Monday, October 6, 2014

The Spectrum of Substance Use & Abuse

I have recently been giving a lot of thought to what it means to be “addicted” to something. The idea of being an “addict” might draw to mind some pretty frightening graphic images. On the other hand, its commonplace to talk about one’s vices, cravings, those “can’t live withouts” that help us cope with daily life stressors.  When does an innocuous vice become something seriously concerning to your overall health and wellbeing? We all have coping strategies, but when does coping with a problem become its own problem?

Wouldn’t it be nice if I offered you a black and white answer about the when, where, and how we can tell whether we are headed down a dangerous road of addiction, in order to take the next exit before crashing. In reality, however, the road signs that mark danger are extremely subjective, personal and often just out of sight.

Take this example: Work is stressful, and you develop a routine of enjoying a drink at the end of a hard day at work. After a couple of months, one drink doesn’t quite do it anymore- you start having 2, then 3, then 6. Then work becomes a little more stressful, and you decide to start your day with a little booze to take the edge off the morning. It starts to wear off by midday, and you start going to a bar on your lunch break. Before long, you are stashing mickeys in your desk at work. Next your coworker notices and tells your boss. You lose your job, and so you turn to the bottle to help you cope with that- you begin drinking all day at home. Your partner feels neglected and helpless and decides to leave. You want to stop, you see your life crumbling, but you simply cannot live without the alcohol to cope.

This story might sound extreme (“that would never happen to me”), but what the story is trying to emphasize is that substance use can transform gradually and slyly to substance abuse and substance dependence. When was the turning point from manageable to perilous? I want to share with you a tool that helped me understand the grey zones of substance use: a spectrum of substance use. This tool can help you self-assess where you are at with your vice or vices of choice, in order to empower you to acknowledge what might be one of those obstructed road signs, and/or to seek the appropriate help. 

Beneficial:
- Use has positive effect on health, spirituality, or social life (e.g. coffee to increase alertness, traditional herbs for cultural purposes)

Non-Problematic:
- Recreational, casual, or other use that has insignificant health or social impact  (e.g. drinking socially or on special occasions)

 Problematic:
- Use that starts having negative health consequences for self, family/friends, or society at large (e.g. getting sick, missing work or school, missing social events, getting in trouble with the law…)

Dependent:
- Use that has become habitual despite the negative health and social impacts (e.g. getting in a car accident under the influence, friends and family cannot stand to be with you…)
  
    

The purpose of giving you this tool is as much about helping you to understand and identify the different categories of use and the associated risks and symptoms, as it is about recognizing the grey zone between each category. The grey zone is where it is exceedingly important to ask yourself how you are doing, and to have conversations with those around you. Recognizing and naming where you are along this spectrum is nothing to be ashamed of. Life is far from easy and we all need coping strategies to help us through. The key is to find adaptive healthy coping strategies that help you to soothe yourself in the short term in a way that does not undermine your well being in the long term (e.g. talking to loved ones, exercise, massage, artistic expression…). What are some of your healthy coping strategies? What could they be? Have these conversations with supportive loved ones, experiment with your coping strategies, and learn what you are capable of.

by Naomi Adams, Graduate Intern

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