Most of us know someone impacted by addiction. Most of us probably know an addict, whether we, or they, know it or not. But what does it mean to be addicted?

The reasons why people consume mind-altering substances vary: to relax, to have fun, to alter reality, to rebel, to escape, to ritualize important events. But substance use, in my understanding, can be boiled down to one simple idea: I want to change how I feel.

There is nothing inherently wrong with this desire, but herein lies the real danger of drugs and alcohol: they work! Substances are immediate and intense in their ability to alter one’s concept or experience of reality. They’re really good at what they do, perfect in fact.

To be addicted is not simply about (over)consumption of a substance though. Rather, it is a state of being in which one relinquishes power, choice, and control to a substance, or process, that once was beneficial and is no longer.

It is not useful or practical to continue repeating the same actions over and over again. Rightly named, this is compulsive behavior. Psychologically then, addiction can be understood as a compulsion to assuage the obsessive belief that how I feel is insufficient or wrong and should be changed.  

No, seriously, what is addiction?

From a clinical or process oriented perspective, addiction is a conceptual handle by which it is possible to take hold of, explore, and better understand a subtle, ambiguous process that includes both positive (yes, positive!) and negative consequences.

Segmented into stages, or perhaps a continuum, addiction looks something like this:

Experimental use > Social use > Regular use > Harmful use > Dependent use.

The original positive consequences that spurred use – fun! conviviality! connection! – bend towards the negative with increased use. But again, addiction is not merely about consumption. It is about the reasons for use, the patterns of use, the consequences of use, and the denial of the need for change or personal evolution beyond one’s relationship with drugs and alcohol.

Moving from early experimental and social use toward dependent use one’s life is reduced; that is, the components that contribute to a full life are gradually lost: family, friends, freedom, economic security, physical health, self-respect, meaning.

They are replaced over time by an increased reliance on substances to modulate one’s sense of “normal" or happiness. Graphically, this process might look something like this.*

At some point in this process, somewhere between regular use and harmful use, an invisible line is crossed landing one in addiction. It is possible, of course, to stop, examine this process, and implement change. However, the closer one moves to dependent use the harder it is to effect change.

As one’s freedoms are reduced one’s power, choice, and control are eroded and one’s life becomes narrower and narrower. This is characterized by the compulsion to repeat the same behavior over and over again and each time expecting different results. "This time, everything will work out!" And that, my friends, is insane!

To simplify this process even further, I borrow the model of addiction as conceptualized by a friend of mine in Alcoholics Anonymous:

Fun > Fun with problems > Problems.

Over the next few blog posts I will explore each of these stages in order to provide a means of understanding the confusing and all too often deadly path of addiction. For now, I’ll direct you to the song “Underneath the Bottle” from Lou Reed’s 1982 album, Blue Mask. A more perfect description of addiction would be hard to find.


*The continuum of addiction model was adapted from Atlanta therapist, Ralph Boynton, my former supervisor at Odyssey Family Counseling Center, and Annie Kelahan, my current supervisor at Therapy Works ATL.