Substance addiction
Continued use of alcohol or drugs despite clear harm, with loss of control over amount, craving, and increasing priority given to the substance over obligations and relationships. It exists on a spectrum from mild to severe.
What drives it
The substance regulates feeling: it relieves anxiety, shame, boredom, pain or social awkwardness fast, and repetition sensitises the brain's 'wanting' system so the craving grows even as the pleasure fades.
How it shows
Work
Functional for years in many high performers. Long lunches, drinking at every client event, Monday absences or flat Mondays, irritability before the evening drink, smell of alcohol or mints, inconsistent performance, defensive reaction to jokes about drinking, 'I work hard, I play hard'.
Relationships
Broken promises about cutting down, hidden bottles or receipts, mood changes linked to availability, arguments about quantity, memory gaps about evenings. Partners start monitoring and covering. The person minimises: 'Everyone drinks like this in my industry.'
Self
You plan your day around when you can drink or use. You set limits and break them. You feel defensive or irritated when someone mentions it. You need more to get the same effect, and you feel low or shaky without it.
What tells it apart
Behavioural addiction: Behavioural addictions have the same craving and loss of control but no ingested substance, so there is no tolerance or withdrawal from a drug; the signs are time, money and secrecy around the activity.
Denial: Denial is the defence that often accompanies addiction; the addiction itself shows in behaviour (amounts, failed attempts to cut down, consequences) whatever the person says about it.
Emotional dysregulation: Emotional dysregulation is the underlying difficulty with feelings; substance addiction is one way of managing it, so ask what the person feels in the hour before use.
A test
Ask whether they have tried to cut down and could not, and watch for use continuing despite consequences they have acknowledged; if so, suggest an assessment with a GP or addiction service, and take seriously that stopping alcohol or some drugs abruptly can be medically dangerous.
Questions to carry
- After a decision to cut down, what happened, and what consequences have been named while use carries on?
- What does a drink or a hit do for my feelings in the first ten minutes, and what does it cost later?
How strong the research is
strong
Where it comes from
Alcoholism as disease by E. M. Jellinek, 1960; incentive-sensitisation theory by Terry Robinson and Kent Berridge, 1993; substance use disorder in DSM-5, 2013
Sources
- Vincent J. Felitti, Robert F. Anda and colleagues, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults (the ACE Study) (1998)
- Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (2008)