Alcohol, drugs and prescription medications referred to as substances are widely used in modern day society and in our American culture. We grow up with substances and consider them a part of our lives like eating food and drinking water. Trouble with substances usually occurs when they are taken for granted much like taking a close relationship for granted. Any kind of relationship can fall apart and erode without consciously making an effort to keep the relationship safe, functional and useful. The first common mistake with substances is to believe nothing has to be done to use a substance safely. Just ingest something like alcohol and expect to feel good. There are five stages of using substances that progressively become more troublesome and can eventually lead to addiction and death.
Stage 1: Experimentation. This stage only lasts as long as the user becomes familiar with the effects of a substance and how much it is liked or not. Liking the substance will be motivation to continue using the substance and move into stage 2. If a person finds the substance unappealing, there will be little motivation to continue to use the substance.
Stage 2: A relationship is formed with the substance and the outcome or success of the relationship will depend upon many factors. About 80% of the population who use alcohol, drugs, and potentially addictive medications will develop a safe relationship with the substance. There are usually mistakes made along the way like hangovers, embarrassments, legal, personal and family consequences, an area that is commonly called substance abuse. What is critical is one’s ability or willingness to admit or see the mistakes or negative consequences and make durable adjustments in using the substance. Most people in the 80% do make the necessary adjustments and learn how to have a responsible, safe relationship with the substance. At risk in this stage would be young users of alcohol and drugs. Because teenagers have been endowed with risk taking behavior as part of their development, adding alcohol and drugs to their life style becomes more fuel for the fire.
The remaining 20% will not have the ability to see and identify the negative consequences associated with their using and, therefore, they move on to stage 3. Their experience with the substance will be viewed as more important and positive than the problems or hassles they are experiencing in life. By blaming everything including family members, instead of the substance as the cause of the hassles and problems, the using pattern becomes fixed and protected. Research has demonstrated that for most individuals who move into stage 3, there are brain, psychological and familial predispositions that set up denial and harmful dependency.
Stage 3: This stage is the early beginning of addiction. Unfortunately most individuals who enter stage three through five usually have to bottom out to create a sincere desire to change behavior and recover. It is the lucky ones who can recover without experiencing a serious loss of relationships, occupation , health, finances and self. In this stage it is not relevant how much one is using but what happens when using. “I use only on the weekends” or “on the holidays” cannot justify OK using if on- going negative consequences occur when using. The consequences or problems from the using are not recognized and can even be normalized by the using circle of friends or culture. In this stage the use creates an euphoria and the individual swings back to basically feeling normal. However as problems build with less resolution, feeling normal gets less obtainable and the individual reverts more toward the euphoric relief of the substance. Stage three can last up to a life time. The individual may recognize the dependency and there may be some attempts to recover, but not enough bad things have been identified to be convinced there is a problem. In this case the individual will move onto Stage 4.
Stage 4: In this stage the individual has lost the good time high or the euphoria. One is using to feel normal. If not using, the person will experience withdrawal symptoms like nausea, extreme anxiety and flu like symptoms. Every day use is common in order to feel normal. So a person starts out feeling crummy and can feel better when using. It is very difficult for the individual to deny there is a problem in this stage and there may be attempts to get off the merry go round. Ultimatums to get help from the courts, spouse/significant other or family members are common. Some individuals are successful getting better, but ultimately the level of desire one has to get better determines the final outcome.
Stage 5: Now the individual when sober is feeling very bad and when attempting to feel better by using continues to feel bad. The individual has lost the good time high and any sense of feeling normal. This is the end of the road and, if not arrested, death will occur from the addiction. It was a progression over time using the substance that got the individual to this stage. Recovery can occur at any stage, but it will depend upon what stage of change the person is in. Pre-contemplation is when the individual is not interested to change. Contemplation is thinking about changing. Preparation is getting ready to make a change. Action is making the change, and finally maintenance is being involved in a useful and effective recovery life style. Because there are so many subtle dynamics and aspects to pay attention to in recovering from addition, a successful prognosis is dependent upon getting help and using outside support.
My approach is to offer support and information to help a person stay on track in their recovery. There are many options to use in the recovery process but they have to be used in order to be successful. When old behaviors change to new behaviors, recovery is very possible. The biggest block to getting better is shame, an attitude that I’m not good enough or a strong sense of embarrassment. Addicts who died from their addictions could not shake off their shame. They felt too proud and self protective to get help. If you or a loved one of an addict is confronting this issue, your battle will be dealing with shame. It is a choice between letting go of shame or death.