Managing Substance Abuse and Addiction


It might be useful to start with some basic definitions.  While most of these come from the world of Alcohol and Drug Treatment, they can be applied just as well to any activity that includes the potential for excessive use or misuse.  First of all, Use simply refers to the ingestion of a chemical (or by extension, pursuit of an activity) for a particular purpose, usually pleasurable.  The word “use” doesn’t have a particular positive or negative connotation.  Someone who has a single cocktail at a social event to “loosen up” is using alcohol for a specific purpose, as is their colleague who has several cocktails every night, and more on the weekends, as a means of managing the combined stresses of work and family life.  The difference is one of degree, both in terms of amounts consumed and the negative consequences that result.

By contrast, Abuse is excessive use which results in negative consequences.  Many of us have had the experience of intermittently abusing alcohol or some other substance, with the result that we “paid for it” the next day in the form of a hangover.  Usually, it’s the pattern of recurring abuse, either regular bingeing or chronic daily/near-daily overuse, that drives people to seek treatment.  

Tolerance is the process of becoming accustomed to the effects of a drug so that it loses its potency over time.  Tolerance usually results from changes that are taking place in our nervous system, with the result that, over the course of using the drug, it takes a bigger and bigger dose to get the same effect.  Tolerance occurs with some drugs but not most; the classic example in the world of drug abuse is narcotics.

We are considered to be Dependent on a substance (or perhaps even a specific set of behaviors such a physical exercise) whenever we need to use the substance or engage in that behavior in order to feel good enough to perform everyday behaviors.

And finally, Addiction is a pattern of behavior that we persist in performing, even when there is clear evidence that it’s unhealthy, damaging and/or bad for our well-being.  This definition emphasizes the fact that addictive behavior is compelling behavior.  It’s behavior that we feel strongly drawn to engage in, despite its negative and destructive consequences, presumably because it provides some kind of temporary comfort or relief from aversive circumstances or life events.  It’s only when the harm caused by addictive behavior finally outweighs the transient relief it provides that we seek treatment.

Typically, when we think of addictive behavior, we tend to think of substance abuse – drugs and alcohol – and these are certainly the addictions that are most prevalent in our culture.  There are other kinds of addiction though, which can be just as destructive and take just as much of a toll in terms of overall quality of life.  These would include compulsive gambling and sexual addictions for example, as well as food addictions and, less commonly, addiction to physical activity.  While the most obvious risk of some kinds of addiction might be to physical health, it’s just as likely that relationships, job performance, and overall quality of life will take a serious hit as a result of chemical (and other) abuse and/or addictive behavior. 

By now, there is ample evidence that a propensity toward addiction tends to run in some families.   Not all siblings become addicts though, and there are many addicts who do not have a strong family history.  I think this says two things:  those of us who have strong family histories do well to be especially vigilant; and, in many cases (and maybe in most) the genetic potential to overuse and possibly become addicted will be activated by specific life events and environmental triggers.  In fact, one of my biases as a therapist is that when substance abuse becomes a problem, it always develops as a response to some set of life events, usually having to do with ongoing stresses, relationship challenges, or both.  Early childhood trauma and family history can be contributors as well.


Managing the Problem:

The good news is that we now know a great deal about effectively treating substance abuse and addiction.  What you’ve probably heard before is very true in my opinion:  problems with addiction and substance abuse have nothing to do with will power, innate intelligence, strength of character, or moral virtue.  Rather, the problem is that a very compelling pattern of behavior has been established that, to a large degree, comes under the control of complex brain chemistry.  For this reason, it takes a specific set of behavioral strategies, well thought through and carefully applied, to effectively break up the pattern.  Medication therapy, improvements in diet, sleep and physical activity, and lining up effective social and interpersonal supports can all be components of such a program.  And all of these are supplemental to the core work of developing healthy and effective skills for managing ongoing stressors, improving relationship skills, and when needed, resolving longstanding emotional conflicts.   

So, if you’re stuck in a cycle of addiction or substance abuse, it’s not your fault.  But, it is your problem to fix and the opportunity is available for you to take the steps to learn to manage the problem effectively.  If you’re looking for help, please feel free to call or email me using the contact information below.  Here in Seattle we have a wealth of resources for managing problems with substance abuse and addiction, and I would be very happy to try to answer your questions and to offer whatever assistance I can in steering you toward the services and support you’re looking for.