While there is no absolute scientific formula for identifying when an individual’s drug consumption has developed into a full-blown addiction problem, most rehabilitation counselors agree that there are four distinct stages of drug use that may lead to addiction. The four stages are generally acknowledged as drug use or experimentation, the misuse of drugs, the abuse of drugs and a drug dependency or addiction. While individuals in the first or second stages of use and misuse may not necessarily progress into drug addicts, individuals in the third stage of drug abuse are likely to develop full-blown addiction problems.
Drug Use or Experimentation
The first stage on the potential road to drug addiction, the use of drugs without experiencing any negative consequences is what rehabilitation counselors refer to as experimentation or simple drug ingestion. Enjoying a drink, smoking a marijuana joint or taking any other drug with friends or colleagues without any serious social or legal consequences is regarded as drug use or experimentation. While such behavior is not to be encouraged, it is a fact of life for many teens and adults.
Misuse of Drugs
The misuse of drugs occurs when the individual experiences some form of negative consequences as a direct result of having ingested any one particular drug. For example, someone who becomes inebriated at a party or get-together and is stopped for drunk driving on his or her way back home has misused alcohol even if that person does not normally drink to excess and is not an alcoholic. Examples including the one just mentioned occur in a fairly large percentage of the North American public at some point in a person’s life, and while not everyone who has misused drugs becomes an addict, the regular misuse of any drug is a telltale sign of an addict in waiting.
Abuse of Drugs
When an individual frequently misuses drugs in spite of any negative social or legal consequences that may result from such misuse, said individual has progressed from an occasional misuse of drugs to the more serious stage of the abuse of drugs. In effect, the negative consequences arising from the misuse of drugs has done nothing to curb the individual’s appetite for drug ingestion to the point of inebriation even in the face of serious penalties and possible broken relationships. Often begun as a temporary form of emotional escapism, drug abuse leads to much more serious problems in the long run.
Drug Addiction and Dependency
Once an individual has begun to abuse drugs, it is likely that the continuation of such behavior will lead to a drug addiction or dependency problem. Drug addiction or dependency is defined as a compulsion to take drugs despite any and all negative consequences to the individual’s relationship with his or her family, friends and work colleagues; physical and mental health; personal finances; job security; and at one extreme, a criminal record. While the reasons an individual progresses from the simple or occasional use of drugs to a possibly fatal dependency on drugs are not all clear, once this stage has been reached most addicts cannot function without consuming drugs. Addictions can be physical, psychological, emotional or any combination of the three, but at this stage professional help must be sought.Social Drug Use, Regular Use
Social drug use is the use of any drug or combination of drugs in social situations, or for social reasons. If such social use causes any harm, physical or otherwise, to the user or others, it is also considered abuse. Social use of alcohol or other drugs often leads to further and elevated use.
Alternatively, those with strong tendencies to isolate themselves socially may move from experimentation to regular use in the absence of social situations.
Problem Use, Risky Use
Examples of problem use or risky use of drugs and/or alcohol include binge drinking and drug abuse.
Binge Drinking
Binge drinking is heavy use of alcohol periodically. This can result in harm to the physical health of self and others, and negative behavioral consequences, which may result in bodily harm to self or others. For example, harm may be caused by heavy periodic use of alcohol or other drugs while pregnant, driving while intoxicated, or either neglecting or inflicting violence on self and others while under the influence. The National Household Survey On Drug Abuse (NHSDA) defines binge alcohol use as drinking five or more drinks on the same occasion at least one day in the past thirty days.
Substance Abuse
The characteristic feature of substance abuse is the presence of dysfunction related to the person's use of alcohol or other drugs. HHS (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration [HHS/SAMHSA], 1994) describes substance abuse as "the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning." Substance abuse may or may not involve physiologic dependence or tolerance. For example, use of substances in weekend binge patterns may not involve physiologic dependence; however, it may have adverse affects on a person's and possibly others' lives.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association is used across the medical and mental health fields for diagnosing both substance abuse and mental health disorders. According to the DSM-IV, substance abuse is "a mal adaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by" a variety of possible symptoms of impairment. Neglect of children is specifically listed as a potential symptom of substance abuse (American Psychiatric Association, 1994)
Addiction, Chemical Dependency
Addiction may be a chronic, relapsing disorder and as the disease process progresses, recovery becomes increasingly difficult. Chemical dependency occurs most frequently in those who have a family history of the disease. Chemical dependency may cause death if the person does not completely abstain from using alcohol and other mood-altering drugs (HHS/SAMHSA, 1996a). The DSM-IV distinguishes dependence from abuse primarily by the presence of more abuse symptoms (three or more rather than at least one), and the possible presence of tolerance (needing more of the substance for the same intoxicating effect) or withdrawal (physical symptoms that occur when the substance is not used).
The American Society of Addiction Medicine (ASAM) describes drug dependence as having two possible components:
- Psychological dependence
- Physical dependence
Psychological dependence centers on the user's need of a drug to reach a level of functioning or feeling of well-being. Due to the subjective nature of this term, it is not very useful in making a diagnosis. Physical dependence, however, refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of alcohol or other drug use. Tolerance, dependence, and withdrawal develop differently depending on the particular substance (HHS/SAMHSA, 1994)..
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