How Does Alcohol and Other Drug Use Progress from Social Use to Dependence?
Dear Dr. Steve:
I dont know whats happened to me. One minute Im 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 doesnt seem real. This
isnt how it was suppose to be for me. I was the golden boy. I was going places. But
Im thirty-two years old and my life is falling apart all around me. I just lost my
drivers license for three years thanks to my third DWI. A few months ago I lost yet
another job. I cant fool myself anymore. It was because of my drinking and drugging.
I came in late, left early, or didnt 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 allkeeping up with the lies, juggling the money, the meaningless
affairs, and living with the fear of being caught and found out. I feel like Im
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, were 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 togetherthat is if she is of a mind to
stick with me. As I said, I dont know how things wound up like this. One day I was a
party boy and seemingly the next day Im a drug addict. Its all a blur to me
now but I know that I didnt intend for things to wind up like this.
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.
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.
people initially use alcohol and other drugs with the intention of using only occasionally
or for specific purposesand 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.
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 drugsimpacting the progression from abuse to dependency. And
certainly the amount and frequency of drug use will have an effect.
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 didnt 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.
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
of use: Occasional, perhaps a few times monthly.
Sources of drugs/alcohol: Friends/peers primarily. Youth may
use parents' alcohol or licit/illicit drugs
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.
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:
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
2: Alcohol and other Drug Abuse
of use: Regular; may use several times per week. May begin using
during the day. May be using alone rather than with friends.
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
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
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.
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
Feelings sought include:
Relief from negative feelings, such as boredom and anxiety
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
School or work performance and attendance may decline
Changes in personality
Lying and conning
Change in friendships - will have drug-using friends
Decrease in extra-curricular activities
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
3: Alcohol and other Drug Dependency/Addiction
of use: Daily use, continuous. (May be periodic/episodic)
of drugs/alcohol: Will use any means necessary to obtain and secure needed
drugs/alcohol; will take serious risks, including engaging in criminal behavior.
Drugs/alcohol are needed to avoid pain and depression
Many wish to escape the realities of daily living
Use is out of control
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
Physical deterioration includes weight loss, health problems
Appearance is poor
May experience memory loss, flashbacks, paranoia, volatile mood swings, and other mental
Likely to drop out or be expelled from school or lose jobs
Lack of concern about being caughtfocused 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.
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
Business hours are Monday through Friday, 8:00 AM to 5:00 PM local time
how to prevent and recover from chemical dependency as well as the aftereffects of
chemical dependency on you and your family. Read Dr. Frischs, Psy.D. series of
Insanity to Serenity.
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