Alcohol and drug use are complicated social issues. Everybody has an opinion. And political opinions are useless when there is a potential problem. Where the debate stops is when alcohol and drug use affect normal functioning in a person or a group of people. That’s where substance abuse is talked about.
In my opinion, there is no agreed upon definition of substance abuse. The American Psychological Association has a book Diagnostic Statistical Manual 5 (DSM-5) that has information about symptoms, traits, etc. But as a recovering alcoholic/addict, I have worked with many people who struggle with these issues. I have seen some classic DSM-5 candidates and I have seen folks that failed to meet all the criteria. With over 30 years of recovery, I made up my own.
Firstly, I cannot tell you that you have a problem or a loved one has a problem. Only you can do that. Substance use is a disease of denial. As long as you deny that you have a problem, you will not have the problem. And it is amazing the lengths that people will go to deny they have an issue with drugs and alcohol. And I mean AMAZING….tragically for those within their sphere, too. The self-destruction people will endure is maddening and saddening.
Secondly, substance abuse is a family problem. Someone with a substance issue will almost always negatively impact those around them: spouse, kids, family, friends, jobs, etc. Those closest to the person are encourage to seek out help for themselves so they can start the healing and recovery process they need. Being in orbit with an addict is like being in orbit with a house fire. People get burned.
Thirdly, there is hope for the afflicted. There is always hope for them and for those around them. But it takes work. With things go back to normal? Most assuredly ‘No’. You cannot change history but the future can be new and improved. This history will always be there but with recovery, it often becomes a source of inspiration.
Here is what I value as criteria for assessing substance users:
- What happens to you when you use – The amount you drink/use is not necessarily the ‘tell’. If when you drink, bad things happen to you and those around you (collateral victims) then there may be an issue. DUIs, arrests, police encounters, job loss, fights, broken relationships, financial problems, depression, etc.
- Why do you drink – If you cannot explain exactly why you have to have a drink, then there may be an issue. Good days and bad days are not good enough reasons. Everybody has those and there is massive segment of the world who have worse days than Americans and they do not drink/use drugs ever.
- One drink/hit is not enough – If you start out to have one drink/hit and end up having several, then there may be an issue. Of course, I have heard all the other reasons to have more than one. Yeah, yeah…right!
- Sick and Tired of Being Sick and Tired – Think about this one. For all the you do to change your life, your fortune and your relationships but nothing seems to work. Living life on life’s terms is a constant struggle. Running away and hibernating seem like good options. You might have a substance-related issue.
- You Don’t Look Like a Drunk or Druggie – If you have a mental profile of what a person with substance use looks like, you may be right. There are a lot of folks with substance issues that look just like you in the mirror.
- If people around you telling you not to use – It is a disease of self-denial but those around you do not have it!! They are trying to tell you something you choose not to see. Ding, Ding, Ding!! Those around you are there because they value you so do them a favor and value their insight into you.
Physical Addiction – This is just what is sounds like. A person’s body is physically addicted to a substance so a physical craving will set in when blood levels reach a certain point. Each person’s ‘point’ is different. Physical cravings unsatisfied produce withdrawals. If withdrawals are likely, then a chemical detoxification management is warranted. Alcohol withdrawal is the most dangerous and a person can actually die from them. For most other drugs, withdrawals are extremely painful and uncomfortable. Regardless, detox centers are available.
Psychological Addiction – This is where recovery becomes intense. Behind every person’s misuse of alcohol and drugs, there is a psychological story that helps them continue to use…despite the ‘stuff’ that happens in life. This is where counseling and support are needed. But neither are the panacea, the user has to want to change their life to the bottom of the very soul. Half measures result in half sober which usually ends up completely NOT sober. Misery returns quickly to those that try sobriety and fail.
Stages of Recovery
Here are the 4 stages of Recovery as I see them. They are not sequential but there is a general trend that follows a certain sequence. There is no defined time in each stage. It is very common for recovering people to cycle through the stages several times but not everyone cycles back through stage 1 again. Everyone’s path is different and unique. The most important thing is that you will always have support available to you…should you choose to use it. You can also choose to ‘white knuckle’ your recovery by yourself if you so choose.
- Physical Addiction
- Problem Recognition
- Detox/Treatment/intervention/Support Groups
- Maintained Abstinence/Physical Desire Gone
- Advanced Recovery
- Counseling/Support Groups
- Shadow Work
- Coping Skills/reframing
- Psychological Defense
- Inner self alignment with spiritual beliefs
- New found spirituality
- Not Religion
Where Counseling Fits In
Because of my own recovery background, counseling fits in through all 4 stages. This is unique to me and other counselors who have sustained recovery. I did not get into counseling because of being in recovery but it is a tremendous asset. I get it. I get the pain. I get the loss and sorrow. I get the struggle. It is worth the struggle.
Counseling provides anonymity and a safe environment in which to identify the reasons behind the choice of addiction. Alcohol/Drugs are only a symptom. They are negative coping behavior used to deal/avoid other issues: childhood trauma, personal failures, divorce, infidelity, career/life choices, etc.
I cannot get you or your loved one sober. That is up to them. It is more than just bad habits. I can help them change their thinking and their behaviors so the substance use is no longer an option. But it is up to them.
Approximately 27M people in the US have some sort of alcohol/drug related issue. So conservatively, you can estimate the 20-30% are actually addicted to some degree or another. Worldwide, there are only a rough estimate of just over 2M participating in AA recovery.