“I used to refer to my drug use as putting the monster in the box. I wanted to be less, so I took more – simple as that.” – Carrie Fisher, Wishful Drinking
In the clinical world of drug and alcohol treatment, a line has been defined between substance abuse and substance dependence.
The Diagnostic and Statistical Manual defines substance abuse as a “[M]aladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances” (DSM-IV-TR (4th edition, Text Revision; APA 2000).
“Substance dependence is more serious than abuse. This maladaptive pattern of substance use includes such features as increased tolerance for the substance, resulting in the need for ever-greater amounts of the substance to achieve the intended effect; an obsession with securing the substance and with its use; or persistence in using the substance in the face of serious physical or mental health problems.” – National Center for Biotechnology Information
Both substance abuse and substance dependence are problematic and merit intervention. By getting hung up on semantics, we fail to acknowledge the most important voice in this process – our own.
Below, you’ll find a list that encompasses signs of both substance abuse and dependence. Review it with the understanding that the intensity of interventions and length of recovery vary depending on the prevalence and severity of one’s symptoms:
Secrecy – Hiding the Behavior From Friends, Family, or Colleagues
“There are panicked rushes to inject in public toilets, a desperation to hide injection sites from employers (if you can manage to keep a job as I did) and perpetual fear of a crack down. It is a vicious trap for the desperate, wounded and impoverished.” – Leonardo: Exeter, UK
The act of concealing drug and alcohol use is a red flag that your behavior has crossed the line from experimentation and/or moderation into abuse or dependence. When people hide things, it typically stems from shame and fear. Human responses to shame and fear perpetuate the abuse and addiction cycle and discourage many from reaching out for the help that they need.
Blackouts Following a Drinking or Drugging Episode
“Roofies aren’t a myth, he said, but studies suggest the fear outpaces the incidence. Turns out, ‘being roofied’ often doesn’t involve roofies at all. People just don’t realize how common it is to experience a blackout.” – Sarah Hepola, Blackout: Remembering the Things I Drank to Forget
A blackout is not to be mistaken with passing out. In a blackout, the person under the influence appears to be lucid and functional, but later has no memory of the events that took place. Essentially, blackouts are a form of amnesia or short-term memory loss.
Change in Physical Appearance With Less Attention to Self-care
“Drinking makes you ugly. Not pretty, or sexy, or glamorous, or sophisticated. Ugly. It’s also terribly unhealthy for you.” – Holly Glenn Whitaker, Hip Sobriety
Oftentimes, those abusing substances exhibit marked changes in personal appearance. These changes hail from both physical and emotional sources. Some signs include broken capillaries in the facial region, dark undereye circles, unkempt hair or clothing, and significant changes in weight. As the substance problem progresses, attention to self-care and hygiene often declines.
Physical Withdrawal Symptoms When Not Under the Influence of a Substance
“If you have never been addicted, you can have no clear idea what it means to need junk with the addict’s special need. You don’t decide to be an addict. One morning you wake up sick and you’re an addict.” – William S. Burroughs, Junky
Physical withdrawal symptoms, like anxiety, nausea, insomnia, vary from person to person and depend heavily on both the substance being abused as well as the quantity and length of time that the person has been abusing it. Here are some typical withdrawal symptoms and timelines related to different substances from the American Addiction Centers:
- Heroin and prescription painkillers: flu-like symptoms lasting 24-48 hours
- Benzodiazepines: anxiety and/or seizures lasting weeks or (in some cases) months
- Cocaine: depression and restlessness lasting 7-10 days
- Alcohol: tremors and/or seizures lasting three days to several weeks
“For me, everything’s too much and nothing’s enough.” ― Mary Karr, Lit
When a substance is repeatedly abused, the body often develops a tolerance. A drug or alcohol tolerance occurs when an increased amount of the substance is required to achieve the effect that was initially experienced. What begins for many as moderate use slowly segues into “problem territory” as a result of an increased tolerance and dependence.
Using More of the Substance Than Intended – Loss of Control
“I’d go to a party and promise Michael I wouldn’t drink too much. He’d plead: ‘Just take it easy, okay? Watch yourself,’ and I’d swear: ‘I won’t. I don’t want to get too drunk.’ I’d mean that, of course, and I’d start out by measuring myself: one glass of wine the first half hour, one glass the second, and so on. But then something would snap, some uncontrollable process would kick in, and all of a sudden it would be two or three hours later and I’d be on my sixth or tenth or God knows what glass of wine, and I’d be plastered. I couldn’t account for it, couldn’t explain it, couldn’t even rationalize it, although I struggled mightily to. I seemed to get drunk, blind drunk, against my will.” – Caroline Knapp, Drinking: A Love Story
For those contemplating recovery, it is common to first explore moderation. Moderation plans typically involve the creation of specific parameters around substance use that limit quantity and frequency. When these boundaries are set and continually broken, there is likely a drug or alcohol problem or addiction at play.
“I am only sticks and spasms. Money gone. Love gone. Career gone. Reputation gone. Friends gone. Hope gone. Compassion gone. Usefulness gone. Second chances gone. And if there had been any hesitation about dying, that’s gone now, too. I take a huge hit.” – Bill Clegg, Portrait of An Addict as a Young Man
Whether the abuser is withdrawing from family and friends or carrying them along for the ride through erratic behavior changes and physical symptoms, the impact of substance abuse is widespread. The severity of family-relational issues often progresses along with the addiction and can range from subtle discord to irreparable destruction.
Loss of Interest in Healthy Activities/Hobbies and Professional Aspirations
“I do know that I have little to no interest in anything. My life consists of sleeping and eating, I feel like a bump on a log. But i have no motivation to do anything. – Anonymous, SoberRecovery.com Community Forum
As substance abuse progresses, the desire for drugs and alcohol slowly supercedes day-to-day commitments. Oftentimes, voluntary activities like sports and recreation are the first casualties followed by more professional commitments. Over time, little to no pleasure is derived from activities that don’t include drugs and alcohol and feeding the addiction takes precedence over all else.
Continued Use Despite Negative Consequences
“End-stage addiction is mostly about waiting for the police, or someone, to come and bury you in your shame.” – David Carr, The Night of the Gun
When social, emotional, legal, and physical consequences surface, some substance abusers report having a “wake-up call” and change their behaviors accordingly. However, when negative repercussions occur and the drug or alcohol use persists, this is indicative of a serious problem.
Risk Taking Behaviors
“I was too busy destroying my life to bother with a minor detail like contractual obligation. I had veins to blow. A child to ignore. Friends to rip off. An apartment I hated on sight to pay for and move into.” – Jerry Stahl, Permanent Midnight
Nearly anyone who experiments with drugs and alcohol will describe a decrease in inhibitions. When substances are abused heavily, however, these decreased inhibitions can quickly spiral into risky behaviors. There are scientific and psychological elements at play that lead many people under the influence to make decisions that they would never make if they were sober.
As you evaluate your own use of substances, consider just one question: Does my relationship with drugs or alcohol concern me? Rather than fixating on labels and diagnoses, this question allows you to focus on what is truly important. If your behavior concerns you, then it’s time to make some changes.
If you struggle to identify a link between your substance use behaviors and your psychological, social, and physical struggles consider the above list of signs. Having as little as one of the indicators reflects a problem. The good news? There are countless, individualized paths to recovery and you don’t have to travel the recovery journey alone.
National Council on Alcohol and Drug Dependence–NCADD
Jen Anderson is a Licensed Clinical Social Worker (LCSW), Sobriety Coach, and former alcohol enthusiast living in Florida with her husband and son.