What’s with All the Drinking and Drugging?
Despair and Destruction Behind the Curtain
Addiction often hides behind moments of social drinking, leaving many to battle their demons in silence.
Introduction
Fentanyl is not the problem. Well, yes, 80,000 lives lost to fentanyl in 2023 alone is a problem - but it is only the tip of the iceberg for what is going on in America alone. Substance use is our dirty little secret. Despair and destruction behind the curtain are being masked by toasts and good times on the daily stage. Substance abuse is ravaging lives, families, and relationships all around us.
I’m not saying all substance use is bad. Doing so wouldn’t be honorable considering how much I enjoy my happy hour wine. I am saying we have a problem. A really big problem. A mostly hidden problem that is hurting lots of people.
But here is what everyone misses: Having a basic understanding of substance abuse and addiction should be considered fundamental life knowledge, like money management and how to eat right. If people knew as much about substance abuse as cholesterol, we would be in much better shape. This knowledge is not something you are born with. You have to figure it out as you go - oftentimes through excruciating experience.
Why Understanding Addiction Matters
Keep reading for important insights that may help you help yourself and others.
But wait - substance abuse is not cool for polite conversation. Most everyone is in their own private dance and wants to keep it that way. We don’t talk about addiction because it makes people uncomfortable. It can come off as an invasion of privacy to ask questions.
Too bad. Uncomfortable or not, let’s nail down some basics so you can be part of making things better - or at least avoid making things worse.
Numbers Please - What Are We Talking About? The Scale of the Problem
You may think addiction and substance is in the mix with homelessness as an issue. You would be wrong. It affects magnitudes more people. Substance abuse is a global problem but let’s use US data since it is readily available and illustrative. A whopping 16.5% of Americans meet the criteria for Substance Use Disorder, according to the Department of Health and Human Services. That means if you know five people, one of you is struggling. Let that sink in.
In 2020, approximately 40.3 million Americans aged 12 and older had a substance use disorder. These numbers do not include other forms of addiction like gambling or pornography. Unless living under the proverbial rock, while reading this, you are thinking of someone you know who shows signs of being in the struggle one way or another..
An estimated 95,000 (approximately 68,000 men and 27,000 women) die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. Over 72,000 deaths in 2017 were attributed to alcohol overdose.
Another addiction, tobacco, remains the leading cause of preventable death in the U.S., responsible for over 480,000 deaths annually.
Why Is This Happening?
A combination of factors conspire to fuel substance abuse and addictions. These forces impact individual people differently, so we need to be careful about a one-size-fits-all mentality. Having said that, let's dig a bit here looking for root cause answers.
Human condition is the fundamental starting point. We are programmed to avoid pain and seek pleasure. This is not a bad thing, and we didn’t do anything wrong to cause this. It is how God made us. Life inside reasonable boundaries of pleasure-seeking and pain avoidance can be just great (with one exception we will talk about later).
The gift of free will empowers us. Making (and learning from hopefully) wrong choices is part of our journey.
Danger enters when pleasure-seeking or pain avoidance (more common) runs amok. Health is compromised, marriages fall apart, jobs are lost, financial issues emerge …the list goes on.
This human condition drama takes place against a social and cultural backdrop that strongly encourages consumption. Substance consumption, especially alcohol, is woven into the fabric of how we interact, socialize, and relax. Pretty much every social or entertainment event includes highly visible consumption. The question is usually “open bar” or “cash bar” - not “will there be a bar?”
Drinking is normalized. Expected. The person not drinking is the odd man out - sometimes even being called out or poked fun at for not properly joining the party.
The Role of Commercialization
Social and cultural forces are amplified relentlessly by commercialization. This is hard for me to write because I’m a big-time free markets guy. My observation is that free markets are an engine for opportunity, innovation, and progress. They also empower commercially driven exploitation of the human condition. If advertising didn’t influence behavior, we would not have advertising. The alcohol industry spends over $1,000,000,000 per year on advertising in the U.S alone. Try to imagine how much destructive behavior that influences.
Young people (okay, all of us) constantly see sports and entertainment heroes pitching drinking - making it look cool and the way to enjoy friends and have fun. How could that be bad?
Yea, But Why Would Anyone Overdo It?
We are not hurting ourselves or each other on purpose. That would be stupid. We are not stupid. So what gives?
Glad you asked. Let’s start by acknowledging that many people consume moderately without getting into trouble. For them, the benefits of modest consumption are real, and the cost is low. The glass of wine at happy hour or dinner stops there. Drinking beer while watching football ends with the game.
For millions of others, however, mind-altering substances are used to escape emotional pain, anger, anxiety, and insecurity. It works. At first. Then they need to feed the rat for more temporary relief. Like real rats, these psychological rats do not go away when fed. They come back for more - and tend to grow, demanding to be fed more and more.
As the rat gets harder to satisfy it is not uncommon for higher power substances to be used. Most people abusing hard drugs such as heroin, fentanyl and meth did not start there. They moved up the potency curve over time - doing what it took to feed the insatiable rat.
Consumption leads to more consumption, which leads to overconsumption which can lead to chemical dependency and the complications that result. All while the rat(s) live on.
A Harsh Example of Self-Medication’s Slippery Slope: Anna’s Story
Self-medicating to avoid problems or run from pain probably tops the list of reasons people go over the slippery slope of substance abuse.
Anna, in her mid-30s, started using street opiates to cope with overwhelming anxiety from childhood trauma and a strained marriage. What began as an occasional escape quickly became a daily need. Her husband, unable to reach her through the fog of addiction, left. Her job soon followed after too many missed deadlines and unexplained absences.
Alone and spiraling, Anna hit rock bottom in a motel room, broke and battling withdrawal. Months in rehab helped her confront her pain and break free from the cycle. She lost her marriage and career along the way, but her sobriety became the foundation for rebuilding her life - one hard-won day at a time.
Substances as a coping tool for life’s pressures is another common gateway to despair. All too often - and once again - consumption leads to more consumption, which leads to overconsumption and all manner of wreckage. Since life’s stresses never end, neither does the substance use/abuse.
Melissa’s Story: Drowning Stress in Substances
Melissa, a single mother juggling two jobs, started taking prescription painkillers after a back injury. The pills not only eased her physical pain but also numbed the constant stress of bills and parenting alone. As pressures mounted, so did her dependence. What began as temporary relief spiraled into addiction, costing her custody of her children and leaving her in a cycle of rehab and relapse.
For the folks above, resolving the underlying reason they fell into substance abuse can allow restoration of healthy living - possibly even including a glass of wine at dinner without going back over the slippery slope.
Now the Exception
Some people have the disease of addiction, which involves brain chemistry malfunction. For these people, mind-altering substances quickly result in logarithmic multiplication of brain receptor cells, overpowering the judgment center and survival instinct. This phenomena essentially renders the individual powerless over the brain’s demand for more substance.
The disease of addiction is incurable and fatal - but treatable. Treatment involves 100% abstinence from all mind-altering substances and lifestyle programming necessary to maintain abstinence.
The American Medical Association (AMA) codified the disease of addiction in 1987. Since the main point of this piece is to help you help others, the diagnostic criteria for the disease of addiction are summarized below:
Using more of a substance than intended or using it for longer than you’re meant.
Trying to cut down or stop using the substance but being unable to.
Experiencing intense cravings or urges to use the substance.
Needing more of the substance to get the desired effect - also called tolerance.
Developing withdrawal symptoms when not using the substance.
Spending more time getting and using drugs and recovering from substance use.
Neglecting responsibilities at home, work, or school because of substance use.
Continuing to ‘use’, even when it causes relationship problems.
Giving up important or desirable activities due to substance use.
Using substances in risky settings that put you in danger.
Continuing to use despite problems to your physical and mental health.
Some people are short. Some are tall. Some have the disease of addiction, which really sucks. No, it's not fair. Life is just that way sometimes.
Final Thoughts and Your Role
My hope is that after reading this, you are better equipped to be a positive voice in the confusion of substance abuse and addiction. Ideally, using your influence to guide self-medicators towards resolving underlying psychological/emotional issues. Also to support people with the disease of addiction in the hugely difficult process of gaining and maintaining 100% abstinence.
Using your influence is tricky and fraught with limitations and pitfalls. Keep coming back to learn and share helpful insights about what does and does not work.
Future commentary in Lessons from Addiction will focus on pathways to healthy living and success in sobriety.
Until next time,
Craig
Craig A. Williamson
Lessons from Addiction
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