Some Things You May Not Know About Substance Abuse, Part I

It’s not how much you use, it’s what happens when you use.

Grandma doesn’t drink much. She only has a glass of champagne every New Year’s Eve, as a matter of fact. But, boy, oh, boy, you should see what happens then.

Last New Year’s she danced on the kitchen table, fell, and broke her hip.  The year before, she stripped off all her clothes in front of her children and her grandchildren, who had permission to stay up late that one night. It was not a pretty sight. Champagne seems to have that effect on her. The year before that, she broke her arm. I don’t know about before that, but there are whispers that she made out with her husband’s best friend one New Year’s while under the influence, but you never know.

Grandma has a drinking problem.

Yes, that’s right; she has a drinking problem, even if she only drinks once a year. Officially, her diagnosis would be alcohol abuse, if she sought help. Simply defined, alcohol abuse is continued drinking despite problems. These could be social problems, health problems, legal ones, problems at work, whatever. For her, they are health and social problems. No one is taking her to court and she isn’t getting fired, but she is humiliated and things keep getting broken. She may have endangered her marriage. She has problems that wouldn’t have been there if she didn’t drink. She’s going to have to decide what to do about it.

She might stop drinking; turn down that glass of champagne. The New Year will come whether she drinks it or not. If she had stopped years ago, she wouldn’t have had all these problems; but she didn’t. She didn’t stop because she just couldn’t get her head around the fact that alcohol problems have little to do with the amount or frequency of alcohol use. They have everything to do with problems.

Let’s just say that one year she decides, you know, I’m not going to drink next year. I don’t know if I’m going to break my hip again, but every year something happens and it’s just not worth it. Next year, I’m going to be sober.

Let’s say she says that, but, the next new year, she drinks again. She wasn’t going to, but someone poured her a glass of champagne and it was there, so she drank it. Now she has a new problem.  She lost control. She only drinks once a year, but she still loses control.

So, you see, you don’t have to be a skid row bum, sitting on the sidewalk, drinking out of a paper bag, wasted most of the time, to have problems with alcohol. You just need to have problems with alcohol to have problems with alcohol. You need to have problems and continue to drink anyway, even if it’s only once a year.

The guy drinking on the sidewalk most likely has a different kind of substance use disorder. Grandma has alcohol abuse. The guy on the sidewalk may be alcohol dependent, or addicted, as we often say. Most may say that the guy on the sidewalk has a more serious disorder, but I say Grandma’s is pretty serious. Serious as a broken hip.

To get to the point of an addiction like the guy on the sidewalk has, it’s necessary to use large amounts with some frequency. Addicted people usually experience increased tolerance for the substance; they need to use more and more to achieve the desired effect, or they need to go to stronger and stronger forms of the drug. The guy on the sidewalk does not drink Wild Irish Rose because he likes the taste. He drinks it for its high alcohol content.

When people use large amounts of a substance, they begin to experience a second sign of addiction: withdrawal, the dreaded hangover. When you’re in withdrawal, you basically feel the opposite of the way you felt when you had that buzz. If the substance made you feel calm, you are jittery; if you are social, you can’t stand people and noise; if you are happy, then you are miserable.

Our body is trying to get back into balance. It’s compensating to your having consumed so much and is trying to tell you something. If you’re having hangovers, you’re well on your way towards addiction, if you are not already there.

Once you get withdrawal, you have two choices: a) You can stop using the substance and let your body, over time, heal itself, or b) You can use some more and avoid withdrawal by not withdrawing. Have some of “the hair of the dog that bit you”, as they say. Many people elect option b. Indeed, many people who have severe withdrawal, must continue to drink or they will die from their hangover, unless they get some professional help.

In Grandma’s case, she doesn’t use enough alcohol to develop tolerance or withdrawal, but that doesn’t mean she doesn’t have a problem with alcohol.

Oh, and the same thing goes with other substances: cocaine, heroin, marijuana, tobacco, whatever. The frequency and the amount is not the problem. The problem is the problem.

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