Crossing the Line . . . From Abuse to Addiction

At 3:15 today Carol, 37, will cross the line from drug abuse to addiction. No trumpets will blare. No red flags will wave. For Carol, her addiction will be as hidden from her as it is from her loving family and friends.

Image courtesy of Maggie Smith at

Image courtesy of Maggie Smith at

Carol is an “almost addict.” Before today, her abuse of pain medication was mostly taking an extra pill to deal with her back pain and tension. Past attempts to cut back have not been successful. In fact, because she has developed a tolerance to the medication, Carol finds that she needs that “extra” pill more frequently just to get any relief at all.

Even last week when it took two extra pills in combination with a glass of wine to help manage her pain, her abuse was still in the “almost” category. There had been no serious consequences or issues yet. There was certainly some risk involved from the combination of opiate medication and alcohol. But she only did that once. And all things considered, it helped a lot and she was able to get some things done that were being neglected.

Image courtesy of renjith krishnan at

Image courtesy of renjith krishnan at

But today, at precisely 3:15, Carol crosses into addiction.

Instead of picking up her 14 year old daughter from school for a doctor’s appointment, Carol is at a friend’s house to “borrow” some pain relievers. The abuse of her prescription caused her to run out early, so now the back pain is severe. She could not imagine anything helping but her medicine. There was no way she could manage her daughter’s appointment. Carol’s plan was to borrow the pills, get to the school, then to the appointment. But things didn’t work out. The friend was late, and that set everything else behind.

At 3:15 Carol was still waiting for her friend—and the pills. She called her daughter who was just barely able to catch the bus. No harm-no foul. The appointment could be rescheduled. First things first.

This was not the only time Carol failed to keep an appointment, or meet parental obligations. It’s not like she would beat the kids or went missing for days on end. But sometimes she would be a little too buzzed to help with homework or was too stressed from running out of pills to tolerate a parent-teacher event.

Carol’s failure to pick up her daughter is significant because it is now an established pattern of behavior. She continues to abuse drugs despite the consequences. While she rationalizes her actions, the result is another failure in parental responsibility. Even though she knew she would probably be late, she minimized the risk and mentally justified her drug seeking behavior.

While Carol is aware of these events, she thinks about them in ways that minimize their severity and implications. To Carol, there are good reasons for them all.

Image courtesy of cooldesign at

Image courtesy of cooldesign at

To Carol, her situation does not rise to the level of impairment that most people picture when thinking of a “drug addict.” There is no prostitution, burglary or theft from family/friends. She is not spending large sums of money to support a habit out of control. But addiction is insidious and Carol’s priorities are being influenced, unconsciously and biologically, so that now her drug use aggressively competes with her roles of parent, wife, employee, volunteer, and community member.

Science tells us that Carol’s addiction is due to her brain being physically changed in areas that influence thoughts and feelings. Her motivations, memories, and perceptions have been hijacked by an addiction process that has literally altered the way she thinks and behaves.

Let’s get something straight. Carol is a good person. Her addiction is not her fault and she should not be punished or blamed for it. This was not a planned event. It was hardly a choice, either. She is, however, responsible for her behavior and the choices she does make, even when those decisions are influenced by impaired thinking and emotions.

Does Carol love her daughter? Of course she does. But she also loves her pills, and as she spirals into her illness she will unconsciously make excuses for her increasingly compulsive use of opiates.

Hopefully, Carol will get a wake-up call before some devastating incident occurs. Perhaps someone close will see what is happening and help motivate her to seek treatment. There are well-researched, effective therapies and medications available, along with community-based self help programs such as AA and Narcotics Anonymous. Treatment helps to manage the illness while the brain heals and the individual develops effective coping strategies for a life long recovery.

Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Some warning signs that Carol has moved from abuse to addiction:

  • She is taking the substance in larger amounts than prescribed
  • She wants to cut down, but feels incapable of doing so
  • She is spending more time “chasing” her medicine (drug seeking), to cover when her prescription runs out
  • She has failed to meet important role obligations due to her abuse
  • She has begun taking her drug in combination with other drugs (alcohol)
  • Despite consequences, Carol continues to use and abuse
Image courtesy of ponsulak at

Image courtesy of ponsulak at

Some warning signs of drug abuse moving to addiction:

  • You are using drugs in a risky or dangerous manner: Drinking/drugging while driving, combining drugs with alcohol or other types of mood altering drugs, doing things when under the influence you would not normally do
  • Taking more than prescribed or taking more than planned
  • Neglecting responsibilities at work or at home due to drug use
  • Getting into legal difficulties such as arrests for disorderly conduct, stealing, DUI related to alcohol, or possession for illicit drug use
  • Having problems in relationships- the loss of old relationships, withdrawing from others and avoiding people who don’t get high, conflicts with the spouse over use
  • Spending more money on the drug than one can afford
  • Intense cravings that can only be relieved by use

Short Definition of Addiction (American Society of Addiction Medicine): Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Drug Abuse can be defined as “harmful use” of a drug or alcohol. There are risks and consequences when substances are taken in ways unintended. Abuse generally precedes addiction with a host of warning signs that can initially be quite subtle. If occurring in a social context with other people who use and abuse, it can be even more difficult for the individual to recognize the true impact his or her drug use is having.

The term “addiction” is about the disease process, not physical dependence. While dependence can certainly be a sign of addiction, a person can be physically dependent but not have the disease of addiction, i.e. takes the prescribed medication as intended and without engaging in compulsive, abusive use. Conversely, physical dependence does not have to be present for someone to suffer from addiction.

Use does not inevitably lead to abuse or addiction. It is less about how much drugs/alcohol is used and more about the consequences of that use.

Brown Dan 1About the Author: Dan Brown is the Lead Clinician of Addiction Services at Aspire Indiana.  While the beliefs and opinions expressed in this blog are solely those of Mr. Brown, you can learn more about Aspire Indiana at  You can also follow Mr. Brown on Twitter @DannyCBrown.

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