You are stuck with whatever the original problem was - shyness, anxiety, depression, abuse - and now you have more problems piling up as your world collides with reality. Relationships break down, jobs are lost, financial problems build, and you may have trouble with the law as well as physical problems caused by the addictive substance.

A housewife who started drinking at night to get to sleep finds that she cannot sleep at all, despite drinking continuously all evening. A trucker who began using amphetamines to stay awake during long hauls finds that he can’t keep his weight up, that he is paranoid and restless, and that his skin is breaking out in sores. A college student who started using marijuana to relax at parties finds that he can’t get through the day without smoking, that he is coughing all the time, and that he is failing in school.

During the time that this downward spiral is occurring, you are probably making some attempts to control it. You might adopt various rules - no hard liquor, only beer. No drinking before five p.m. on workdays. Drinking only on the weekends. No more crack, only marijuana. No more than fifty dollars per week on drugs.

You might even stop drinking or using for prolonged periods of time. But because you haven’t addressed the other issues, this attempt will eventually fail. You are attacking the symptom - the use of the substance - without looking at the cause, which is the addictive disease itself with all its different aspects.

A “dry drunk” is an alcoholic who has stopped drinking because of the negative consequences but has never looked at the damage that has occurred to relationships, personality, and morals. If you’re in this situation, you are probably miserable. Addiction professionals call this “white knuckling,” because it’s as though you’re holding on so hard to keep yourself from using that your knuckles get white. And eventually you get tired. It’s at this point that addicts often switch their drug of choice, from alcohol to marijuana or benzodiazepines, from opiates to alcohol, from cocaine to crystal meth, and so on.

If you manage to stay dry and not relapse or switch substances, you still suffer from the distortions in thinking and the damage to relationships that developed as the addiction progressed. You probably continue to place blame elsewhere for your shortcomings and to be self-centered and insensitive to the needs of others. Your self-esteem and sense of realistic effectiveness have been damaged by the addiction. As one recovering alcoholic put it, “I’m not going to be a dry drunk, because I can be just as unhappy drinking.”

Where is this spiral leading? Remember the lab rats who are given a choice between food pellets and cocaine. They will press the lever for the cocaine, despite their need for food, until they collapse and die. Even self-preservation takes a backseat to the addiction. “I knew that I was either going to stay messed up, get locked up, or get covered up,” said one woman at a treatment center. That is the truth about addiction. You might be able to continue to control environment and consequences for a while, but eventually your quality of life suffers, and the outcome may even be death.

In some ways people with more destructive addictions are fortunate, because consequences are severe and obvious and the dreadful possibilities are laid out before them over and over again. People who experience less dramatic consequences might continue using or drinking all their lives without ever facing the need to recover. But their relationships wither and their spiritual life fades away.

The choice is this: recovery or death. Addictive disease is a fatal illness, with no cure. There is a chance for a reprieve.

Addiction can be brought into remission, and the addict can begin repairing the damage and rebuilding his or her life.

But addiction is the only fatal illness I know of that contains an element of will. The addict is the one who chooses the outcome. Addicts in recovery choose their outcome every day, and so do active addicts. With every day that goes by, you have the choice: addiction or recovery.

Recovering addicts describe this as an elevator going down.

The bottom floor is death. You can get off the elevator at any floor you choose, or you can ride it all the way down.

It’s your decision, and yours alone.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information