You Might Be An Addict

(And by ‘Might Be’ I mean ‘Are’)

The “Opioid Crisis” is all over the news these days, thanks to cheap heroin cut with fentanyl and heaven-knows-what-else that’s filling up morgue drawers throughout the country. If you think the numbers of overdose deaths are staggering now, medical examiners would be up to their elbows in bodies without Narcan, a drug that scrubs opioids off of the brain’s receptors during overdose, literally snatching people from the grip of the Grim Reaper. Many people that have stopped breathing and whose hearts have stopped beating are only on this side of the grass because of tthis wonder drug. While addiction has recently become a hot topic, it’s certainly not like it’s new, though we do seem to find plenty of novel substances to become addicted to all the time. Also not new is the stigma and overwhelming shame attached to addiction, attached to being an addict. It elicits such a strong negative response that we’re not even supposed to use the word ‘addiction’ anymore- it’s too derogatory- so now we’re to refer to it as ‘substance use disorder,’ lest we offend anyone. That said, to save myself some aggrevation, I am still going to use the word addiction in all of its various forms (shhh!) so I apologize in advance if anyone takes offense. I’ll also be using the term ‘using’ when referring to the use and abuse of drugs and alcohol.  I’m actually amazed that the word addiction is so stigmatizing that even physicians aren’t supposed to dare utter the term. That just goes to show that no matter how we raise awareness about addiction, about how it affects people in every walk of life, and that anyone can become an addict, nobody wants to be labeled as one….especially an addict in denial. It ain’t just a river in Egypt.

I’ve been listening to people’s deepest and darkest thoughts for over 30 years, and in that time I’ve heard people rationalize every behavior and habit under the sun, but none as vehemently as the abuse of alcohol and drugs. The way these rationalizations percolate through people’s minds is interesting. They’ll say, “I’m not an addict because I don’t use that much” or “I’m not an alcoholic; I only drink a little here and there.” To this I tell them that it’s not how much they do or don’t use that makes them an addict. That’s generally when they say, “Well, I know I’m not an addict because I don’t have withdrawls, I don’t get tremors and I don’t shake, even when I don’t use for weeks.” Hmmm. I think they think that one stumps me. But it doesn’t. “Nope, I hate to tell you, that’s not at issue either. Just because you don’t have withdrawals does not mean you don’t have an addiction.” To this they say, “But, but, I only use in certain situations, like at weddings, or funerals…” Blah, blah, blah, blah.  Doesn’t matter- where you use or how often- it just doesn’t matter in terms of whether you’re an addict or not. And then there’s the flotsam and jetsam of rationalizations: “I would never shoot up, I just wouldn’t do that; I never drink shots, I only drink beer; I don’t use marijuana wax, I only smoke a joint every now and again; I would never take pills, I only drink.” The list goes on. The truth is that the amount you use, when you use, how often you use, where you use, whether you withdraw or not, and the means by which you get the drug into your system does not factor into determining if you’re an addict; those things matter not. Right now you may be wondering, ‘So what does matter?’ How do you tell if someone’s an addict? There are behavioral, physical, and psychological factors that can be examined to make the determination. First, I’m going to cover the behavioral stuff, and then I’ll get to the physical and psychological stuff. There are essentially five general behavioral criteria to consider if You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The first criteria centers on relationships with the people around you. Does a significant other- a lover, partner, spouse, parent, sibling, grandparent, etc- complain about your using? Do they say you change when you use…that you’re a different person? Sound familiar? Do you blow off responsibilities to use? Does finding the money for the drug, getting the drug, and using the drug occupy your mind above all else? Does it change the priorities in your life? Do people in your life complain you’re irritable or that you’re no fun anymore? Do you withdraw and isolate yourself to use or while high? The complaints of family, friends and loved ones are signals that using is impacting significant relationships. This is a definite sign that addiction is present. I have patients say, “I get up and go to work every day, blah blah blah blah; I make money to support my family; I’m a good provider; I do this, I do that; I still go to the gym every day, yada yada yada…” Yeah, but you come home and drink three martinis and yell and scream at your children and your wife. Yeah, but you spend all day Saturday locked in your study in an Oxycontin haze. Those things are problematic! If using impacts significant relationships, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The second factor to consider is the use of drugs and/ or alcohol in spite of physical, emotional or personal damage; damage to mind and body. Some examples: the alcoholic who is gaining weight and having liver failure. The woman who smokes tobacco but needs oxygen to breathe. The man who smokes marijuana who can’t think clearly, has memory deficits and thought and decision-making issues. The woman who’s smoking meth even though it’s killing her lungs and rotting out her teeth with meth mouth. The guy who’s injecting heroin even though he’s got gnarly scabs and infected abcesses all over his arms and legs. The man who has a cocaine problem but continues to use in spite of arrhythmias and strokes. If using causes physical and/ or mental issues but you still use regardless, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

The third factor focuses on work, your employment. Problems at work, starting to miss work, starting to come in late, making mistakes at work, poor relationships with co-workers, lacking follow-through, becoming lackadaisical or flippant at work, and not excelling/ achieving at work, especially if the behavior is new or recent. These are all drug-related signs. People say, “Oh, for 23 years I’ve gotten up and gone to work every single day and I’ve done fine.” Sure. Okay, but in that 23 years, how many times have you been promoted? Have your reviews and evaluations shown consistent improvement? Or does your boss complain about your personality, how you don’t have a good attitude, how you’re forgetful of things, how you seem to have no energy, how it seems like you’re not enjoying your work? If using affects your work performance in any way, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).  

Factor number four is pretty simple: legal issues and their consequences. DUIs come to mind, but any legal problems stemming from the use or abuse of drugs and alcohol count here. That might include anything from charges for possession of drugs, fighting in public, assault, disorderly conduct, disturbing the peace or domestic violence all the way to charges associated with vehicular collisions, even manslaughter. If using has put your attorney’s kids through private school, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’). 

The fifth and final criteria is a two-fer; it’s super important because the first part is the one thing you can never get back once it’s gone, and the second part is something very hard to get back once it’s gone. Any guesses? Give up? They are time and money. Time spent using is wasted; (no pun intended) it’s time gone from your day, your week, your month, your year, and ultimately gone from your life for good. That time could’ve been better spent being productive, doing literally anything but using. As for money, Captain Obvious says that money spent on drugs or alcohol is also wasted; it too could’ve been better spent on literally anything but drugs or alcohol. The amount of time and money spent using may prevent you from making more money, because the time you might have spent on a money-making opportunity is spent on using. What’s more, time and money act as a barometer for the severity of addiction…when one goes up, so does the other, and the more of both spent, the more severe the addiction. If you waste your time and money buying and using drugs and alcohol, You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

So just to review, what are the five behavioral criteria to help determine if You Might Be an Addict? If friends and family complain; if there are physical and psychological issues from using drugs and alcohol but use continues regardless; if there are job-related problems from using drugs and alcohol; and if there is time and money misspent and opportunities lost to using…You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’).

Family members, friends, and co-workers are usually in the best position to recognize a drug problem as they are familiar with the person’s habits and behavior, but considering the weight of the word addiction, you can’t just point an accusatory finger at someone. You must educate yourself on the signs of drug abuse. Above we discussed five behavioral factors that can signal drug addiction, but there are also physical and psychological signs to be aware of as well. Recognizing the signs of addiction is the first step to ending addiction, so I want to give some practical information on the physical signs of addiction, overdose, and withdrawl. These signs are the body’s physical manifestations resulting from the presence of drugs or alcohol in the body. 

General physical signs of addiction include, but are not limited to:

– Enlarged or small pupils (opiate use often causes pinpoint pupils)
– Sudden weight loss or gain
– Bloodshot eyes
– Insomnia
– Unusual body odors
– Poor physical coordination
– Looking unkempt
– Slurred speech

Overdose is a medical emergency. In case of overdose, please seek immediate emergency care. Typical signs of an overdose may include, but are not limited to:

– Drowsiness or trouble walking
– Agitation
– Aggression or violent behavior
– Difficult/ labored/ ceased breathing
– Nausea and vomiting
– Hallucinations
– Delusions
– Loss of consciousness

Withdrawl can be a medical emergency. Please consult a physician during withdrawl events. Typical signs of withdrawl may include, but are not limited to:

– Shakiness, trembling, jumpiness
– Loss of appetite
– Nausea and vomiting
– Depression
– Insomnia and fatigue
– Headaches and fever
– Confusion and hallucinations
– Seizures (lasting over 5 minutes is immediate emergency)

In addition to behavioral and physical signs of addiction, drug abuse also impacts a person’s psychological state. When they’re in the grip of active addiction, the person might not realize or recognize these changes. The psychological signs of drug addiction may include, but are not limited to:

– Anxiousness
– Inattentiveness
– Lack of motivation
– Irritability or angry outbursts
– Changes in personality or attitude
– Emotional/ mental withdrawl
– Sudden mood swings
– Unexplained paranoia

We’ve covered the behavioral, physical, and psychological criteria that indicate You Might Be an Addict (And by ‘Might Be’ I mean ‘Are’). Or should I say You Might Have Substance Use Disorder (And by ‘Might Have’ I mean ‘Have’). I like the first better. No matter what you call it, you don’t have to live life in addiction. Actually, that’s an oxymoron- there is no living life in addiction. And if you do oxy, are you a moron? An existential question to ponder. 

For more information and stories about addiction, check out my book, Tales from the Couch, available on Amazon.com.