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Substance abuse is destructive on every level. As we know, abusing drugs and alcohol can produce negative consequences in a user’s life. Dangerous physiological occurrences can develop, families can be split apart, jobs are often lost, once-healthy relationships end, problems with law enforcement and the criminal justice system are common, and suicidal ideation often invades one’s thinking, not to mention the potential for overdose and death.
In this post, I would like to look at the progressive signs and symptoms of drug abuse. Knowing and understanding the signs associated with substance abuse can be useful in recognizing when someone needs help.
Many of the signs listed below are interchangeable for drugs and alcohol (and to some extent other addictions), and the hope is that if someone begins to question their alcohol or drug use, they will reach out to a therapist before severe problems occur in their lives.
1. Cravings
People experience intense urges for the drug as their addiction develops. Obsessing about the drug, purchasing the substance, and anticipating using are all part of cravings. Some have indicated that alcoholics have more of a “thinking” problem than a drinking problem because as physiological urges to drink develop, one’s thinking about using prompts behaviors for drinking.
Cravings are a strong force, with many succumbing to their pull. Many sober individuals relapse in this phase.
2. Physical Dependence
A user’s dependence on drugs or alcohol develops as they grow accustomed to the persistent presence and influence of the substance. Physiological and psychological disturbances occur when the drug is no longer in the system.
An example of dependence would be taking a drug, such as a sleep aid, every night. The person may not be addicted to the medication, but they have grown accustomed to taking the drug to sleep, and without it, they may not be able to get a full night's rest. The body will know that the drug is not in the system, and without that help to induce sleep, it will be intermittent at best. A slow tapering off the medication will allow the body to readjust to not having the medicine in the system.
3. Tolerance
Over time and with prolonged use, people build up a tolerance to alcohol or drugs, meaning they need more of the substance to achieve the same effect. As one drinks alcohol or uses drugs, the body adapts to the changes the substances produce and actually expects the substances to be in the system. If a person continuously uses, the receptors in the brain suppress the effects of the substances, thus requiring more of the drugs to produce a similar effect.
Also, with heavy and constant alcohol use, the liver produces more enzymes to break down the alcohol, disallowing much of it from getting into the bloodstream. A person will need more of the alcohol to get into the system and can actually “push through” the filtering process of the liver. It is not unheard of for someone’s alcohol consumption to go from social drinking to problem drinking and then on to addiction.
The same holds true for drugs. Drug users have been known to go from using five bags of heroin to 30 bags and more a day. No one wants to be addicted to drugs or alcohol, but our biology and physiology wire us to require ever-increasing amounts of an addictive substance.
4. Addiction
Addiction occurs when the repeated use of drugs stimulates the brain’s “reward circuit,” making it difficult for someone to stop using. When a drug is taken, dopamine is released, providing a pleasurable feeling, which in turn compels an individual to want to use it again. As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This negates the high a person feels compared to when they first started using the drug.
At this point is where tolerance develops, and more and more of the drug is needed to get the same effect. Without constant and increasingly larger doses of the drug, withdrawal symptoms begin to develop, sometimes just a few hours after the last dose was taken. The more an addict uses, the more they need to use. This pattern of using to offset withdrawal symptoms only strengthens the addiction. It should be noted that many people experience both mental illness and addiction, with substance use seen as a way to self-medicate the symptoms of mental disorder.
5. Withdrawal Symptoms
Some people experience withdrawal symptoms when they do not get their next “fix” or drink soon enough, or when they attempt to stop using abruptly or try to “wean” themselves off the drugs. It is the presence of a withdrawal syndrome that indicates physiological addiction is at play. In the acute stage of withdrawal, physical symptoms such as tremors, sweating, muscle aches, difficulty concentrating, nausea, vomiting, diarrhea, and cramping will occur.
Withdrawing from alcohol and tranquilizers can produce the most dangerous withdrawal symptoms, including grand mal seizures, stroke, heart attack, hallucinations, and delirium tremens (a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes). In the post-acute stage of withdrawal, emotional symptoms such as anxiety, restlessness, irritability, insomnia, depression, and social isolation are more common. It takes time for the brain to begin to normalize and heal, and for up to two years, the person in recovery may experience a roller coaster of emotions, sometimes on a day-to-day basis. It took time for the brain to get accustomed to drugs and alcohol being a “normal” presence in the system, and it takes time and perseverance for the brain to get back to a healthy state.
6. Poor Judgment
When a person is addicted to drugs, he or she will often do anything to obtain more, including engaging in risky behaviors, such as stealing, lying to friends and family, participating in unsafe sex, selling drugs, and engaging in various other kinds of criminal activity. As the addiction grows, they get into financial trouble, neglect responsibilities, and become severely self-centered.
During any period of the absence of drugs, when signs of withdrawal symptoms begin to set in, an addict will not think with reasoning but will focus only on how they can obtain more drugs to offset their impending sickness. Once this drug-seeking behavior takes hold, a person does not think about eating or sleeping and loses any sense of self-care; the only thought is how to acquire more drugs. Being addicted to drugs can negatively affect every aspect of a user’s life.
7. Development of Unhealthy Relationships/Isolation
As a person begins to use more and more, their circle of friends changes. Healthy relationships fall to the wayside, and new “friends,” more than likely users themselves, appear. These new friends share a commonality in their substance use that, in a sense, “normalizes” the user’s behavior.
Another aspect of drug use is social isolation, in which an addicted person may stop reaching out to family and friends. Instead, their drugs and alcohol become their “friends.” They come to “trust” the addictive substance and feel they can rely on it to produce a consistent experience. This convoluted thinking can drive an addicted person into further isolation.
The Path to Recovery
Substance abuse and addiction are grim subjects, and when one is already ensnared, the situation can seem hopeless. However, while the best policy is never to start using or abusing any substance in the first place, with commitment and hard work, there are paths to healing. There are inpatient as well as outpatient treatment programs that can help an addicted person get clean and remain sober. Along with AA/NA meetings and regular sessions with a therapist, the chances for long-term recovery are good.
Often, an addict’s behavior will spiral out of control to the point where it necessitates a hospital admission. In the case of an overdose, police and EMTs try to revive the victim with Narcan (Naloxone), hoping to “reverse” the effects of the drugs. Sometimes the person who overdosed will be brought to an emergency room and given Narcan there.
If (and if is the keyword) an overdose victim is revived, a recovery specialist may come to talk to the person about long-term treatment. If the person doesn't agree to further treatment, they are free to leave the hospital once medically cleared. If the rescued person does opt for treatment, they will, in all likelihood, be sent to a detoxification program, followed by rehabilitation.
Inpatient rehab is for those who have struggled with substance abuse for a long time or who may have overdosed a number of times and feel they are finally ready to leave drugs behind. It provides a safe environment with no distractions to treatment. Here, they receive medical supervision around the clock and support from others also in recovery. Inpatient treatment may also provide group therapy, individual therapy, and, in some facilities, exercise, yoga, and meditation classes.
There is a higher likelihood of success if a person goes into residential treatment for 21 days or longer, depending on individual needs. Inpatient substance abuse facilities are a powerful place for healing because of their team approach to treatment, and because the patient is removed from the people, places, and things that caused them to start using in the first place.
Another way for a person to get substance treatment is a partial hospital treatment program, where the person comes to a facility during the day for group therapy, then goes home after the program. This type of treatment is for those who are less at risk for relapse than someone in a residential program. It allows them the flexibility to manage their responsibilities at home or in the community. In this situation, although the drug of choice may be different, there is a commonality, with everyone seeking mutual support in discussing ways to avoid relapse.
To read more on this topic and other mental health-related topics, please see my book When to Call a Therapist.
