The Course of Addictive Disease

Most people who start drinking or using drugs do not intend to become alcoholics or drug addicts. How does it happen?

At least half of all the people who develop addiction carry genes that make them more vulnerable to the condition. But it’s not simply genetics. A combination of factors must come together in order for addiction to occur.

First, the substance has to be available, and you have to have some willingness to try it. If your family drinks or does drugs, then you are more likely to see this as normal behavior, as something adults do. Most of the patients I’ve treated in hospital settings for addiction started out with beer or marijuana on the weekends with friends. Drug prevention campaigns in the schools aim at nipping this kind of behavior in the bud, which is a good idea but hard to accomplish given a social climate that encourages drinking and drug use.

The future addict finds that drinking or using drugs solves some psychological or emotional problems. For many, it eases the shyness and awkwardness of socializing. If you already have problems with depression or anxiety, you may find temporary relief with alcohol or marijuana. Or your journey might start with prescription medications for pain or anxiety. In any case, you learn that you can find relief from uncomfortable feelings when you’re high.

Many addicts, especially women, have experienced psychological trauma and various types of abuse. Being intoxicated or high lends a feeling of well-being and provides an escape from the psychological effects of the trauma.

It’s at this point that casual or recreational use slips into reliance on the drug for its emotional effects. You remember the pleasurable experience of being high and don’t see that many negative consequences, so you try to repeat the experience. Obtaining the drug, using it, and recovering from its effects begins to become a priority. You have now drifted over into substance abuse.

At this stage, most people ignore the possibility that addiction could develop. This is the beginning of denial. You might tell yourself, “I can control it.” Or you might latch on to some misinformation that allows you to minimize the risks: “Marijuana is only psychologically addicting” or “They are just trying to scare kids away from using drugs.” You may have an inaccurate idea of what an alcoholic or an addict is, and decide that as long as you can keep a job, don’t get violent, and don’t crave the substance all the time, you are not really addicted.

Elizabeth Connell Henderson, M.D.


Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information

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