How do you know if you have a problem with drugs or alcohol? Usually, if you have to ask yourself that question, it means you likely have a problem. Only once or twice in 25 years of doing drug and alcohol counseling have I met with someone asking themselves this question who turned out to not have a problem. But we can refine that question further.
Symptoms of addiction
On the most general level, you have a drug or alcohol problem if your drug or alcohol use either creates problems in your life or causes you to feel bad about yourself. Problems could be anything from getting a DWI to missing work to your spouse being upset with or concerned about you. The feeling bad about yourself piece is pretty self-explanatory.
But drug abuse counselors and addiction counselors use the American Psychiatric Association's (APA) list of clinical diagnostic symptoms to determine if someone has a problem. If someone has two or more of the following symptoms in a 12-month period, they meet the definition of what is now called a “substance use disorder”: the substance is taken in larger amounts over a longer time period than intended; there’s an ongoing desire to cut down on the use or recurrent failed attempts to cut down; lots of time is spent trying to get the substance, use the substance, or recover from using the substance; use of the substance gets in the way of meeting important expectations related to work, school, or home life; use continues despite it causing ongoing problems in some important area of their life; ongoing use in situations that are physically dangerous; the person keeps using even though they know it causes some ongoing physical or psychological problem; they develop a tolerance for the substance - meaning they need to take more of it to feel the way they want to feel, or if they continue to use the same amount, they feel less and less of the desired effect; or withdrawal - meaning they experience withdrawal symptoms or keep using to avoid experiencing these symptoms.
Many addicts and alcoholics can stop for a while
Many people think that in order to have a drug or alcohol problem, in order to be an addict or alcoholic, one has to be unable to go periods without drinking or using. They think that one can only be an addict or alcoholic if they must drink or use every day. This is a very common misconception. With the vast majority of my clients, this is not the case. Most of my clients with addictions are “high functioning” – they have good jobs, are successful, and their lives look healthy from the outside. Often these are people who have their lives pretty together… except in this one specific area. They often can stop using or drinking for periods of time. But this is not an essential criterion of addiction. The essential piece is not the frequency of use, but the degree to which the use causes problems or distress. For example, you might drink only once per month. But if every time you drink, something bad or embarrassing happens, or you feel bad about yourself, you meet the criteria. In fact, this doesn’t even need to occur every time you drink. But if it occurs repeatedly and you continue to drink, you meet the criteria.
Most of us have heard of “rock bottom” or hitting “rock bottom” in the context of someone’s drug or alcohol use. This is the idea that someone experiences something so unpleasant that they “hit bottom” and realize they need to do something about their addiction. What I find interesting is that everyone has a different bottom. For some clients I’ve worked with, bottom was something as simple as realizing they weren’t being as present with their kids as they might be if they were sober. But other clients have much “lower” bottoms. I’ve had clients who don’t get it despite losing everything: their marriages, their kids, their ability to work (losing their medical or law license), going to jail, and even being homeless.
For more information, visit my Drug and Alcohol Counseling page.
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