CHAPTER 2

The Stages of Substance Abuse and Chemical Dependency

In the past, dependence on alcohol or drugs was seen as a moral problem. The alcoholic or addict was looked upon as a weak person. Today, however, the American Psychiatric Association views dependency as a disease that responds to proper treatment. This is called the "disease concept" of chemical dependency. This chapter will explain that concept.

No one starts out as an addict. Every individual who uses drugs or alcohol begins with experimental use. As a result of this experimental use, some individuals decide to continue to use alcohol or drugs. These individuals move into the second stage, which is often labeled "social use" in our society. Many people are able to remain "social drinkers" for the rest of their lives. Others are not so lucky. Clinicians theorize that some people have a genetic predisposition to become addicted to alcohol or drugs. Such people cannot safely use drugs or alcohol, even socially. What begins as social use quickly turns into "seeking the mood swing." At this point, the individual begins to use alcohol or drugs in place of normal coping skills, to deal with distressing issues in his/her life. This leads to more frequent abuse of alcohol or drugs, which can put the individual on a path towards addiction or alcoholism.

For these unfortunate individuals, continued use of alcohol or drugs will lead to chemical dependency. Chemical dependency is the clinical term for alcoholism or drug addiction. The disease model of chemical dependency is currently followed by most clinicians. Under this model, chemical dependency is a disease. It is primary, chronic, and progressive. "Primary" means that the dependency is not a symptom of some other underlying disorder, but rather is a disease itself. In this model, dependency is not caused by stress or other problems; in fact, chemical dependency is often the cause of distressing situations in the user's life. "Chronic" means that once someone is chemically dependent, he/she will remain dependent for the rest of his/her life. It is a permanent disease. An individual can stop drinking or using and put the disease in remission; this is called "recovery." Someone who is chemically dependent is never cured or completely "recovered," because if that individual ever goes back to drinking or using, he/she will fall right back into the addiction. "Progressive" means that the disease moves in stages. Chemical dependency is often seen as a four-stage process. These stages are listed below. If an individual does not stop using or drinking, the chemical dependency can lead to legal consequences such as jail or prison, mental or physical disorders, financial problems, social consequences, or death. An upcoming chapter examines these issues and addresses ways to help someone who has chemical dependency.

The progressive stages of chemical dependency are as follows:

Stage 1: Learning/Experimental Use

• The user learns he/she can produce a good feeling by using substances.
• The individual uses at parties, under peer pressure, or on weekends.
• He/she finds it easy to get drunk or high, due to a lack of tolerance for the substance.
• The user learns that substances provide euphoria every time; he/she trusts the effects.
• The user controls the use; i.e., regulates quantity to control the mood swing; regulates frequency of use.
• No adverse behavioral effects may be detected; the substance has not yet interfered with lifestyle.
• The user feels good (euphoria), with few consequences.

Stage 2: Social Use or Seeking the Mood Swing

• The user, having learned that substances produce good feelings, starts to actively seek those feelings by planned use of drugs/alcohol.
• Planned use involves buying substances.
• Tolerance begins to be developed (i.e., the user needs more of the drug to get the same effect as before).
• Use may still be controlled and the effect is anticipated.
• Individual uses substance at appropriate times and places; e.g., not at work, not early in the morning, etc.
• Individual develops self-imposed rules about use; e.g., "I won't drink before 5:00 p.m.," "I won't drink around my family," etc.
• Individual may suffer some slight problems, such as hangovers.

Stage 3: Substance Abuse becomes Chemical Dependency

• The individual becomes preoccupied with the mood swing.
• The individual experiences a cost increase due to high tolerance.
• There is an increase in frequency of substance use.
• Solitary use occurs.
• Loss of control occurs; i.e., getting drunk when not expecting to, using more than planned, breaking self-imposed rules, inability to predict outcome of use.
• Lifestyle begins to change. Individual rearranges life so he/she can continue to use.
• Blackouts occur more frequently. ("Blackouts" are memory lapses that occur when the user is awake and appears to be engaged in normal activity; later, however, the person is unable to remember what has been said or done.)
• The individual uses to cope with feelings, such as anger, guilt, fear, or anxiety.
• The individual may be sneaky about getting, using, and hiding substance.
• The individual may be irritable, or may become angry easily.
• Rationalization and projection occur more frequently. ("Rationalization" is a person's attempt to explain his/her behavior in order to avoid responsibility. "Projection" is attributing one's problems to another person.)
• The individual violates his/her value system, which contributes to emotional distress.
• The individual experiences many consequences, such as deterioration of relationships, problems at work, financial difficulties, etc.
• Denial grows. ("Denial" is a person's way of coping with a painful situation by refusing to accept it or believe it. By denying the existence of a problem, a person doesn't have to deal with it or assume any responsibility for it.)
• The individual gives up important activities.
• Self-esteem decreases.
• The individual's physical appearance deteriorates.

Stage 4: Chronic Chemical Dependency - Substances Used to Feel Normal

• Individual uses substance to feel normal (physical dependency) and avoid pain (physical or emotional), rather than for achieving euphoria.
• Blackouts are longer and more frequent.
• The desire to use the substance becomes most important.
• The individual experiences complete loss of control; e.g., arrests, theft, prostitution, etc.
• The individual experiences physical problems.
• The individual experiences paranoid thinking and fear of insanity.
• The individual feels very alone; isolated.
• The individual feels a loss of desire to live; may have suicidal thoughts, attempts.

The THIQ Phenomenon

Before Alcoholics Anonymous (AA) members were aware of the phenomenon of "THIQ" (tetrahydroisoquinolone), they defined alcoholism as an obsession of the mind and an allergy of the body. As far back as 1935, AA members were aware that their bodies reacted differently when they drank alcohol, as compared to the social drinker.

Considerable research has been dedicated to the field of chemical dependency since 1935. We now know that out of all the possible factors that can lead to alcoholism, genetics is the most significant factor. In other words, a person is four times more likely to become dependent on alcohol or drugs when there is a history of alcohol or drug (illegal or prescription) dependency in the family tree. This is called a "genetic predisposition." Having a predisposition for becoming dependent on alcohol or other sedative type drugs means that the individual may have a different bio-chemical makeup than the person who has no family history of alcoholism. This is explained by the phenomenon of THIQ. Some researchers believe that there is a certain gene for alcoholism, which may direct the production of THIQ.

Medical researchers have discovered that this chemical, tetrahydroisoquinolone, or THIQ, is present in the brains of alcoholics and persons who are dependent on depressants, sedative type drugs. Alcoholics have shown levels of this THIQ in their urine and, during autopsies, THIQ has been found in the brains of people who were alcoholics. THIQ is manufactured during the detoxification process of alcohol-a process that is different for alcoholics than for non-alcoholics.

The following explains the detoxification (breakdown) process of alcohol in a person who is not an alcoholic:

1. Alcohol is drunk.
2. The alcohol goes to the liver and the liver changes it into a chemical called acetaldehyde.
3. Acetaldehyde is a poisonous chemical that is immediately changed to acetic acid (vinegar) in a non-alcoholic.
4. The vinegar is changed to water and carbon dioxide and is thereby eliminated.

The alcoholic's alcohol detoxification process is slightly different. It is as follows:

1. Alcohol is drunk.
2. The alcohol goes to the liver and the liver changes it into a chemical called acetaldehyde.
3. Acetaldehyde combines with certain neurotransmitters (chemicals of the brain) to form the complex molecule tetrahydroisoquinolone, or THIQ.
4. This THIQ accumulates in the brain and contributes to cravings for alcohol.

THIQ accumulates in the brain and never goes away. By acting on the pleasure center of the brain, it can produce the same kind of euphoric feelings as cocaine or narcotics such as heroin or morphine. THIQ is also very addictive, which explains why the alcoholic continues to drink even when the alcohol is causing him/her problems. It is very important that a person who is dependent upon alcohol or depressant drugs abstain from all mood/mind-altering drugs, so that the THIQ may live dormant in the brain and not continue to produce cravings.