2 Words That Could Mean You Have a Drug Problem

People who need
help with their drug
or alcohol use
represent all ages,
races, genders and
walks of life, but
there’s one thing
they have in
common: None of
them set out to
become an addict.
Instead, their loss of
control crept up on them until, much like the
story of the frog in the slowly heating pot of
water, they came to realize too late how much
trouble they were in.

Each person’s progression from casual to
problem use is unique, but it often unfolds
along these lines:

At first, your drinking or drug use seems like a
positive. It feels good and it fills a need,
whether to make you more social, help you
relax, boost your confidence, or allow you to
escape the noise in your head for a few blessed
moments. But as you use, your brain chemistry
and circuitry change and you become less able
to feel the same sense of pleasure or relief. That
means more of the substance is needed to get
the effect you’ve come to count on.

With increased use comes problems, however.
Perhaps you start missing work deadlines or
events with the family, or you pay less
attention to things that once mattered to you.
It’s often at this point that two words start
creeping into the conversations you have with
yourself and others about your substance use:
just when.

You may declare, for example, that you’ll drink
or use drugs “just when I’m with friends” or
“just when I don’t have to work the next day”
or “just when I’m really stressed.”
When you reach the just when stage, you are
bargaining with yourself—trying to quell your
nagging concerns (or someone else’s nagging)
about your substance use while at the same
time setting up parameters that allow that use
to continue. All the “justs” become justification.

The Start of a Destructive Cycle

It may seem like a way to prove to yourself and
others that you are still in control, but in most
cases, the “justs” don’t end up limiting you;
they simply keep expanding to accommodate
your growing need. Just when I’m with friends
becomes just when there’s nothing better to
do. And because substances can come to feel
as vital to your survival as the air you breathe,
it may soon feel as though there’s never
anything “better” to do.
The encouraging thing about the “just when”
stage is that it tends to appear relatively early
in the progression from casual use to
dependence, and that means it can be your
canary in the coal mine, alerting you to the
need to take action on your own behalf. If you
hear yourself using just whens, pay attention.
They are telling you that things are moving out
of your control and you shouldn’t delay in
reaching out for help.

If you miss the chance to interrupt the process,
however, you can expect an increasingly
destructive cycle. The more you use, the more
you need and the more dependent you
become. Cravings overwhelm you because not
using now means dealing with painful
withdrawal symptoms such as agitation,
anxiety, nausea and depression. Your drug or
alcohol use is no longer about feeling good but
about keeping from feeling bad. You try to stop
and can’t, and that makes you feel powerless
and ashamed, which can lead to further drug
use.
A Signal to Take Action
It’s important to remember that addiction is a
chronic brain disease that some are more
vulnerable to than others due to genetics,
biology, environment and a variety of other
factors. Its effects on brain circuitry can take
away one of our most basic skills — the ability
to do what is best for ourselves.

The good news is that even for those
predisposed to addiction, recovery is possible,
especially when help is received early. Other
people may have problematic drug or alcohol
use that does not meet the criteria for
dependence but that still negatively affects
their lives. In all of these cases, treatment can
help by offering behavioral and medical
therapies that help control cravings, teach new
ways of dealing with triggers to use, and that
address the issues that often underlie problem
drinking and drug use, such as trauma and
depression.

You don’t have to wait for the just whens to
start before reaching out for help, but if you do
hear yourself saying those two words (or any
number of variations of those words), recognize
them for what they are—not a plan for keeping
your substance use manageable but a message
to yourself that it’s time to take it seriously.
David Sack, M.D.