1. What Causes a Problem Is a Problem if It Causes a Problem

With the publicity surrounding the recent publication of the ASAM (American Society of Addiction Medicine) update on the definition of addiction, it is likely useful to review some of the “indicators of a problem” to which non-professionals can better relate and therefore more quickly use to recognize a problem with substance use. First a quick review of the new ASAM definition:

Short Definition of Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. To review this in more detail, visit http://www.asam.org/DefinitionofAddiction-LongVersion.html

As precise as this definition is for professionals, my experience when working with individuals in earlier stages of readiness to change their drinking and other drug use has been that such definitions present easy targets for those looking to deny their problem. Because defining addiction for professionals and for “consumers” can yield wildly different responses, this post will focus creating a “short list” of indicators that may suggest one’s use is not so much use as it is reason for concern.

In no specific order, here is a short list of indicators. Having but one of these does not necessarily suggest a problem, but as the number of indicators increases, so does the likelihood that one’s use is problematic if not indicative of addiction:

1. “What causes a problem is a problem if it causes a problem.” This ‘bumper-sticker’ wisdom comes from a well know lecturer in the alcoholism field, Fr. Joseph Martin. What it means is, if I am wondering if my substance use is becoming a problem for me or if I wonder if my significant other’s use is becoming a problem, guess what...it is becoming a problem.
2. Increasing time spent thinking about using, planning to use, or finding the economic means to support that use. For the professional this suggests “compulsion”; for the consumer it is rationalized as “preoccupation with an enjoyable activity.”
3. Similar to #2, my use has become an increasingly important determinant of how I budget my time. For example, previously enjoyed or favored past times are bypassed to make time to use. Drinks with friends rather than ball games with kids; smoking-up in the basement rather than watching TV with the family;
4. Protecting the supply. Although most people have some beer, wine and/or spirits in the house they do not have “cases” of their favorite beverage stockpiled. NOTE: The well stocked wine cellar does not necessarily mean the “oenophilist” or connoisseur of fine wines has a drinking problem. Related to this is the need to use more to gain the desired effect...which increases the importance of protecting the supply.
5. Changes in the people with whom I use. To change the people I socialize with and/or the places I socialize in in order to accommodate changes in my use pattern can foreshadow a movement towards a problem. To spend less time with John and Mary who go home after 2 in order to hang with Bill and Flo who “really know how to party,” signals a change worth noting.
6. A shift from 2 beers/sours on Fridays to 3 or 4 shots and beers “a couple nights a week” warrants consideration. Likewise, when “splitting a bowl” a couple times a month morphs into finishing a blunt a couple times a week, or Tylenol-III 2X/day for 3 days becomes Oxycodone PRN.
   

These indicators are more environmental or behavioral; personal indicators include:

1. Minimizing reported use or using secretively. Social users have too much and say, “Boy, did I over do it last night; I’m going to have to be more careful in the future.” The problem user says nothing about the overdose and deftly changes the subject if someone brings it up.
2. When considering how to budget money or time, use moves from being a “want” to becoming a “need”; from being a luxury to a necessity.
3. Changing other factors in my life in order to accommodate the use...I eat less so I can drink more (concern about weight); I switch from “good stuff I like” to “less good stuff I can afford” to consume more on the same budget; spending less on clothes or entertainment to accommodate expanded patterns of use.
4. Becoming a different person when using or the “Dr. Jekyll (the accomplished, “nice guy when sober”) / Mr. Hyde (“bestial” ghoul when using) syndrome – young kids are particularly adept at both noting this and commenting on it.
5. Sincere pledges, to self or others, regarding change are easily overturned. NOTE: The true mark of control is not saying “no” to “a” drink or drug—anyone can do this; it is saying “no” to a drink or drug I want.
6. A questionable ability to predict when I will next use and/or once starting, when I will stop.
   

There are numerous screening check lists and indicators available online (for example, see http://www.ncadd.org/). Likewise, any bookstore has numerous publications in the “self-help” section. Some are good, others, not so much. Irrespective of what you read, hear, or listen to, the bottom line regarding one’s use is, what do I tell myself? This reflects back to the first item on the first list noted above: What causes a problem is a problem if it causes a problem.

Substance use disorders are bona fide health care issues, a brain disease if you will. We have stigmatized these disorders in our culture and these stigmas have prevented individuals from recognizing that something is amiss until what was amiss becomes “a mess.” If you think something is amiss regarding your pattern of use, speak with someone who can help you step back, revisit the facts in your life, and consider an objective albeit candid new perspective from which to view these facts.

What do you think?

Dr. Robert