How Much is Too Much?
Many of us have used and possibly abused substances for one reason or another at some point in our lives, whether it be alcohol, prescription meds, cigarettes, or food. Maybe you overdid it on the Red Bulls or smoked a blunt at a get-together, since now it’s legal in California.
But when does substance use become ab-use?
There’s a fine line between using a substance and abusing a substance. Think of substance use as a continuum, at one end is abstinence (no use) and at the other end is addiction. In reality, most people are somewhere in the middle.
If you occasionally use and moderate your use, you would be closer to the abstinence end of the continuum, toward the middle. If you use regularly and it has become more of a habit or you’re using excessively, you would probably be closer to the other end of the continuum.
This does not mean you are an addict!
We tend to throw those terms out quite a bit, substance abuse and addiction, and the media feeds on the drama of addiction. But what does it all mean and how much is too much?
When professionals talk about substance abuse it can be summarized as misuse, and yes, that’s a broad term that can mean a lot of things. Misuse can include the following:
- Using an illegal substance or drug (e.g., heroin, meth)
- Using in dangerous or risky circumstances (e.g., drinking and driving)
- Using more of a substance than is recommended or prescribed (e.g., taking more Vicodin than what your doctor prescribed, like taking 4 pills at a time rather than 1 to 2).
- Binging on a substance or consuming an excessive amount of a substance in a limited period of time (e.g., binge drinking on the weekends)
- Using a substance for another purpose other than for which it’s prescribed (drinking cough syrup to get high rather than for a sore throat)
- Mixing substances that can multiply its effects (e.g., mixing alcohol with opiates and/or benzos)
If misuse has become a pattern—even a bad habit, if you look at it this way—it can become problematic. But, again, it doesn’t mean you are an addict. If that’s the case, then you can take some steps to reduce your use or prevent yourself from using in risky situations, to prevent use from escalating to addiction. Here are some tips:
- Identify potential triggers—people, places, things that might signal it’s time to use or drink—such as bars or sports events, and make a plan.
- Set limits ahead of time and remind yourself of your plan (e.g., tell yourself you can have 2 beers at the football game and plan for what you will say or do when you get that urge for a 3rd beer).
- Learn to say NO when you reach your limit. It doesn’t mean you’re being rude or no fun if you hold off on using or drinking more.
- Have support. Tell someone you have set limits and want to abide by your limits; then ask them for support around doing this. Telling another person gives you more accountability, which can be very helpful. Call someone.
- Stay aware and give yourself reminders of your limits (e.g., setting up reminders on your phone or verbally reminding yourself).
- Change the conversation topic or engage in an alternative activity (e.g., dance instead of sitting and drinking).
- If the situation becomes tense or you feel pressured to use or drink, leave the situation and step outside (or tell them you have to use the bathroom). Some fresh air and deep breathing can help you clear your head and figure out what to do.
- If you have to, make an excuse to stop using or drinking (e.g., say you have to get up early tomorrow for work or tell them you have an early morning meeting).
- And, of course, if you are with a group of friends, make someone the designated driver.
These are simple steps you can take to limit your use and prevent yourself from using excessively or engaging in risky behaviors you would not otherwise do. These are still in your control. This is an important point because when you lose control of your drinking or substance use, that’s when you find yourself hovering in the abuse section of the continuum. If it is frequent or daily loss of control over your substance use or drinking, then you may be heading toward addiction.
But what makes an addict an addict? We often think that addiction happens to other people, but in reality, you probably have a friend, family member, neighbor, or coworker who abuses or is addicted to substances. Or the addict may be you, in which case, it’s still not too late to change behaviors. There are certain criteria that one must consider in diagnosing addiction, and I would advise as a psychologist, you don’t diagnose yourself because you may be wrong, and you may have assumptions of what it means, that could be unhelpful or even harmful.
Two important criteria that may signal addiction are the presence of tolerance and withdrawal symptoms.
Tolerance is needing more and more of a given substance to get the same effect. For example, or you used to get buzzed off a few beers and now it takes a 12-pack. This in and of itself doesn’t make you an addict. We’ve seen an upsurge in the use of opiates for pain control, with more and more people having to take more and more opiates or stronger opiates to control the pain. This is tolerance, and tolerance builds quickly with opiates, whether they are prescribed or not. There are other ways to control pain that are available, which will be the subject of a future blog. Regardless, tolerance is one important factor of addiction.
The second major factor in addiction is the presence of withdrawal symptoms which may occur when the body and brain expect a substance to be taken, and it isn’t. The body starts to display symptoms that occur when the substance is decreased or stopped. For example, an opiate user will start to go into withdrawal usually about 12 hours after the last use. Symptoms include fever, nausea, vomiting, diarrhea, and runny nose…like a severe case of the flu. This is when someone with an addiction to opiates usually uses again. The addicted person uses to avoid the symptoms of withdrawal, not just to get high. He or she will eventually come down again, and often uses, a cycle that repeats itself over and over.
Some withdrawal symptoms like in the case of the flu-like symptoms with opiates and heroin, are less dangerous and eventually cease. Other substances such as meth cause a different kind of withdrawal, sleep. It’s not unheard of for someone who has been up a few days on meth, crashes by sleeping for the next couple of days…all day. He or she doesn’t experience physical symptoms like fever or vomiting, but may sleep an extended period of time, which can scare someone who checks in on them, thinking, “Is he or she dead? They haven’t gotten up in 3 days.”
Withdrawal symptoms occur when the substance is decreased or stopped.
With some substances, however, as in the case of alcohol or benzos, the withdrawal symptoms in and of themselves can be fatal due to the possibility of seizures. This is why someone who is in withdrawal from alcohol or benzos, are usually advised to detox in a medical facility so that they may be monitored for DTs or seizures and doctors can administer the appropriate medications if needed.
Again, it’s important to reiterate that self-diagnosis is not advised but if you realize you or someone you know or love does have a problem with substances, you may want to get help. Stopping substance use doesn’t just mean detoxing. Some people may think if they detox, that’s it…they’re cured! But that is not the case. Recovery starts with the detox. Actually, it starts even before that, but we won’t get into the science of addiction. Recovery is about learning to live a clean and sober life and relapse prevention is a vital part of recovery. This is when seeing someone may help.
Actually, seeing someone for help at any point of this continuum may be useful, but in the case of addiction and recovery, there are many more facets to address than you may know. But stay tuned, because relapse prevention and recovery will be the subject of a future blog….
Would you like more information about substance use and addiction? Contact us for a free initial consultation.