It’s amazing to me how much misinformation there is out there about drugs and substance use. Especially when there are so many people who use some kind of drug/substance every single day. I’m writing this post to explain 1)the basics of what drugs are, 2)some reasons people use them, 3)the different types of drug use, and 4)how to tell when substance use (not necessarily a problem) may be turning into a substance use disorder (harmful to self and the people who depend on you).
Substance use and substance use disorders are 2 specialities of my clinical/counseling work and I work from a harm reduction philosophy/approach to therapy. Abstinence and harm reduction are 2 ways of looking at substance use issues. Abstinence as a philosophy is basically “Just Say No”. It’s traditionally the view that the only way to deal with substance use problems is by never using or by totally stopping using drugs/substances. Abstinence as a philosophy is not particularly interested in asking people to reflect on why they use the way they do. Abstinence as a philosophy instead tells people why they use (moral failures, weakness, addiction as a disease, etc.) and then tells them to stop using drugs. It can be an effective strategy depending on the person and the situation, but doesn’t work for everyone or every situation so it shouldn’t be the only solution. “Just stop using” can be too basic for people’s complicated lives. Harm reduction works from the idea that people have complicated relationships to drugs and abstinence is not the only solution to struggling with substance use. Sometimes abstinence (the specific act of not using a given drug, not the philosophy) is the answer. And harm reduction recognizes “no use” as 1 of many options. Harm reduction sees substance use problems as a public health issue (instead of a moral/character failure or a disease). Harm reduction strategies uses empathy and compassion to work together with people on how to realistically be healthy, safe, and well on their terms.
Harm reduction also takes the approach that people have been using drugs for different reasons since the beginning of time and are going to keep using drugs. Shaming ppl, stopping them from getting jobs, taking away their homes, locking them up in labor camps…I mean prisons…obviously doesn’t do anything to stop people from using (the drug game is alive and well even in prisons). What all these policies really do is cause harm and human suffering without actually getting to the heart of the issue. What works is working together with people and, if they want to change, helping them figure out how to change how they see, think about, and use each of their drugs on their own terms. Harm reduction is also about giving people accurate and unbiased information so they can make their own choices. And through information giving and collaboration, harm reduction is another way to help people become more self-aware about their use and to become more curious about themselves and how they act.
So What Are Drugs?
A drug is a something that changes how your central nervous system (your brain and brain stem) works. Any substance outside your body that changes your brain chemistry when you use it is a drug. Examples of drugs are coffee, cigarettes, alcohol, Celexa, marijuana, cocaine, Oxycontin, poppers, Klonopin, etc. These are all drugs because they change your brain once you take them. In the US, drugs are arbitrarily broken up into categories like legal vs illegal, medicine vs not medicine, recreational/part of society vs something to be ashamed of. But these categories weren’t created based on actual knowledge and research. They are based in stigma and prejudice. It’s always assumed that people who use stigmatized/shamed drugs are illogical, but people use all drugs for a reason. And usually these are logical reasons that actually make sense when you sit down and listen to people. The fact is, drugs work and people tend to choose the drugs (legal and otherwise) that best fit their brain chemistry and the experiences they are looking for.
Here are some reasons ppl use drugs:
For fun/to get intoxicated
(Let’s not even front here, y’all.)
As a part of cultural, social, and/or religious rituals
- Champagne at New Years Eve
- Ayahuasca ceremonies
- Marijuana in the Rastafarian religion
- Wine in communion/eucharist in Protestant and Catholic Christian faiths
During social settings and/or to build community
- Going to a bar with coworkers
- A professional/networking “function” serving alcohol
- Sharing a cigarette and smoking outside together
As medicine and to cope with life (prescribed by a Dr or self-medicated)
- Smoking marijuana to cope with social anxiety before going out
- Having beer or some wine after work to de-stress
- Taking antidepressants every day for depressive symptoms
- Taking prescribed stimulants (Adderall) or unprescribed stimulants (cocaine) to treat ADHD symptoms
What Is Drug Use?
In my clinical work, I see drug use as a person’s specific relationship to each drug. It’s easier to talk about substance use and figure out options this way. This perspective allows us to do some digging and look at all the reasons why people use drugs. Then it’s easy to see how people can develop a bond, create good memories around, and feel emotions towards the substances in their lives. Especially if it’s a part of your culture or if it’s a substance that you have been using for a long time. This drug could have literally saved your life at one point. It could have comforted you. It could remind you of family gatherings, the playoffs, or chilling with your close friends. And everyone is different. Everyone has a different brain/brain chemistry, has different genetics, grew up in different environments, and has different life experiences. Each drug is going to affect each person differently. Each relationship with each drug is going to be different. And each relationship is complicated. 1 drug can cause some problems and fix other problems at the same time. Just like a relationship with another person can be complicated.
In their book, “Over the Influence: Second Edition: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use” by Patt Denning and Jeannie Little, they talk about the different types of use/relationships that people tend to have with drugs. Learning the different types of relationships and being able to label one’s relationships to drugs begins to take away the stigma/shame that comes with drug use. And it sheds light on the misinformation and myths surrounding drug use and when use can become a problem. The relationships to drugs they describe in the book are: No use, Experimental use, Occasional use, Regular use, Heavy use, and Chaotic use.
Not using now or never used a particular drug
Experimenting with it a few times because you’re curious
Using the drug occasionally without a pattern
Example: Drinking during the holidays or using poppers sometimes when you have sex
Using a drug on a regular basis to the point that it’s become part of a routine and there’s a pattern
Example: Smoke weed every night after work or snort coke every weekend at parties
Using a drug more than you probably should, depending on your health and social norms
Example: You have diabetes and drink a couple beers a night. Technically not a lot, but because of your diabetes, even that little bit of beer puts your health at risk
Example: You could be physically dependent on coffee. Need to drink it everyday at the same times or you’ll get headaches, irritable, and can’t focus
Example: Smoking weed or cigarettes when you have asthma or COPD
A heavy use that the person cannot control and their entire life is controlled or revolves around using that drug (what is usually called “addiction”)
Example: Losing your job or not being able to pay rent because you are spending your time and money getting, using, and/or recovering from using drugs
Examples of how the different types of relationships to different drugs can look over time:
Has a history of chaotic use with alcohol
Never used crack
Experimented 1x or 2x with Molly
Smokes marijuana regularly everyday after work
Example: Person B
Regularly sniffed a bag of heroin daily after work for years while keeping a job
Retired at age 67 and heroin use became chaotic without the job schedule and when the person couldn’t pay bills anymore
Went to substance use treatment and now is abstinent from heroin
Experimented with marijuana, Molly, and Lean a few times in college
Occasionally takes Xanax (without a prescription) before going on planes
Heavy use of alcohol to fall asleep at night despite some issues waking up in the morning for work
Like I said before, a person’s relationships to drugs can be very complicated. Someone can have a history of chaotic use with 1 drug and need to stop using that 1 drug forever, but is able to function on other drugs. And even those relationships to drugs can change over the years. A relationship with a drug can start off stable, become chaotic, and then through treatment/hard work become stable again. Some people have used substances and never developed a chaotic relationship to any substance. Again, this is why awareness (I think I talk about this in some way in every post) is so necessary.
How Do I Know When My Use Is A Problem?
So how do you know when your use is becoming chaotic? In the Diagnostic Statistical Manual, 5th edition (the manual used by mental health professionals to diagnose mental disorders), chaotic use is described under “substance use disorders”. There are many different types of substance use disorders in the DSM 5, including alcohol use disorder, opioid use disorder, etc.), but all use disorders basically have similar core 11 symptoms (and only 2 is needed to be diagnosed a use disorder):
Using more of the drug than planned for longer than you meant to
You keep wanting to stop or trying to stop, but fail
Spending a lot of time getting, using or recovering from the effects of the drug
Using the drug has start to negatively affect obligations at home, work, or school
You keep using drugs even though it’s messing with your relationships with people
You drop the things/activities you used to like to use more of the drug
You keep using drugs even if it’s physically dangerous/risky
You keep using drugs even if it has caused a physical/mental health problem or using drugs has made your health worse
You develop a tolerance: you need more and more of the drug to get high because the same amount is affecting you less and less over time
You start going through withdrawal (get sick) if you take a break from using and you try to avoid withdrawal
Again, the substance use disorder diagnosis is another way to talk about chaotic use. One way to tell the difference between using drugs and having a substance use disorder is using 3 out of the 4 Ds (1st mentioned in my depression post here): Distress, danger, and dysfunction, (deviance is not useful here because of the stigma put on certain drug use and certain people).
Does your drug use (and your relationship to the specific drug) cause you distress? Does your drug use put you in danger? Does your drug use affect your ability to function: pay bills, go to work/school, etc.? Working from a harm reduction philosophy, I don’t care if a client is using drugs as long as the specific drug they are using is not causing them distress, doesn’t put them/their health danger, and doesn’t change their ability to pay their bills/successfully go to work, school, etc. And I want to separate distress caused by 1) society stigmatizing certain types of drug use over others…versus 2)someone feeling upset because of the effects naturally caused by their choices.
Example 1: Feeling distress because of unfair drug laws that prevent people from working, receiving housing, and/or having custody of their children even if the person’s use is not chaotic and the person could reasonably take care of all their obligations. This is a man-made problem, created by society. It’s related to systemic racism or classism and is not a problem that the individual created themselves. Their distress is in response to the punishment that society is unfairly inflicting on them.
Example 2: Feeling distress because their chaotic use is preventing them from paying rent and keeping an apartment. This distress is directly related to their substance use disorder.
So I’ve explained what drugs are, the different types of substance use, and the difference between using drugs and having a substance use disorder. So at this point, you might be wondering: Ok so how can I tell if my use right now is becoming a problem? Not everybody has a copy of the DSM 5 just chilling in their home. I get it. But what many of us do have is internet access. Use these free online drug use screenings to see if you need to start slowing down your use or seek treatment. Assessing your own use/relationship to the drug or drugs in your life before it starts to become chaotic is important (similar to how you’d check in on the relationships you have with the people in your life from time to time). Two short, easy to take questionnaires that I can recommend for y’all are the Drug Abuse Screening Test (DAST-10) and Michigan Alcohol Screening Test (MAST). Both are available for free with a quick Google search. If your assessment results say that you need to “reassess later” or have a low-level problem, that would be a sign to consider slowing down your use. If your results say you are experiencing moderate to severe difficulties due to your drug use, you may have a substance use disorder. Consider looking into treatment including 1-on-1 psychotherapy.
Using drugs isn’t a problem. When your use starts to become chaotic, that’s when it’s time to be concerned. Chaotic substance use is a symptom of a larger problem and again, this is a public health issue. Society creates problems for itself when it criminalizes health issues instead of dealing with the root causes. I hope this post helps you reflect on your own relationships with legal and illegal substances and create relationships with drugs that work for you.
Thanks for reading. The next post on 6/24/18 will be Part 3 of the 4-Part parenting series, focusing on parents’ expectations of parenthood and thinking about the kind of relationship you want to have with your child as they grow up.