What is Binge Drinking?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Binge drinking is a huge problem.

Some people have one drink after dinner each night. Other people save them up and have all seven on Friday night. Drinking seven drinks on Friday night is not the equivalent of one drink a day. The negative consequences, psychically, mentally and legally, increase rapidly as the blood alcohol content rises on any one drinking occasion, a practice called binge drinking.

Binge drinking is defined as having five or more drinks on one drinking occasion for a man. For a woman, because of her reduced metabolism of alcohol in the stomach, four drinks on one occasion is considered binge drinking. That one “drinking occasion” could be over a short period of time, like drinking shots, or it might entail a more measure drinking like doing in most of a six-pack over the course of the afternoon.

Lots of people resisted the idea that they could be an “alcoholic” because they did not drink every day. The newer way of thinking about this is that it is not what you drink or how often you drink but what happens when you drink that defines an alcohol use disorder. If when you drink you end up drunk or you drink excessively, then you have an alcohol use disorder.

If you only drink occasionally, but when you do drink you consume a lot, you are a binge drinker and at risk for a great many alcohol-related problems.

Bing drinking alcohol is associated with increased drug use.

Among drinkers between 12 and 25, those whose typical pattern was to binge drink when they drank, they were also much more likely to use multiple other drugs. This pattern of drug use, called Poly-Substance use, is extra risky and correlates with a lot of complications physically, mentally and legally.

Patterns of drinking can obscure the magnitude of alcohol use problems.

In treatment programs, there has been a tendency to separate the drug users from the people who have legal consequences because they drove drunk. Rarely is a drunk driving case a driving problem despite all our efforts to treat DUI’s as if the problem was the driving after drinking.

There are a lot of misconceptions about who drinks, how often they drink and how much the average American drinks. Half of all Americans have not had a drink in the last month. Ten percent of our population consumes half of all the alcohol. Those who binge drink can hide the existence of an alcohol use disorder for a long time by concentrating that drinking in occasional drinking binges.

Medical problems from Binge drinking.

Binging as well as daily high levels of alcohol consumption are associated with a large number of physical health problems. While one drink a day has been touted as good for everyone but fetuses and potentially pregnant women. Unfortunately the more you drink the more the risks of illness.

Alcohol consumption is associated with an increased risk of cancers, heart disease, problems of the digestive system, a variety of liver maladies, pancreatitis, and the list goes on and on.

Binge Drinking and Fetal Alcohol Spectrum Disorder.

Current thinking is that any amount of drinking on the part of a pregnant woman can affect the fetus. Binge drinking is particularly risky for women who are or may become pregnant. One challenging aspect of this problem is that woman frequently do not know they are pregnant until after some period of time has passed. Women who binge drink are at increased risk to drink heavily, engage in risky sexual behaviors, and then find out that they became pregnant during that period of heavy drinking.

Mental Health overlooks a lot of alcohol and drug-related problems.

Those who work in the substance use disorder field see a lot of connections between substance use and mental, emotional and behavioral disorders. Those who focus specifically on physical or mental health issues are less likely to notice those substance use disorders, especially something like binge drinking.

In drug treatment, those who only use occasionally and even then rarely get into trouble, are at high risk of developing problems eventually if when they use they binge. A small amount of alcohol consumption increases the risk of having problems with depression. Binge drinking even one time a year can result in DUI’s or other legal issues. Even occasional polysubstance abuse can result in life-altering consequences.

If you binge drink there is help available.

If when you drink you binge, or you find you are drinking and using more than intended consider getting help, talking with a professional, before your partying becomes a life-altering or ending event.

For more on these topics see:  Drug Use, Abuse and Addiction    Recovery   What is 

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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What is an Alcohol Use Disorder?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

How is Alcohol Use Disorder different from Alcoholism?

Used to be a time when doctors treated medical issues, Therapists treated mental illness, Social services treated poverty-related issues and – well – no one exactly wanted to do anything with drug addicts and alcoholics. Times are changing.

Turns out that no matter where you are and who you work with there is a good chance that people around you are being affected by chemicals, alcohol in particular, long before they reach the “alcoholic” or “Chemically Dependent” stage.

In Drug and Alcohol counseling we used to spend a lot of time debating what made you an alcoholic or addict. Turns out the lines are fuzzy. One estimate is that 90% of alcoholics have full-time jobs. Some people do not drink that often. Half the adult U. S. population did not drink in the last thirty days.

Even if you only drink once a year, say for New Years, if you have gotten into fights while drinking, gotten DUI’s several times, then your only drink once a year is not of much import. If when you drink, bad things happen, then you have an Alcohol Use Disorder. The DSM uses the expression “Problematic Pattern of Alcohol Use.”

What we discovered was that it was not so much what you drink or when you drink that matters when it comes to Alcohol Use Disorders, it is what happens when you drink that is significant.

The Symptoms of Alcohol Use Disorder.

The new DSM-5 has switched to the use of the term “Alcohol Use Disorder” to indicate someone whose use of alcohol is causing them problems whether they are “Alcoholic” or not and lists 11 criteria for Alcohol Use being a problem. Here is my plain language version of those Criteria.

  1. Once you start drinking you drink more than you planned on and/ or keep drinking longer than planned.
  2. You keep trying to cut down on your drinking. In other Alcoholism texts, this is also described as efforts to control your drinking or to quit drinking. See, people do not try to cut down, control or quit drinking unless it is a problem.
  3. Drinking eats up a lot of your time.
  4. You have cravings for alcohol when you are not drinking.
  5. Drinking gets in the way of work, school, home life or recreation. A real Alcoholic cuts out this other stuff so they can concentrate on their drinking.
  6. You know that when you drink bad stuff happens but you keep drinking anyway.
  7. You start cutting out other parts of your life to spend more time drinking.
  8. You try to get away with drinking even when you know it makes the situation dangerous.
  9. You keep drinking even though you now realize it is causing you problems.
  10. Your body starts building up tolerance. (See post “What is Tolerance” in the “What is” section.)
  11. You experience “withdrawal” when you stop drinking and the blood alcohol level starts dropping. (See post “What is Withdrawal” in the “What is” section.)

These problems with Alcohol can come in mild, moderate or severe. Mild Alcohol Use Disorder would have 2-3 of these symptoms, Moderate has 4-5 symptoms and severe has 6 or more.

If you or someone you know is exhibiting these symptoms think about treatment and or self-help groups. The sooner Alcohol Use Disorder gets treated the better the life prognosis. While sooner is better it is never too late to get treatment for an alcohol use disorder as long as you are alive.

Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs, AOD professionals and the terms and descriptions used in the DSM.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What are Alcohol-Related Disorders?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

Alcoholism is not the only problem alcohol causes.

Most of the time when people think of the problems that could be caused by alcohol they think of the “chronic” alcoholic. A lot of what people “know” about alcohol-related issues turns out to be untrue.

Most people who have the problem we used to call Alcoholism, and are now calling a moderate to severe alcohol use disorder, have full-time jobs. About 90% of those who are dependent on alcohol physically or mentally work full-time. They may have trouble keeping those jobs but they can go on getting and changing jobs for a long time.

Someone does not have to be an alcoholic or even have an Alcohol Use Disorder to experience an alcohol-related problem. If a surgeon shows up drunk to do your heart surgery, do you really care if this is the only time it happened? A pilot flying drunk even once is one time too many.

Because alcohol disinhibits and impairs coordination people do things when drunk they might not do when sober. They also fail to do things they should, like stop for an oncoming car. You will find a number of other posts at counselorssoapbox.com on the problems drugs, alcohol and mental illness cause. The “What is.” Series of posts includes a number of post on this topic and more will be publishing soon. If you want to see those other posts the best way is to subscribe or follow counselorssoapbox.com

Here is the short list of 5 problems that together make up the Alcohol-Related Disorders. This is based on the new DSM-5 but it parallels other classification systems and ways of thinking about Alcohol-Related problems.

Alcohol Use Disorder (F10.10 or 10.20.)

This used to get divided into Alcohol Abuse and Alcohol Dependence, then we started looking at the difference between physical dependence, psychological dependence, alcoholism and Chemical Dependency and the lines got blurry depending on who was describing the problem. Now we think if when you drink you have a problem, you have an alcohol use disorder, which can come in mild, moderate or severe. More on Alcohol Use Disorder in an upcoming post.

Alcohol Intoxication (F10.129, 10.229, or 10.929.)

This is not funny the way some entertainers portray it. When drunk, people can get distorted thinking. Being intoxicated increases the risk you will do something you would not do sober. Drunk people hurt themselves and others, both directly on purpose and in unintended ways. You only need to drive drunk once if you kill someone, and you have destroyed their life and yours. This, when you drink it is a problem, qualifies as an Alcohol Use Disorder.

It is also possible to drink enough to die if you run that blood alcohol level up high enough and fast enough.

Alcohol Withdrawal (F10.239 or F10.232.)

A well-kept secret is that you can die detoxing off alcohol, especially in combination with other drugs in your bloodstream. The experience of a hangover is so common that you will find lots of online hangover remedies. (Hint here, only not drinking and lots of time after drinking have been proven to treat hangovers.)

Alcohol withdrawal gets treated medically sometimes and in detox facilities a lot. Facilities that treat alcohol withdrawal are the busiest substance abuse treatment facilities there are.

Other Alcohol-Induced Disorders (lots of codes depending on what the alcohol induces.)

Sometimes things that look like a mental illness are caused by prolonged drinking. This can be lifetime prolonged or just a single run. Contrary to popular opinion it is not necessary to make people sober up and get thirty days or any other period of time sober before assessing or treating them for other problems. It just takes a lot more effort and skill on staff’s part.

Unspecified Alcohol-Related Disorder F10.99.)

This gets used when a clinician thinks that Alcohol may be the cause of or may have contributed to your problem but you do not have symptoms that match any of the other diagnoses close enough to get that other label. Yes, I know that these labels can be somewhat subjective. Despite the best efforts to create very precise categories for issues, there are some problems that just do not fit the existing categories. Still, Professionals need some sort of label for what they are treating and not every client fits these labels exactly.

Those are the five Alcohol-Related disorders. More on this and related topics coming up in the “What is” series of counselorssoapbox.com blog posts.

FYI. These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Acetaldehyde?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is Acetaldehyde?
Photo courtesy of Pixabay.

The more Acetaldehyde the sicker you get.

If you have ever had a really good time, drank a lot of alcohol to celebrate and then experienced a hangover afterward you can in large measure thank Acetaldehyde.

Acetaldehyde is the first breakdown product as your liver starts to go to work on that alcohol. You and your liver are not in agreement on the consumption of alcoholic beverages by the way. For the liver, not much is worse than alcohol. So no matter what noxious, poisonous or even used and expendable chemicals you liver detects it generally goes to work on the really bad stuff, meaning alcohol, first.

The first time your liver experiences alcohol it may be mystified by how this poisonous substance got into the bloodstream. But it will quickly gear up and produce ever-increasing amounts of alcohol dehydrogenase (ADH) the enzyme that breaks down the alcohol.

This first step in the processing and elimination is why disulfiram, trade name Antabuse, by interfering with that first step in the breakdown, makes people who take disulfiram become very sick when they drink. The theory was that this would be an adverse experience that stopped the person with the alcohol use disorder from drinking. In practice, those with an alcohol use disorder will avoid taking the med or they will endure the adverse effects so that they can still drink. Disulfiram has helped some people but it does not seem to be the magic cure we had hoped for.

Men’s stomachs produce some ADH, you ladies should know that your stomachs produce little or no ADH. The result of this gender difference is women get higher doses of alcohol entering the intestine than men do even if you drink the same amount.

Once the alcohol is broken down to produce acetaldehyde the liver kind of kicks back and takes its time working on that acetaldehyde. Turns out that the acetaldehyde is more poisonous to the body than the alcohol was, but it takes more time for your liver to gear up and get that stuff broken down.

So despite all those hangover remedies, you will need to wait while your liver prioritizes the processing of the alcohol before it gets going full steam on the Acetaldehyde.

Eventually, your body will produce other enzymes related to ADH to break down the acetaldehyde into acetic acid and then ultimately that will be processed into water and carbon dioxide. The liver has only one speed when it comes to using ADH to break down Alcohol. No matter how much alcohol you put in the bloodstream your liver just works at its one speed. This whole chemical manufacturing process going on inside your body just takes time.

Putting up with the hangover is just a small price to pay for having a liver that works so hard getting all those toxins out of your body.

Please treat that liver well because if it ever gets damaged and goes on strike your whole interior neighborhood will become polluted and eventually your body may become uninhabitable.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Does Alcohol make you happy or angry?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Bottles of alcohol.

Alcoholic Beverages.
Photo courtesy of Pixabay.com

Set and Setting change perceptions of drug use.

Set and setting, the impact of places and mood on drug user’s experiences plays a large role in the way alcohol and drugs affect the user’s mood and behavior.

Not everyone who takes the same dose of a drug has the same experience. One person who drinks becomes angry and another happy. The time and place of drug use influence the way in which a drug user or problematic alcohol drinker may be affected by their particular drug of choice.

We need to understand these influences to explain why two different people may describe their experience of using a drug in very different ways. The same person may also experience one drug differently at different times. Here are some ways set and setting may alter the drug user’s perceptions.

Set – Mindset matters.

What you expect a drug to do is likely to be the result you get. Well sort of. First the why and then the why not.

Two drinkers each consume the same amount of the very same alcoholic beverage. One becomes angry and combative and the other becomes happy and mellow. Why? Isn’t a drug a drug?

The effects alcohol and other drugs have on people vary with the mood they have when they consume that drug. If someone drinks because they are angry they are more likely to become increasingly angry. The alcohol’s disinhibiting effects allow them to take action, express that anger in ways they would not express it if they were sober.

A happy person, expecting to become happier while drinking, will find that is exactly what happens.  Again disinhibited they may act on that celebratory mood, dance on the table or kiss a stranger but believing that alcohol will make them happy they will become happier.

Sometimes, at least partially, a drug users expectations will override the actual effects of the drug. Mindset also has to do with the reasons for using a drug.

When you take a medication to control pain you are less likely to develop a problem than when you use a drug to change the way you feel emotionally. See physical pain may go away or you may become used to it. But using a drug or alcohol to change the way you feel increases the risk that you will use more and more until eventually that drug no longer makes you feel better but you need it just to feel normal.

Drinking or drugging to change the way you feel is one of the riskiest ways to use substances. Why? Because it works so well. Once you begin using drugs and alcohol to change the way you feel you risk becoming dependent on that drug to change the way you feel.

Setting – where you use a drug matters.

The effect of setting is often underestimated. This leads to strong disagreements about the nature of drug use and addiction.

A patient takes a drug in the hospital. Say they are given morphine for pain. Despite substantial doses over a number of days most people who receive pain medication in a hospital setting do not go on to become addicted.

If that same person were to purchase the very same quantity of this same drug in an alley, there is a high likely hood that addiction would result.

Some religious groups use wine as a part of their service. People rarely behave inappropriately as a result of that one drink at church. But let that same person have a glass of wine late at night in a bar and there is a chance, maybe a good one, that they will behave in a way that they do not normally act.

Drugs, legal and illegal, become a part of the ritual during which they are used. If your ritual is to get high, use all the drugs you can and act violent, that is what you will do. If you believe a small quantity of wine will increase your feeling of religious connection that too will occur.

Both set and setting are tied to placebo and nocebo effects. The way in which you perceive a drug’s use and its effects influence the experience you have.

People who are drinking non-alcoholic drinks but believe they have been given drinks containing alcohol begin to act as though they were becoming disinhibited. They may slur their speech, stagger and become loud and boisterous. They may get louder, joke more and do things that in other settings they would be embarrassed to do. The belief that they were drinking alcohol has altered their behavior.

That does not mean that the effects of drugs or alcohol are purely mental. Give those people who had been drinking a non-alcoholic beverage, but thought it contained alcohol, a reaction-time test and they will suddenly sober up and do just fine.

The converse is that people who drink a lot and develop a tolerance may feel they are not drunk at very high blood alcohol concentrations and with tremendous loss of coordination. While they may think they are fine, those who drank a lot will fail a sobriety test in the lab or in the field.

In any discussion of drug use and abuse, we need to keep in mind the psychological as well as the physical effects of those drugs. Where people use, the setting, and what they are thinking when they use, the mindset, may affect their perceptions of the drug and the risk of developing an addiction or other problems with usage.

Set and setting may alter the way the experience feels but that does not mean that the mind is strong enough to undo the effects of substances. You can think your way into addiction but you can’t think yourself sober. Being clean and sober takes action also.

For more on this see:

Why not everyone ends up addicted to pain medication – set and setting

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is your problem drugs or people?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

Are people in your life making too much out of your recreational drug use?

A number of people recently have been describing how they do not feel they have a problem with drugs. They are not addicted. They have or have had a job. There have been no awful withdrawal symptoms. These people report that they are not addicted and that they just use drugs for fun. These conversations have been both in person and via mail or chat.

The common complaint is that others in this person’s life are being unreasonable and are upset because this person wants to have fun. The common thread in these conversations is that these others are off base because they object to the person I am talking with have fun, enjoying themselves and doing drugs recreationally.

This blog post is of course written in generalities. I do not know each reader’s situation. Your situation may be very different from the ones I will describe. Let’s take a look at some of these interpersonal conflicts that occur around drug use and how both the user and others in their life are perceiving this recreational drug use. Below are some of the people who have objected to someone’s drug use.

The topic is drugs but as far as I am concerned alcohol should get lumped in as a drug. Alcohol alters consciousness and it impairs functioning at times. Our societal attitude to alcohol may be less rigid than the attitude towards other drugs but those attitudes are changing and penalties for doing things while intoxicated continue to increase.

Your Spouse or romantic partner objects to your drug use.

Often the first person to notice a problem with your drug use will be a close romantic partner.  So you need to ask yourself did this person have a problem with your behavior before you two moved in together or has their opinion changed and why?

If they said nothing before you became a couple but are now asking you to cut out or stop your drug use what has changed? If situations have changed, you have kids, need to make a house payment and so on that may be the reason they are talking differently now. They may just have thought that once you were in a committed relationship you would act more grown up.

Some people are ready to settle down for the kids and the future before others. Consider which is more important, your ability to do all the drugs you want because you do not see them as being a problem or making your partner happy and being a good parent?

It is also possible that the people in your house can see the signs of trouble in you before you can see them. If more than one person has complained about your partying, you need to look at this carefully.

Do your parents criticize your drug use?

One big reason that parents tell their kids that drugs or alcohol is a problem? Because they have done those things and gotten themselves in trouble. That or they grew up in an environment where people were acting irresponsibly as a result of substances.  It is rarely because your parents are trying to hog all the fun.

As people grow up there is a tendency to push parents away, separate yourself and become who you are as an individual. Some people pick a new career, change their religious preference or join another political party.

Other people dabble with drugs and alcohol. If your parents are noticing your drug use, then it is likely that you are already having problems. If when you use bad things have happened, you need to take another look at that use.

Are coworkers commenting on your drug use?

If your coworkers are expressing concern about your substance use then it is likely that your use has interfered with your job performance.

Frequently I hear that the person’s drug use is not causing any problems. They might say something like “The only one I am hurting is me.”

If you are missing work, coming in late on Mondays or calling in sick a lot, the truth is your drug use is making your coworker’s life harder when they have to cover for you.

Your boss knows you are partying.

Bosses often notice an employee has a problem early on. Many people in drug treatment have to deal with the added issue of having been fired from several jobs. Bosses may ask you if there is something going on, problems at home? If your performance has gone downhill, is substandard, or you are late and absent a lot your partying is getting in the way of having a job.

Police contact suggests something is wrong.

If you are having issues with the police then ask yourself, would you have those same issues if you were not doing drugs or drinking? Yes, you can do what you want with your life, but if it is impairing your ability to drive, getting you into fights or attracting the notice of the police then there is something wrong.

Did the Judge say you needed treatment?

If the judge says you need a drug treatment program then you need one. Why? Not necessarily because your drug use is that bad. You may not be an addict. Yet. But the fact that you are in front of the judge and that this person knows about your drinking and drugging tells us that your use has become a problem. Maybe it is only a legal problem, but it is still a problem.

Are you on parole or probation?

If you are on Parole or Probation take another look at you. When you are trying to get your life straight any drug use, alcohol included, can impair your judgment and send you back.

You say “I should be able to do what I want?” Maybe, someday. But really is your right to drink or drug more important than staying out of jail?

Consider that one study concluded the vast majority of people in prison were drunk or high in the 24 hours before they committed the crime that put them away. Alcohol and drugs are not your friends. Not the kind of friends that want you to stay out anyway.

The person who was injured in the accident you had knows it’s a problem.

If you hurt someone either intentionally or accidentally while under the influence, that was like not cool. Everyone can have an accident, but if you were high when it happened we think this is not so much an accident as a case of your ability to function was impaired and your hurt someone else as a result.

Clearly, you were not just hurting yourself.

Did you know there are countries in Europe where the legal limit for a DUI is point-zero-two (.02)? That’s right- one drink and you can’t drive over there.

Will all these reasons keep people from drinking and using?

Not likely. Many people will still say that they should be able to do what they want because they are only hurting themselves. Every year a whole new crop of humans will experiment with drugs and alcohol. But if you find that any of the people on this list are complaining about your drinking and drugging then maybe you need to take a hard look at how much of your life you are giving up to do those things.

For more on this topic see:

Drug Use, Abuse, and Addiction

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is addiction real? Does it have a cause?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Cigarette smoking is addictive.
Photo courtesy of Pixabay.com

Comments on the deltaFosB post and the causes of addiction.

Some comments came in on the DeltaFosB post I think need discussing.

Normally I do not answer or re-comment on comments on posts. If you like a post cool. I will thank the reader for the like and that is that. If you disagree, then you are entitled to your opinion. I reserve the right to be wrong and so should all of you. Further arguing with people about their comments is not likely to change their mind so I try to use as much of my time as productively as possible and move on to new things.

This time feels different. On the chance that there are others who drew the same conclusions from the post that one reader “Tom” drew, I thought it would be worth further discussion.  I posted the headline to the original post with a link to the post on google+ and this comment from Tom was received over there.

Gambling Addiction

Gambling Addiction
Photo courtesy of Pixabay.com

First Toms comment on the post and then my explanations of why I think Tom is off base here.

“…there really does seem to be a physical change in the brain that accounts for why some people become addicted to chemicals, drugs in particular, and behaviors…”


I think that’s confusing hypothesis with findings. No one is seriously reporting that they have found the cause of addiction. For one thing, there is seriously insufficient research to support a global generalization of that sort.

People have been trying to find this mythical organic cause of addiction, and failing, for decades. What you report does go beyond the speculative, although it surely is not pure speculation. The research we have only supports informed speculation, to my mind.

The ambiguity in this phrase – “…that accounts for why some people become addicted…” is dangerous. I think what you’re really trying to say is something like “…that accounts for why some addicts become addicts…” As written, you appear to be talking about all addicts, and that is far beyond what we can address with the research you review, I think.

The fact remains that most people who drink alcohol are not addicts. Most people who use heroin are not addicts (little-known fact). Most people given opiates for pain can’t wait to get off of them, because of their unpleasant cognitive side effects. Those who become addicted are a small minority, and they seem all to have something in common: a persistent uncomfortable mental state which psychoactive substances/behaviors moderates. Happy people do not become addicts.

This has been known for a long, long time. But people just don’t want to let go of the “demon dope” hypothesis. The reality is more complex.

My response to Tom’s comments:

Alcohol addiction

Alcohol addiction
Photo courtesy of Pixabay.com

It appears that you are reaching conclusions from what I wrote that are not what I was saying. I suspect we have some fundamental philosophical differences here. We seem to be using words differently also. Look up the word addiction in a number of dictionaries and you will get a variety of definitions. I am concerned that people are using the term Addict as a pejorative term. The homeless and the mentally ill get that treatment also. Asserting that “addicts” are in some fundamental way different from non-addicted people is reassuring to some. If you have a job and a home you can tell yourself that you are not an “addict.” This obscures the very real issue of a growing problem of substance use and behavior use disorders in our society.

Let me try to clarify what I was saying about the criticisms you raised of the blog post.

  1. The term “some people” was written because I believe that those who develop an addiction, chemical or behavioral are people. To argue that “addicts” are somehow different from other people is to blame the person with the disorder for their condition. This is often done with other social issues like homelessness, poverty, and crime.
  2. The research reported on was concerning epigenetics and gene expression. This suggests that something happens which turns people who are not addicted to a behavior or a substance into those who have a dependency or reliance on this as a way of functioning. Behavioral “addictions” remain controversial with only gambling having been added to the most recent DSM. This research point to changes in the brain functioning when people reach a point of losing control over their use of that behavior or substance.
  3. If we call “it” addiction we get one paradigm. If we refer to something as chemical dependency or having a substance use disorder we get another. As a society, we are moving towards a “doublethink” approach to this issue. People who take prescribed medications do develop tolerance and withdrawal. There has been some pressure to alter the description of chemical dependency (the new term for what used to be called addiction) by adding craving as a characteristic of addiction. This might lead to the conclusion that someone can be “addicted” to a medication and not be an addict. This simply changes the terms to define away the problem of what is causing this condition.
  4. Referring to the premise that behaviors and drugs can at some point, for some unknown reason take someone from experimentation or use to being addicted as a “demon dope” hypothesis is a stretch.

If we accept that addiction could be a disease then the disease model fits. Compare this to the “demon Bacteria” theory of tuberculosis. One way of determining if something is a disease is to ask three questions.

Is there a specific agent that may be causing this condition?

Is there a host that gets the disease?

Is there a way in which this agent gets into the host?

Does this “demon bacteria” cause tuberculosis?

There are people who are around some specific other but do not get the disease. Does this mean that the bacteria is not the cause and that people who get T.B want to have it?    “Bad air,” wearing dirty clothing and failure to wash your feet, along with a raft of other behaviors, have been postulated as causing the thing that we now attribute to the disease tuberculosis.  You can be around someone with an infection, and you may or may not get the disease. Your immune system, the length, and severity of exposure the room size and other factors can influence whether you get the disease.

Do addictions fit this model? Yes, mostly. There are agents, pornography or a drug (alcohol and prescribed medications could be included here.) Yes, it is an individual host that gets the disease, though with what we are calling addictions, the family and society are also affected. Lastly, there has to be an exposure to the agent. Unless you view pornography, take drugs or drink, you will not develop an addiction to these behaviors or substances.

  1. Reporting “a cause” is not the same as reporting a one and only one cause. We are reasonably sure that faulty brakes can result in automobile accidents. Faulty brakes are not the only reason for auto accidents. It seems likely that further research will find other things occurring in the brain before, during and after exposure to the behaviors or drugs which cause chemical dependency. My statement is further qualified by the statement “seems to be.” This hypotheses or theory needs more research and testing. What has emerged to my satisfaction is that there is some sort of actual brain change occurring in “Some” of these people we currently describe as having a substance use disorder, addiction or as being “addicts.”

I am increasingly unconformable using the word “addict.” We do not describe people with other disorders as their disorder. We do not, or should not, refer to someone who has been diagnosed with cancer as “the Cancer.”

  1. Absolutely it is likely that this one pathway, the repeated exposure to a behavior or substance, is not the only possible mechanism or reason. Smoking is not the only cause of lung cancer but the connection seems far beyond any chance correlation. Early research on Alcoholism reported that many “problem drinkers” drank to unconsciousness or blackout the first time they drank. Additional research has pointed to a genetic risk factor as well as exposure to alcohol playing a role. Research on genetic causes of alcoholism has been inconsistent. One study reported having a bio parent who drank alcoholically increased the risk that a person would become an alcoholic by 400% even if they never met that bio parent. Others studies have pointed to the increased risk of the environment. None of this negates the probability that repeated exposure to a behavior or chemical could change the “default setting” in the brain and result in the use of substances being an automatic behavior.
  2. Your statement that “Happy people do not become addicts.” is on its face false for several reasons.
  3. No one is or should be happy all the time. People who might be described as “happy people” all experience episodes of other emotions. There are no such people who are always happy.

Many people drink or use drugs to celebrate, at some point, sometimes the very first time, they go to extremes and develops a substance use disorder. Someone who drinks only one time a year, say for New Years, but over the last three years received two DUI’s and was arrested once for a bar fight clearly has an alcohol use disorder.

  1. Alcoholics or addicts do not look differently than the non-addicted person. About 70% of drug addicts, those who report to treatment with a substance use disorder, have full-time jobs. About 95% of alcoholics work full-time but still find themselves unable to control their drinking when they try.
  2. Most teens who begin to use substances report the reasons they first tried substances was because it sounded like “fun.” Later in the process of developing a substance use disorder, they will report that they do it “socially” and eventually that it has stopped being “fun” and now they continue with the drug or behavior because it is difficult and painful to stop.
    While there are many factors involved there is increasing evidence that there are not two kinds of people “normal happy” ones and “addicts” but that for reasons we do not yet fully understand at some point a behavior or a substance can alter brain functioning and result in an addiction. Describing people who take prescribed medications and develop tolerance, withdrawals and a physical addiction as not being addicts is, in my opinion, a distinction without a genuine difference.

Thanks for the comment anyway, it inspired this further explanation.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.