accelerate physical and/or psychological dependence. For example, tolerance and withdrawal (symptoms of physical dependence) develop quicker with the use of heroin, than many other drugs. Many addicts have expressed surprise at how quickly they became psychologically dependent on crack cocaine. Other factors, such as age and gender, can affect the metabolism of alcohol and other drugs—impacting the progression from abuse to dependency. And certainly the amount and frequency of drug use will have an effect.

The second stage in the process of alcoholism and addiction is problem use or abuse of alcohol and other drugs. In this stage, the amount and frequency of use increases. Individuals may find themselves using alone where before they perhaps used only in social situations. Intoxication occurs more frequently. In this stage, changes in lifestyle may begin to become more obvious. The individual spends more and more time with using-friends in using activities. They become more and more distant from their non-using friends and family members. Where before using didn’t necessarily cause adverse consequences, now adverse consequences are beginning to occur. Mood swings may become more predominant. Sleeping patterns change. The individual may begin to experience drastic fluctuations in their weight. Problems whether they be financial, legal, occupational, or school related begin to occur.  Feelings of discomfort, guilt, fear, depression, or shame may be experienced after the effects of the drugs wear off.

If use continues, the individual may reach the third stage which is dependency. At this stage, one experiences loss of control over their use, increased tolerance for their drug(s) of choice, a greater preoccupation with obtaining their drug(s) of choice and using, and continued use despite experiencing adverse consequences because of their using.


Stage 1: Experimental and Social Use
of Drugs and Alcohol

Frequency of use:   Occasional, perhaps a few times monthly. 
Sources of drugs/alcohol:  Friends/peers primarily.  Youth may use parents' alcohol or licit/illicit drugs

Reasons for use: 
To satisfy curiosity
To acquiesce to peer pressure
To obtain social acceptance
To defy parental limits
To take a risk or seek a thrill
To appear grown up
To relieve boredom
To produce pleasurable feelings
To diminish inhibition in social situations.

Effects:
At this stage the person will experience euphoria and return to a normal state after using.  A small amount may cause intoxication.  Feelings sought include:  
Fun, excitement
Thrill
Belonging
Control

Behavioral indicators:
Little noticeable change
Some may lie about use or whereabouts
Some may experience moderate hangovers
Occasionally, there is evidence of use, such as a beer can or marijuana joint

Stage 2: Alcohol and other Drug Abuse

Frequency of use:  Regular; may use several times per week.  May begin using during the day.  May be using alone rather than with friends. 

Sources of drugs/alcohol:  Friends; begins buying enough to be prepared.  May sell drugs to keep a supply for personal use.  May begin stealing to have money to buy drugs/alcohol.

Reasons for use: 
To manipulate emotions
To experience the pleasure the substances produce
To cope with stress and uncomfortable feelings such as pain, guilt, anxiety, and sadness
To overcome feelings of inadequacy

Persons who progress to this stage of drug/alcohol involvement often experience depression or other uncomfortable feelings when not using.  Substances are used to stay high or at least maintain normal feelings.

Effects: 
Euphoria is the desired feeling; may return to a normal state following use or may experience pain, depression and general discomfort.  Intoxication begins to occur regularly, however.

Feelings sought include:
Pleasure
Relief from negative feelings, such as boredom and anxiety
Stress reduction
May begin to feel some guilt, fear, and shame.
May have suicidal ideations/attempts.  Tries to control use, but is unsuccessful.   Feels shame and guilt.  More of a substance is needed to produce the same effect.

Behavioral indicators:
School or work performance and attendance may decline
Mood swings
Changes in personality
Lying and conning
Change in friendships - will have drug-using friends
Decrease in extra-curricular activities

Begins adopting drug culture appearance (clothing, grooming, hairstyles, jewelry)
Conflict with family members may be exacerbated
Behavior may be more rebellious
All interest is focused on procuring and using drugs/alcohol

Stage 3: Alcohol and other Drug Dependency/Addiction

Frequency of use:  Daily use, continuous.  (May be periodic/episodic) 

Sources of drugs/alcohol:  Will use any means necessary to obtain and secure needed drugs/alcohol; will take serious risks, including engaging in criminal behavior.

Reasons for use:
Drugs/alcohol are needed to avoid pain and depression
Many wish to escape the realities of daily living
Use is out of control

Effects: 
Person's normal state is pain or discomfort
Drugs/alcohol help them feel normal; when the effects wear off, they again feel pain
They are unlikely to experience euphoria at this stage
They may experience suicidal thoughts or attempts
They often feel guilt, shame, and remorse
They may experience blackouts
They may experience changing emotions, such as depression, aggression, irritation, and apathy

Behavioral indicators:
Physical deterioration includes weight loss, health problems
Appearance is poor
May experience memory loss, flashbacks, paranoia, volatile mood swings, and other mental problems
Likely to drop out or be expelled from school or lose jobs
Possible overdoses
Lack of concern about being caught—focused only on procuring and using drugs/alcohol

Take advantage of your honesty and get help. Contact a qualified healthcare provider so that you can be properly evaluated. Go to Alcoholics Anonymous or Narcotics Anonymous.

You can contact Alcoholics Anonymous at:
In the U.S./Canada: Look for "Alcoholics Anonymous" in any telephone directory. In most urban areas, a Central A.A. office, or "Intergroup," staffed mainly by volunteer A.A. s, will be happy to answer your questions and/or put you in touch with those who can. Or, you can write to: A.A. World Services, Inc., P.O. Box 459, New York, NY 10163 - (212) 870-3400. www.alcoholics-anonymous.org

Outside of U.S./Canada, write or call the General Service Office located closest to you.

You can contact Narcotics Anonymous at:
World Service Office in Los Angeles
PO Box 9999
Van Nuys, California 91409 USA
Telephone (818) 773-9999
Fax (818) 700-0700
www.na.org

Business hours are Monday through Friday, 8:00 AM to 5:00 PM local time


Learn how to prevent and recover from chemical dependency as well as the aftereffects of chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of Recovery books—From Insanity to Serenity.

Pathfinder’s Checklist

1.) Contact a qualified healthcare provider.
2.) Contact your local chapter of Alcoholics Anonymous or Narcotics Anonymous.
3.) Read as much as you can about the disease of alcoholism.
4.) Read as much as you can about Recovery.
5.) Meet as many people as you can at Alcoholics Anonymous or Narcotics Anonymous meeting.
6.) Integrate the Twelve Steps of Alcoholics Anonymous or Narcotics Anonymous into your life.

G.B.U.

Steve



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