- The line between substance abuse and addiction involves uncontrollable cravings and use despite problems in important areas of life.
- The time it takes to shift from abuse to addiction is influenced by the type of drug, how it’s ingested, genetics, and brain chemistry.
- The CAGE test is comprised of four questions and can help diagnose alcohol addiction.
The time it takes to develop an uncontrollable craving for alcohol and other drugs can be weeks and months, or years and decades. My co-author and friend, James B., drank heavily throughout high school and his first years of college before he lost control of his drinking. James became addicted to cocaine, however, in less than a year. I’ve had patients report that they lost control over their use of pain pills within weeks or months of filling their first prescription. A few even claim to have become addicted almost immediately.
More common, however, is the experience of my friend Dr. Jordan, who took his first drink—bootleg whiskey—at sixteen. He drank socially through college and medical school, and then became a heavy drinker while he was developing his medical practice. He routinely downed six to seven drinks on weeknights and more on weekends. Although he was drinking far too much, he could still choose when and how much he drank, or even if he drank. In his mid-thirties, when his wife left him because of his drinking, he was able to cut back to save his marriage.
A decade later, however, Jordan’s wife sustained serious injuries in an automobile accident and died after months of suffering. Jordan fell off the cliff, and within a few months, he was involuntarily drinking a gallon of vodka a day. Too impaired to drive to the hospital at night, he began inventing reasons why he could not respond to emergency calls.
As a doctor, Jordan was painfully aware that he had become addicted to alcohol, but after trying repeatedly to quit, he gave up all hope of recovery. Fortunately, a chance encounter with someone at his church led to a spiritual experience that enabled him to quit drinking instantly. When I met him some months later at a medical conference, he was convinced that he would never drink again. Despite this confidence, Jordan listened to my advice and admitted himself to a treatment program for medical professionals. Several months later, when his craving for alcohol returned with unbearable intensity, he had the tools and support system he needed to avoid a relapse.
The time it takes for a heavy drinker or drug user, like James or Dr. Jordan, to cross the line from abuse to addiction is thought to depend on a number of related factors:
- The type of drug. Generally speaking, nicotine, cocaine, methamphetamine, prescription pills, and heroin are thought to be more addicting than alcohol or marijuana.
- How the drug is ingested. Because drugs that are smoked or injected reach the brain more quickly, they are thought to be more addicting than drugs with slower delivery times, such as those that swallowed or sniffed.
- Genetic risk factors, particularly a family history of addiction.
- The brain chemistry of individual users.
The exact moment when abuse ends and addiction begins is impossible to determine, but the line is crossed when a drinker or user cannot control his or her craving for alcohol or other drugs, even when they are causing trouble in one or more important areas of life—such as family, friends, health, school, career, finances, or legal matters.
Crossing this line is not a conscious process. At its heart is an invisible chemical reaction that begins in the cells and molecules of the brain’s reward system and extends to virtually every structure and function of the brain.
CAGE: A Diagnostic Test for Alcohol Addiction
- Have you ever felt the need to Cut down on your drinking?
- Have you ever been Annoyed by criticism of your drinking?
- Have you ever felt Guilty about your drinking?
- Have you ever had an Eye-opener first thing in the morning?
“Drinking” can be replaced with reference to specific drugs. If the patient answers two or more of these questions with “Yes,” the possibility of alcohol addiction is significant. A positive answer to the last question, drinking an “eye-opener” in the morning, is considered by many clinicians to be diagnostic of addiction, as it suggests withdrawal symptoms.