In parts 1 and 2 of my addiction series I explored the broad concept of addiction and the early stage that I called simply, Stage Fun. Both posts included descriptions of the negative consequences of substance use and addiction.

Below, I discuss other kinds of problems and how they emerge as one progresses further along the addiction continuum.

What is Choice?

A common client refrain in the addiction field is that substance use is a choice. I agree. Yet there is more to the story than a rational yay or nay. Choice is in play during one’s early use, but over time dopamine plays a starring role in influencing choice. This is because of the jolt it delivers to the human brain as a result of substance use.

The brain of a substance user moving along the addiction continuum is like a child who after being spun through the air enthusiastically demands, “One more time!”  

We know that for some the choice to use becomes more automatic. For these individuals it is less than a fully formed rational decision. It begins to resemble something more akin to a knee-jerk reflex.

The choice to use might once have been the end result of mulling options to a straight-forward and innocuous question like, what shall we do this weekend? But over time your brain, being the genius that it is, notices patterns and seeks to simplify whatever process is in play.

The brain is an efficient system and loves shortcuts. It will eliminate conscious decision-making to save energy whenever possible. In time, the decision to use is almost instantaneous and addicts simply assume that a conscious choice was made.

Bad habits are hard to change

Margaret Wehrenberg refers to the brain’s ability to simplify complex operations as “chunking.” A chunk of information is basically a habit, “a complete and automatic set of actions that occur without conscious decision.”

Substance use evolves over time to become a habitual action for too many of us. Information is chunked together without our conscious awareness and we act accordingly. The addict eventually begins to rely on substance use to regulate an ever increasing assortment of life experiences: good, bad, or indifferent.

Most of us like to entertain the fiction that we are the captain of our own ship, that we are intentional and methodical at all times. But as one moves further along the addiction continuum choice is not as simple as saying I will or won’t do something. There are competing and unexamined forces at play.

What begins as fun morphs into an unconscious habitual solution to personal struggles. Given enough time this habit becomes an all-consuming need, a craving that dictates our choices and behaviors.

Phenomenon of craving

Dr. William D. Silkworth, who treated Bill Wilson, co-founder of Alcoholics Anonymous, at Charles B. Towns Hospital in New York City, wrote in “The Doctor’s Opinion,” in Alcoholics Anonymous, that all alcoholics “have one symptom in common: they cannot start drinking without developing the phenomenon of craving.”

Craving, in my opinion, is evidence of the inability to drink or drug safely. When activated, it subsumes all else. Craving is the internal driver that pushes alcoholics and addicts to consume. As the saying goes, “one is too many and a thousand is never enough.”

It can manifest silently or loudly, but one thing is certain, when craving enters the picture we have exited Stage Fun and entered Fun with Problems. We no longer want to enjoy our chosen substance, we need it.

Substance use is characterized by avoiding at all costs the experiences associated with not using. In other words, at a certain point in most addicts’ stories, use is no longer simply about getting loaded. Instead, the urge or craving to use is rooted in the avoidance of negative psychological and physiological consequences that emerge when one chooses not to use.

Our brain, once it grows accustomed to the rewards of using drugs and alcohol, learns that throwing a hissy fit (moodiness, impatience, anger, judgement, self-righteousness, etc.)  is a good way to get what it wants: an altered reality (and dopamine!).

Like everything else in addiction, craving is a double-edged sword. It propels one further into addictive processes and therefore is a negative force. Yet by encouraging use, craving protects the addict from experiencing the not so pretty consequences of withdrawal.

99 Problems

Addiction also unleashes real world negative consequences, things like: jail, injury, illness, death. These can happen early for some, but over time the process is fairly predictable. We begin to hurt loved ones, lose friends, suffer professional setbacks, face legal troubles, lose self-respect.

The further one travels into addiction the more one loses. As substances take priority, other things must fall by the wayside.

Some substances have the potential to speed up this process of loss, but the progression is the same despite the timeline. Yes, there is a qualitative difference between some classes of drugs, but just because it can take alcohol decades to destroy a life, does that make it less destructive?

Despite initial losses during Fun with Problems the benefits of use, for addicts, still outweigh the deficits and it’s “easy” to ignore such problems for many years. The brain tricks us into believing that despite the horror around us, substance-induced oblivion is the best option available to us. It provides an identifiably consistent answer to any question asked of it.

Individuals with so-called “high bottoms” are willing to address problems associated with the fun of substance abuse prior to losing as much as others who hit rock bottom. They don’t need to lose everything in order to change course. Thankfully, as addiction education has become more prevalent and substance use is less stigmatized there are more people who fit within this category. I wish the numbers were higher.

So, about that river in Egypt….

Because of the mind’s ability to wield powerful psychological tools like denial it’s easy for addicts to ignore the complex operations at play in their mind. This is especially true as long as substance use continues to provide relief.

We as a culture like to believe in our ability to look beyond appearances, but it’s too easy to assume that if someone looks good, they must feel good. One’s insides always match their outsides, right?  

The term “functional alcoholic” describes individuals who outwardly are meeting society’s markers of success. If major responsibilities are met the psychological or interpersonal consequences of addiction can easily be rationalized away as stress, poor nutrition, lack of exercise, insomnia, or some other real, but wholly inadequate explanation.

When living in the Fun with Problems stage this perception is one of the trickiest knots to undo, even for the addict herself. “I can’t have a problem. I’m still paying my bills. I’ve got friends. My family loves me.” All of these things might be true, but that doesn’t mean there isn’t a problem.

Unfortunately, many of us only become willing to admit to a substance abuse problem when Fun leaves the equation and we only are left with Problems. In my next installment, I’ll explore this final stage of addiction.

For now, here is one of the more devastating songs about addiction, Robbie Fulk’s “Barely Human” from his album Country Love Songs.