Just because someone doesn’t meet diagnostic criteria for substance abuse or dependence doesn’t mean drugs aren’t damaging their world.
There’s a space between normal behavior and an official diagnosis called “almost addicted” that has serious consequences, according to Dr. J. Wesley Boyd, MD, Ph.D, an assistant professor at Harvard Medical School and author of the book Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
People who are almost addicted still struggle because of their drug use. They may have problems in their personal or professional lives. They also might meet criteria for drug abuse or dependence in the future — at which point it becomes tougher to treat. Intervening now can lead to healthy changes and prevent a full-blown crisis, said Dr. Boyd, also a staff psychiatrist at Cambridge Health Alliance.
Warning Signs of Almost Addiction
People with drug problems are easy to spot. This is actually the biggest myth about drug use, Boyd said. One of his first patients was a professional who was using hundreds of milligrams of oxycontin, every day, for over a year. His wife had no idea. His co-workers had no clue. And there were no complaints about his work performance.
(He finally got caught after a pharmacist called the police. Fortunately, after treatment, years later, he was still drug-free.)
But there are signs to look for. In Almost Addicted Boyd features the Drug Abuse Screening Test (DAST) along with other key questions. These are some of the obvious and not-so-obvious signs he mentioned:
- Abusing prescription drugs
- Inability to get through the week without using drugs
- Feeling guilty about drug use
- Having loved ones worry about your drug use
- Being told by loved ones that your behavior is strange
- Losing friends over drug use
- Losing a job over drug use
- Engaging in illegal activities to get drugs
- Not giving your full effort at work because of drug use
- Writing work emails or doing other things online while under the influence and regretting them later
- Divulging important information about work while under the influence
- Embarrassing your family
- Berating loved ones while under the influence
- Cheating on your spouse while under the influence
How Loved Ones Can Help
There are many things loved ones can do, Boyd said. These are his suggestions:
Don’t enable the behavior. Don’t make it easy for your loved one to keep abusing drugs, Boyd said. Consider how you might be feeding their habit. Take the example of a mom who was giving her teenage son money for lunch and the mall. He kept asking for more money more often. Turns out, as he told Boyd, he was using the cash to buy drugs.
A loved one also might make excuses for a family member who misses work after a night of drug use. “Covering for the behavior allows it to continue longer than it might,” Boyd said.
Talk to your loved one – and stick to the facts. When approaching your loved one, be as straightforward and objective as possible, Boyd said. It’s certainly easier said than done, but try to keep your emotions out of the conversation.
“Whether they’re almost or full-on addicted, most people live in denial,” he said. So if you tell someone “I think you’re abusing drugs,” they’ll likely just deny it. Instead, let the facts drive your conversation. Say “I noticed your eyes were bloodshot and you showed up late to work.”
Ask others to step in. If your loved one is in denial, gather support. For instance, if the person is religious, ask a clergy member to speak to them, Boyd said. If they’re not religious, ask a primary care physician, he said.
Employ leverage. If your loved one refuses help — or again is still in denial — Boyd encourages families to employ any leverage they can (within legal limits, of course). In the adolescent substance abuse program at Boston Children’s Hospital, Boyd and his colleagues use the 7 Cs of leverage: cash, credit card, checks, car, cell phone, computer and curfew.
When you have little or no leverage, rely on the law. For instance, while it’s incredibly difficult, if your loved one is facing legal charges, Boyd advises families to “let the law run its course.” Often, he said, these individuals will be put on probation, which includes drug testing. As he said, “any period of enforced sobriety is better than no sobriety.”
What You Can Do
If you’re the one who’s almost addicted, consider your relationship with the drug openly and honestly, Boyd said. See a mental health professional who specializes in substance use or a primary care physician, he said. Attend support groups such as Narcotics Anonymous or Alcoholics Anonymous. “The only request for going to these meetings is the desire to stop using your substance,” he said.
Some people may be able to quit on their own, Boyd said. For instance, since her teenage years, Boyd’s mom smoked two packs of cigarettes every day. After learning she had early emphysema, she quit cold turkey.
However, if any aspect of your life is at risk – such as your ability to work or keep your home – or there’s an immediate threat to your health, seek professional help right away, he said.
No one is immune to addiction, Boyd said. One of his supervisors, a substance abuse expert, used to say, “As far as I know the reason I’m not a heroin addict is that I haven’t tried heroin.”
Even casual use can become too much. If you’re almost addicted, seek help. If your loved one is almost addicted, offer help.