What Is Substance Abuse?

Transcription

1 Chapter 2 What Is Substance Abuse? T I have been to hell and back with my husband. When he drinks and goes out on a binge, he s gone for days at a time, blows every cent we have, puts people I love in danger, risks legally getting me in deep trouble because the autos are registered and insured in my name, and oh, the millions of lies that come with this game are so overwhelming. Each time he has a drinking splurge, which is a lot, he is always apologetic, making me countless promises about going to a therapist, taking meds, attending AA, you name it he promises it. None of these promises are ever followed up on and if I mention them the next day he gets defensive and angry. -Amy A. 9

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3 Once I start using I make things so much worse. Today I am scared to use or drink cause I know how much trouble I get myself in every time I ve given up in the past. For years I tried to handle my drinking and using. I would get myself out of trouble for a while but always get myself in so much deeper and put myself through so much pain until I wished I were dead. At times I think how it would be great if I could use without the booze and drugs messing up my life but the reality is for me that is impossible The above is an excerpt from an I received from Barbara B. You can easily see how the quality of her life has been adversely affected by her continued consumption of alcohol and other drugs, can t you? Therein lies the essence of the first type of alcohol and other drugs problem that we ll examine, Substance Abuse adverse consequences. Now, a reasonable question to consider when assessing your consumption of alcohol and other drugs is where does the non-problem consumption of alcohol and other drugs end and Substance Abuse begin? For me, that s an easy line to draw. However, people often blur the line between non-problem consumption of alcohol and other drugs and Substance Abuse by making distinctions such as: The type of alcohol and other drugs consumed Marijuana doesn t harm you like alcohol does, or I don t drink hard liquor, only beer, or You make 11

4 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? it sound like I m a street junkie. But these pills are all prescribed by my doctors. The quantity of alcohol and other drugs consumed I only drink two glasses when I get home from work, or I only smoke half-a-joint with my wife, or I don t drink anywhere as much as your father drinks. The frequency with which alcohol and other drugs is consumed I only drink on the weekends, or I only drink twice a week. The occasion on which alcohol and other drugs is consumed I only drink when I m watching sports on television, or I only drink wine at dinner. Implied in each of the above distinctions is the assertion that a person couldn t possibly have a problem with alcohol and other drugs because. None of these distinctions are relevant when it comes to assessing whether or not you have a Substance Abuse problem. Simply put, type of substance, quantity of substance, frequency of consumption, and the occasion when consumption takes place are non-considerations for drawing the line between nonproblem consumption of alcohol and other drugs and Substance Abuse. There s only one question to consider when distinguishing between non-problematic consumption of alcohol and other drugs and Substance Abuse do you continue to consume alcohol and other drugs despite the recurrence of adverse consequences? To better help you assess whether or not you have a Substance Abuse problem, let me suggest the following three questions for you to consider. 12

5 What Is Substance Abuse? 1) Is your consumption of alcohol and other drugs the cause of adverse consequences to your emotional, physical, social, occupational, legal, financial, and/or spiritual well-being? 2) Does your consumption of alcohol and other drugs cause recurring adverse consequences? 3) Do you continue to consume alcohol and other drugs despite the recurrence of adverse consequences caused by or exacerbated by your continued consumption of alcohol and other drugs? That s a mouthful. So let me break it down for you. However, before I do, let me point out to you the importance of these three questions. The non-problem consumer of alcohol and other drugs does not experience recurring adverse consequences from their continued consumption of alcohol and other drugs. The non-problem consumer of alcohol and other drugs is both willing and able to change their behavior(s) associated with the consumption of alcohol and other drugs when they do experience an adverse consequence as a result of their alcohol and other drugs consumption. The non-problem consumer of alcohol and other drugs is both willing and able to alter or stop altogether their consumption of alcohol and other drugs in order to ensure that they don t experience recurring adverse consequences. 13

6 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? When evaluating whether or not you have a substance abuse problem, first, you should examine whether or not your consumption of alcohol and other drugs causes adverse consequences. This is important because adverse consequences from the continued consumption of alcohol and other drugs are what differentiate Substance Abuse from non-problem consumption of alcohol and other drugs. If there are no adverse consequences, then there is no problem with alcohol and other drugs. It s not about how much or how often you consume alcohol and other drugs. It s only about what happens when you do consume alcohol and other drugs. Pathfinder s Checklist Adverse consequences as a result of the consumption of alcohol and other drugs based on the diagnostic criteria for Substance Abuse* 1) Recurrent alcohol and other drugs consumption that impairs one s ability to fulfill their role(s) and responsibilities at work, school, and/or home. 2) Recurrent alcohol and other drugs consumption that puts the consumer of alcohol and other drugs or others at risk in potentially physically hazardous situations such as driving or operating machinery while under the influence of alcohol and other drugs. 3) Recurrent alcohol and other drugs consumption that causes and/or exacerbates interpersonal difficulties at work, school, with people in your community, and/or friends and family members. 4) Recurrent alcohol and other drugs consumption that causes and/or exacerbates legal problems. 5) Recurrent alcohol and other drugs consumption that causes and/or exacerbates financial problems. 14

7 What Is Substance Abuse? 6) Recurrent alcohol and other drugs consumption that causes and/or exacerbates an existing emotional disorder. 7) Recurrent alcohol and other drugs consumption that causes and/or exacerbates an existing physical disorder. *Based on diagnostic criteria that appears in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition How about we take this discussion out of the theoretical and look at some real life situations. Below is an excerpt from Charley C. As you read this excerpt see if you notice what impact, if any, Charley C. s drinking has had on his life. I always seemed to be in control of my drinking, but when there is a problem of any kind I turn to alcohol. For example, my wife and me had been fighting about the debts I have gotten us into because of all the work I ve missed due to my drinking. This led to yet another argument about my drinking. This led to yet another discussion on what a lousy drunk of a father and husband I am. She made me so mad that I stayed out all night drinking. On the way home I ran my car off the road and hit a light pole. When I got home I tore the entire house apart. Well, the police were called and needless to say, off to jail I went for the third time in the last ten months. I was able to beat the charge in court but it cost me thousands in legal fees to do so. Does Charely C. s drinking impair his ability to fulfill his role as a parent and huband? Did Charley C. s drinking put Charley C. and/or others at risk for physical harm? If so, how? Did Charley C. s drinking cause and/or exacerbate 15

8 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? an interpersonal problem? If so, how? Did Charley C. s drinking cause and/or exacerbate a legal problem? If so, how? Did Charley C. s drinking cause and/or exacerbate a financial problem? If so, how? When assessing whether or not your consumption of alcohol and other drugs is problematic, it s helpful to honestly evaluate whether or not your consumption of alcohol and other drugs impairs your ability to fulfill the different roles and responsibilities in your life. In the following excerpt from Carol C., notice what she has observed about the effect that drinking has had on her husband. His mind was affected by the drinking. He was drinking straight vodka for a long time. I can only imagine what that does to the brain of someone who is a diabetic. He was nice one minute and calling our son a retard the next. Yes, you never knew who you would be talking to from one minute to the next. The abuse had gotten so bad that he threatened to kill our son. Did Carol C. s husband s consumption of alcohol impair his ability to fulfill his role and responsibilities as a parent? If so, how? Did Carol C. s husband s consumption of alcohol exacerbate an existing medical condition? If so, how? The following excerpt from David D. vividly demonstrates how his continued consumption of alcohol and other drugs not only adversely affected his ability to function as a student but led to his eventual hospitalization as well. 16

9 What Is Substance Abuse? Graduate school almost killed me. In order to get through school, I used meth. To get to sleep I drank and smoked weed. I was living on drugs and alcohol to function. In the end I flunked-out and wound up in the hospital, really messed up. Did David D. s consumption of alcohol and other drugs impair his ability to fulfill his role and responsibilities as a student? If so, how? Did David D. s consumption of alcohol and other drugs cause a medical condition to develop? If so, how? Notice in the following excerpt from Marvin M. how his wife s use of cocaine not only disrupted their marriage to the point of estrangement but also was the cause of her everincreasing isolation from friends and family members. I finally threw her out after her last cocaine binge. She s staying in a garage in the back of a house that we rent out. There is no shower, no running water of any kind. She won t go anywhere where there are people friends, family, none of it. That tells me that she is more ashamed. Does Marvin M. s wife s consumption of cocaine cause or exacerbate interpersonal difficulties? If so, how? Does Marvin M. s wife s consumption of cocaine impair her social functioning? If so, how? Sadly, alcohol and other drugs can be the match that lights the fuse that leads to interpersonal violence and the inevitable 17

10 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? legal fallout. Francis F. s ex-boyfriend s behavior became so out of control as a result of his consumption of alcohol and other drugs that he went to jail. The last weekend I saw him, he was drunk and very violent so I changed the locks to the house. He then shattered our front window to our house to break in and take everything he wanted. During this time he was drinking quite heavily and ended up beating up his new girlfriend and going to jail. Does Francis F s ex-boyfriend s consumption of alcohol cause and/or exacerbate legal problems? If so, how? Here s an excerpt from an from Gary G. Tragically, his son s consumption of alcohol and other drugs exacerbated the symptoms of an emotional disorder to the point that Gary G. s son had to be hospitalized three times. My son is twenty-one years old. When he was eighteen, he had been drinking vodka at a New Years Eve party and completely went off the deep end and ended up in a mental ward. He was in the hospital for two weeks. His psychiatrist told him that he had bipolar depression and had to stop drinking and smoking dope. Since that time, he has been hospitalized three times. Each time he was hospitalized, he had been smoking a lot of dope and mixing in some vodka as well for increasingly longer periods of time. Does Gary G. s son s consumption of marijuana and alcohol cause and/or exacerbate an existing emotional disorder? If so, how? 18

11 What Is Substance Abuse? Now, let s turn the focus on you and your consumption of alcohol and other drugs with the following exercise. Pathfinder s Exercise 1) How does your consumption of alcohol and other drugs affect your ability to parent your children? 2) How does your consumption of alcohol and other drugs affect your ability to be a husband/ wife/partner? 3) How does your consumption of alcohol and other drugs affect your performance at work/school? 4) How does your consumption of alcohol and other drugs affect your relationships with friends, family members, and/or people at work/school? 5) How does your consumption of alcohol and other drugs affect your behavior in your community? 6) How does your consumption of alcohol and other drugs put at risk your physical safety and/or the physical safety of others? 7) How does your consumption of alcohol and other drugs affect your financial affairs? 8) How does your consumption of alcohol and other drugs affect your legal affairs? 9) How does your consumption of alcohol and other drugs affect your emotional well-being? 10) How does your consumption of alcohol and other drugs affect your physical well-being? If you ve decided that your alcohol and other drugs consumption causes adverse consequences, the next question to consider is: are the adverse consequences that you ve 19

12 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? experienced from consuming alcohol and other drugs a singular or recurring event? It s really very simple. Is the adverse consequence that you ve experienced an isolated incident or a situation that develops repeatedly when you consume alcohol and other drugs? Let s look at an excerpt from Hilda H. s to illustrate the above point. My husband has always drank but not to the degree that he is now. On a daily basis he s drinking ounces of malt liquor. Because he s been fired from his last three jobs for drinking on the job, we have fallen way behind financially. Recently I have had to resort to cash advances the last three months just to make it. Sometimes not even make it. There have been months when I was unable to pay the rent because I had to focus on groceries etc. first. I heard my husband say next week he ll get a job, but then again he s been saying that for the last year and a half. Last night we got a lawyer for bankruptcy. What adverse consequences have occurred as a result of Hilda H. s husband s drinking? Are these adverse consequences an isolated or recurring incident? Below is an excerpt from an from Irving I. You can tell from Irving I. s the wear and tear that his marriage has experienced as a result of his wife s drinking. You can tell that Irving I. s wife s drinking was disruptive over time rather than an isolated incident here and there. For the last ten years I ve been trying to fix my alcoholic wife. I have had compassion and love for her and tried everything 20

13 What Is Substance Abuse? humanly possible. I am now exhausted and pushed to the point of anger and hate. Tomorrow I will file for a divorce. I don t have to worry about the what if I did this or that. I ve done it all. She is no better than she was five years ago, in fact she is much worse. I can t do anything to improve our situation, and I m sick of living with it. She knows what she s doing, and after tomorrow, she ll be on her own. What adverse consequences have occurred as a result of Irving I. s wife s drinking? Are these adverse consequences an isolated or recurring incident? Joan J. s son s consumption of alcohol has damaged his liver. Despite this fact he continues to drink. His liver function tests are so bad. That s why he is sick all the time. The hepatitis can be very catchy when it is at its peak, which his is because of all of the alcohol that he drinks. The alcohol is killing the liver and the hepatitis c is directed to the liver as well. So his liver cannot take a lot but he continues to drink. What adverse consequences have occurred as a result of Joan J. s son s drinking? Are these adverse consequences an isolated or recurring incident? Again, let s bring the focus back to you and examine the impact that your consumption of alcohol and other drugs has on your life. More importantly, let s see whether or not the consequence(s) of your consumption, if any, is a singular or recurring event. 21

14 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? Pathfinder s Exercise 1) What impact does your consumption of alcohol and other drugs have on your family? With what frequency does this occur? 2) What impact does your consumption of alcohol and other drugs have on your friends? With what frequency does this occur? 3) What impact does your consumption of alcohol and other drugs have on your professional or academic life? With what frequency does this occur? 4) What impact does your consumption of alcohol and other drugs have on your financial affairs? With what frequency does this occur? 5) What impact does your consumption of alcohol and other drugs have on your legal status? With what frequency does this occur? 6) What impact does your consumption of alcohol and other drugs have on your physical well-being? With what frequency does this occur? 7) What impact does your consumption of alcohol and other drugs have on your emotional wellbeing? With what frequency does this occur? 8) What impact does your consumption of alcohol and other drugs have on your spiritual well-being? With what frequency does this occur? The third question to consider is: do you continue to consume alcohol and other drugs despite the occurrence of adverse consequences that are caused or exacerbated by your recurrent consumption of alcohol and other drugs? Again, there s nothing complicated about this question. Anything can go wrong once. And for the individual who does not abuse alcohol and other 22

15 What Is Substance Abuse? drugs, an adverse consequence that occurs as a result of their consumption of alcohol and other drugs invariably serves as a wake-up call. Maybe I better call a cab to take me home from the bar from now on. Maybe my wife s seeing something that I m not seeing here and so I ll cut back just to see if it makes a difference. Maybe I ve been more belligerent than I realized. Maybe I better cut back and see if my liver test improves. Maybe I ve been too eager to reach for the pain pills. That s the way an individual who does not have a problem with alcohol and other drugs thinks and responds to a singular predicament that they may find themselves in as a result of their consumption of alcohol and other drugs. They re able to see that an adverse consequence of their drinking is reason enough to [re]evaluate their behavior. Once they [re]evaluate their behavior, they make the necessary adjustments to their behavior as well as to their consumption of alcohol and other drugs so as to ensure that they don t [re]experience adverse consequence(s) from their consumption. To illustrate this point, read the following three excerpts from s that I ve received. Ken K. writes: As a test I would stop for three to four months, never really missing it, start again and WHAM! The cycle would start all over again each time worse. I would click off and become sloppy drunk almost instantly. The same things would happen everytime get in trouble at work, get behind in my bills, get evicted from my apartment, and move back in with my parents. What adverse consequences occur as a result of Ken K. s consumption of alcohol and other drugs? Are these adverse consequences isolated or recurring events? 23

16 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? Does Ken K. continue to drink despite the recurrence of adverse consequences? Does Ken K. have a Substance Abuse problem? If so, why? Laura L. writes: After getting out of intensive care I was just so grateful to be alive and swore to myself I would never touch the stuff again. Yea right 110 days later I drank, went into a black out and broke my wrist in half, all the bones in my wrist were broke, surgery, the whole bit. What adverse consequences occur as a result of Laura L. s consumption of alcohol and other drugs? Are these adverse consequences isolated or recurring events? Does Laura L. continue to drink despite the recurrence of adverse consequences? Does Laura L. have a Substance Abuse problem? If so, why? And finally, Marty M. writes: My last blood test showed the beginning of some damage to my liver. My doc suggested I give up drinking for three weeks, which I did. The next blood test showed a normal liver function. That was a year ago and since then I ve been drinking daily. I can t seem to stop myself even though I know I m doing myself serious damage. I don t drink through the day but kick off around 4.30 pm and drink till midnight or later then eat before bed. 24

17 What Is Substance Abuse? What adverse consequences occur as a result of Marty M. s consumption of alcohol and other drugs? Are these adverse consequences isolated or recurring events? Does Marty M. continue to drink despite the recurrence of adverse consequences? Does Marty M. have a Substance Abuse problem? If so, why? Do you see the continued consumption of alcohol and other drugs despite the recurrence of adverse consequences in the last three excerpts? The person who doesn t have a problem with alcohol and other drugs would make some adjustment in their behavior as a result of the adverse consequences created by or exacerbated by their alcohol and other drugs consumption. On the other hand, the person who has a Substance Abuse problem chooses to continue to consume alcohol and other drugs despite the recurrence of adverse consequences. One more time, let s get back to you and see what can be learned about you from the answers to the following questions. Pathfinder s Exercise 1) Can you identify a time(s) when your consumption of alcohol and other drugs has caused an adverse consequence(s)? 2) If you identified an adverse consequence(s) in #1, was that adverse consequence(s) an isolated incident or one incident in a pattern of many? 3) If you identified an adverse consequence(s) in #1, what action(s) did you take to ensure that the adverse consequence(s) identified in #1 would not occur again? 25

18 ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? 4) If you identified an adverse consequence(s) in #1, how did you alter your consumption of alcohol and other drugs to ensure that the adverse consequence(s) identified in #1 would not occur again? 5) If you altered your consumption of alcohol and other drugs, how long did it last? 6) What does it mean to you as to whether or not you have a Substance Abuse problem if, after altering your consumption of alcohol and other drugs for a period of time, you returned to consuming alcohol and other drugs the way you had previously? 7) What does it mean to you as to whether or not you have a Substance Abuse problem if, after a period of time in which you altered your consumption of alcohol and other drugs, you returned to consuming alcohol and other drugs the way you had previously consumed alcohol and other drugs when you had experienced a recurrence of an adverse consequence(s) or a new adverse consequence(s)? 8) What does it mean to you as to whether or not you have a Substance Abuse problem if you did not change your behavior and did not alter your consumption of alcohol and other drugs after experiencing a recurring adverse consequence caused by your continued consumption of alcohol and other drugs? 9) If you ve concluded that you do have a Substance Abuse problem, what action do you need to take in order to effectively address your problem with alcohol and other drugs? 10) If you ve concluded that you do have a Substance Abuse problem and have identified what action you 26

19 What Is Substance Abuse? need to take in order to effectively address your problem, when will you take that action? That is how you identify whether or not you have a Substance Abuse problem. If you ve identified that you have a Substance Abuse problem and have identified that you want to do something about it, then what is it that you intend to do? To better answer the what and how of altering your consumption of alcohol and other drugs, read the next chapter, How Can I Reduce My Consumption of Alcohol and Other Drugs? If you want to determine whether or not you have a Substance Dependence problem, be sure to continue reading this book, starting with chapter four, What Is Substance Dependence? 27

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