Progression of Drug Addiction

I tell clients all the time that no one is born a skid row drug addict. There’s a long, painful road to the bottom for alcoholics and all others dependent on a drug. Furthermore, not all those who become addicts wind up on skid row. Drug addiction can happen to those who have plenty of financial support. Some addicts almost immediately experience dependence and obsession with a drug when they first try it — especially meth and cocaine addicts. Usually, though, it takes years for someone to become severely dependent to the point that they place at risk all that’s important to them just so they can continue to use their drug. This doesn’t mean, though, that anyone who uses a drug for a long time and often will become an addict. There’s a combination of factors – genetics, dysregulation of brain chemicals, psychological and environmental factors – that create addiction which progressively gets worse. Many people will not become, say, an alcoholic just because they drink on a regular basis for years. A person interested in understanding how addiction works in the brain can read The Science of Addiction.

For the purpose of this post, I simply want to clarify misconceptions about addiction and drug misuse, and how sometimes it doesn’t really matter if a person is dependent or simply misuses a certain drug — it only matters what the person does about their problem. I’ve written about this topic several times, but it’s a complex subject that requires a lot of discussion, and it’s a subject that science is still researching. Scientists have pretty much isolated the part of the brain, the mesolimbic dopamine system, that pertains to chemical dependence (addiction). But when dealing with someone who has a drug problem, all the charts and scientific explanations don’t fully help us understand drug-related behavior. As I wrote above, it’s complex. Everyone has their own version of an addict in their heads, until they come across an addict that doesn’t fit their version.

I’ve dealt with young addicts who within a year were dependent on their drug of choice and totally out of control. I’ve deal with housewives whom no one suspected of having an addiction, who quietly suffered at home, mostly alone,  from a dependence on pills. I’ve deal with respectable business people who certainly never intended to lose control of their drinking, but wound up after 10 years  of drinking in a treatment center totally bewildered that they were drinking daily to keep from falling apart. I’ve dealt with Priests, plumbers, school teachers, homeless men and women, stock brokers, atheletes, high school kids, Psychologists, Biologists, carpenters, accountants and politicians.

I once was very concerned that those who came into treatment at what seemed an early stage in which the person still had control of the alcohol/drugs, but made bad decisions often when drinking or using some other drug, were being treated for addiction but might not be “real” addicts. I later understood that misuse of alcohol and drugs is dangerous and detrimental to mental and emotional health. Perhaps some of the people in treatment don’t meet all the criteria for full blown drug addiction, but they might be in the early stage or they might simply be the type that misuses drugs to deal with life or escape life. Maybe they can quit easier than the person who has a brain disease that creates physical dependency and insane craving. Treatment can help both. I’ve seen many people come through treatment who I suspected were not true addicts, but they needed help learning coping skills and developing an understanding of what they really wanted in life — they decided that drugs were not needed and that they’d be much better off without alcohol or some other drug. Drugs can create problems in lots of ways, and most times the problems don’t get better unless the person receives some kind of help — the problems usually get progressively worse. This doesn’t mean that everyone who has any kind of problem with alcohol or some other drug must go into a formalized drug addiction treatment program, but they usually do need to take actions to deal with the problem, whether it’s AA, talking with a physician, getting support from a friend or family, something to change the self-defeating behavior.