Drug Culture: From Dependence to Abuse to Addiction

“A journey of a thousand miles begins with one step,” the famous Chinese proverb says. And it’s true: every journey — even a hard one — has its own beginning. There are as many roads that lead to drug abuse and addiction as there are people — uniquely individual stories, histories, choices, intentions and happenstances that triggered that first step. That first joint. That first shot. That first painkiller. Addiction doesn’t happen overnight, but it happens insidiously quicker than you might think. A dozen small steps in the wrong direction, and boom! You’re there.

Supervised Dependence

For many people, the road to addiction begins with an injury or medical condition that requires medications prescribed by a physician as part of a structured pain management plan. The patient, over time, may become physically dependent on the drug in order to function, but dependence is not addiction. If the patient uses the medication as directed and continues to live an otherwise healthy and productive life, he or she is not psychologically dependent on the prescription drug. Eventually, if possible given the individual injury or illness, the physician will supervise cutting back on the opioid, weaning the patient off slowly for the safest possible outcome. Withdrawal symptoms are common but manageable. Not all drug-dependent people become addicts, but managing that curve in the road takes ongoing vigilance and physician oversight and accountability.

Recreational Use: The Gateway Is Real

For others, the road to addiction begins with the most readily available drugs like marijuana, tobacco and alcohol. These drugs, the use of which in adolescence is fueled by the need to cope with stressful relationships, insecurities or other, more serious mental issues, become an ongoing, escapist choice. Not everyone who uses marijuana recreationally goes on to use heroin, cocaine or meth, but those who become addicted to marijuana are three times more likely to become addicted to heroin. According to a recent Yale University Medical School study, marijuana users are two-and-a-half times more likely to abuse prescription medications. And there is plenty of scientific evidence to prove early initiation of drug use “primes the brain” for enhanced responses to other, more dangerous drugs.

How Abuse Happens

The first sign of drug abuse happens when those who are physically dependent on drugs — whether the result of ongoing injury, illness or continued recreational use by a person who does not have or need a prescription — forms a mental/emotional or psychological attachment to the drug. He feels he needs it to function. She doesn’t feel “normal” without it. What began as a physical need or a voluntary, controlled decision or set of decisions, becomes less and less so, as chemical changes in the brain reduce a person’s ability to control his or her impulse to use.

When a physical dependence on opioids morphs into psychological dependence, your brain begins actively betraying the body’s survival instinct.
Drugs impair neurotransmitters in the brain, sending abnormal messages that produce cravings when there is no physical pain. Impaired neurotransmitters send craving messages to recreational drug users. The brain does not record the negative impact ongoing drug use is having on the body. Ultimately, as use gives way to abuse, the brain begins to ignore and override the body’s own survival instinct, in preference to the chemical overload in progress.

When Abuse Becomes Addiction

By the time a person’s dependence becomes fully realized — manifested as both a physical and psychological dependence — and misuse or abuse of the drug has become a habitual, ongoing behavior, addiction is happening.

The National Institute of Drug Addiction (NIDA) identifies the characteristics of addiction as:

  • Compulsive use
  • An inability to stop, despite wanting to do so
  • Failing to meet work, family, school and social obligations
  • Dedicating a disproportionate amount of time and resources to drug-related activities
  • Developing a tolerance such that more of the drug is required over time
  • Going through withdrawal when drug use ends or the amount of intake is reduced

In other words, abuse is essentially the open door to addiction. Once a person is habitually abusing drugs, addiction is no longer an “if” but a “when.”

When addiction takes over, every waking moment of one’s life drowns in the need for the drug, how to get it, how to keep it, and how to never be without it. All behaviors — lying, stealing, sexual practices, codependent manipulation, driving under the influence and more — support the survival of the addiction, not the person. The drug becomes more important than life itself.

And when you consider that more than 50 percent of people seeking treatment for addiction are diagnosed with a significant mental health issue, it’s no wonder that addiction is a hard road to beat. Hard, but certainly not impossible.

Begin with the Basics of Addiction Treatment

When searching for appropriate drug treatment programs, whether for yourself or a loved one, knowing the basics can help get you started.

Quality drug treatment programs begin with medically-supervised detox. Detox gives the body a chance to rid itself of drug toxins in a safe environment. It may seem like a drastic way to begin, but until an addict’s body is completely free of the drug, he or she cannot begin to address the root causes of addiction and find a way back to a healthy life.

Once detox has ended, diagnosis begins. During this stage of treatment, a rehab team of doctors and therapists look for underlying addiction causes, such as untreated or undiagnosed mental illness. It is often difficult to determine whether mental illness is the cause of the addiction, or substance abuse has caused a dormant mental illness to surface. In any case, a dual diagnosis helps doctors and therapists design a program that treats both issues simultaneously. This increases the chances of recovery success.

Treatment programs vary in length, but are typically 30, 60, or 90 days depending on individual health insurance plans and other addiction resources. Drug treatment programs can be outpatient or inpatient depending on the severity of the addiction and the individual’s circumstances.

When a person decides to get help for addiction, intake counselors are just a phone call away with answers to questions like:

  • Which treatment options are best for your individual situation?
  • Will insurance benefits apply or are there other payment options?
  • What will the admissions process look like?
  • What can you expect in the early stages of treatment?

Taking that first step toward substance abuse treatment is easier when you and your loved ones have the basic information in hand. The more you know, the more empowered you’ll be to get the help you need. Addiction recovery is possible. Getting sober, getting your life back, getting your relationships back — all of this is possible, but you cannot do it without help. Consider taking that first step of the next thousand miles back to life today.

1 nytimes.com
2 drugabuse.gov

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