Have you ever blacked out at a bar? Lost control at a party? Popped too many pills?
If you relate to the above statements, you will find the Chat 2 Recovery blog helpful.
This will be the first of what I hope to be a regular series of blogs about substance use disorders and their effective treatment. I hope to share my views with an interested community who are willing, in turn, to share their questions and comments. I begin by sharing my understanding of what it means to have a substance use disorder (SUD).
According to our current understanding, there are two types of SUDs; Substance Abuse and Substance Dependence. Substance Abuse is considered to be less severe than Substance Dependence. The predominant factor in both of these disorders is the degree to which one loses control over the use of a substance. The greater one’s loss of control over a substance, the more severe the disorder is considered to be. Substance Abuse is characterized by irregular loss of control. Substance Dependence is characterized by regular loss of control. Loss of control is defined here as either consuming more than one sets out to consume or using the substance for a longer duration than anticipated. The frequency with which this loss of control occurs determines the type and degree of an SUD.
Let’s look at an example of an individual with a Substance Abuse Disorder. Joe typically goes to a bar after work on Fridays for a few drinks with co-workers. Most Fridays, Joe has a few drinks and then goes home to his family without incident. However, periodically and unexpectedly, Joe goes to the bar and overdrinks to the point of blacking out. From this blacked-out state, Joe, one evening, drives his car and gets arrested for Driving While Intoxicated (DWI). In another unexpected instance, Joe drinks so heavily that he has his wallet stolen losing a great deal of money. While, yet, another time he over drinks and gets himself into a physical fight with injuries severe enough to be taken to the hospital emergency room. While these negative consequences of overdrinking appear significant, they occur without much consistency and intermittently over the course of a year. The irregular loss of control, as characterized in this example, would be an example of the SUD known as Substance Abuse. The irregularity of this person’s loss of control is what makes it Substance Abuse.
Substance Dependence is characterized by regular loss of control. Generally speaking, the substance is controlling the person rather than the other way around. The person shows little ability to control how much or how often to use the substance. While it’s common for individuals with Substance Dependence to use daily or quite regularly, frequency of use doesn’t matter as much as quality of use. In other words, what happens when the person uses is the primary factor.
You should now try to assess your own control or loss of control over your substance use. Ask yourself: Am I setting limits on consumption and frequently not following those limits? Am I setting limits on how long I use or how much I spend and frequently not following those limits? Do I determine days when I will not use substances and frequently break those rules?
Ironically, it is often easier to treat a person with Substance Dependence than with Substance Abuse. Because of the intermittent nature of loss of control with Substance Abuse, a person can easily develop excuses and rationalizations for their episodes of using too much. For example, “I didn’t eat that day” or “the drug was more potent than usual.” On the other hand, the person with Substance Dependence has a hard time denying their regular loss of control and can more easily admit to problem use.
While loss of control is the essential symptom of an SUD, there are other symptoms which need to be mentioned. Clearly, the substance use must bring some level of impairment to the individual’s life in such areas as social, occupational, legal, medical, or financial. In addition to negative consequences of use, the individual may also exhibit signs of preoccupation to use (e.g., thinking obsessively about using). For some with signs of Substance Dependence, the individual may exhibit signs of physical dependence on the substance. (Physical Dependence will be explored in a future blog.)
In my next blog, I will review ways of determining if you are exhibiting symptoms of a Substance Use Disorder. Let me know if this description of SUD’s makes sense to you. Please feel free to comment and ask questions below, and I will respond as soon as I can.
Look forward to hearing from you.
Stay well,
Nick Lessa