2 Words That Could Mean You Have a Drug Problem

How you talk about your substance use may be your first clue you have a problem.

Posted Jul 08, 2015

Photo purchased from iStockphoto, used with permission.
Source: Photo purchased from iStockphoto, used with permission.

People who need help with their drug or alcohol use represent all ages, races, genders and walks of life, but there’s one thing they have in common: None of them set out to become an addict.

Instead, their loss of control crept up on them until, much like the story of the frog in the slowly heating pot of water, they came to realize too late how much trouble they were in.

Each person’s progression from casual to problem use is unique, but it often unfolds along these lines:

At first, your drinking or drug use seems like a positive. It feels good and it fills a need, whether to make you more social, help you relax, boost your confidence, or allow you to escape the noise in your head for a few blessed moments. But as you use, your brain chemistry and circuitry change and you become less able to feel the same sense of pleasure or relief. That means more of the substance is needed to get the effect you’ve come to count on.

With increased use comes problems, however. Perhaps you start missing work deadlines or events with the family, or you pay less attention to things that once mattered to you. It’s often at this point that two words start creeping into the conversations you have with yourself and others about your substance use: just when.

You may declare, for example, that you’ll drink or use drugs “just when I’m with friends” or “just when I don’t have to work the next day” or “just when I’m really stressed.”

When you reach the just when stage, you are bargaining with yourself—trying to quell your nagging concerns (or someone else’s nagging) about your substance use while at the same time setting up parameters that allow that use to continue. All the “justs” become justification.

The Start of a Destructive Cycle

It may seem like a way to prove to yourself and others that you are still in control, but in most cases, the “justs” don’t end up limiting you; they simply keep expanding to accommodate your growing need. Just when I’m with friends becomes just when there’s nothing better to do. And because substances can come to feel as vital to your survival as the air you breathe, it may soon feel as though there’s never anything “better” to do.

The encouraging thing about the “just when” stage is that it tends to appear relatively early in the progression from casual use to dependence, and that means it can be your canary in the coal mine, alerting you to the need to take action on your own behalf. If you hear yourself using just whens, pay attention. They are telling you that things are moving out of your control and you shouldn’t delay in reaching out for help.

If you miss the chance to interrupt the process, however, you can expect an increasingly destructive cycle. The more you use, the more you need and the more dependent you become. Cravings overwhelm you because not using now means dealing with painful withdrawal symptoms such as agitation, anxiety, nausea and depression. Your drug or alcohol use is no longer about feeling good but about keeping from feeling bad. You try to stop and can’t, and that makes you feel powerless and ashamed, which can lead to further drug use.

A Signal to Take Action

It’s important to remember that addiction is a chronic brain disease that some are more vulnerable to than others due to genetics, biology, environment and a variety of other factors. Its effects on brain circuitry can take away one of our most basic skills — the ability to do what is best for ourselves.

The good news is that even for those predisposed to addiction, recovery is possible, especially when help is received early. Other people may have problematic drug or alcohol use that does not meet the criteria for dependence but that still negatively affects their lives. In all of these cases, treatment can help by offering behavioral and medical therapies that help control cravings, teach new ways of dealing with triggers to use, and that address the issues that often underlie problem drinking and drug use, such as trauma and depression.

You don’t have to wait for the just whens to start before reaching out for help, but if you do hear yourself saying those two words (or any number of variations of those words), recognize them for what they are—not a plan for keeping your substance use manageable but a message to yourself that it’s time to take it seriously.

David Sack, M.D., is a psychiatrist, addiction blogger and CEO of Elements Behavioral Health, a nationwide network of addiction treatment centers that includes Park Bench drug rehab in New Jersey and Brightwater Landing in Pennsylvania.