UNDERSTANDING THE ABUSE CONTINUUM
This post is part of a series on creativity and addiction.
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In recent years, the addictions field and the science behind it have grown and changed enormously. Some controversies have been settled and new ones have developed to take their place.
Emerging information on addiction and on brain functioning promise new understanding and treatment options. By employing harm reduction and motivational enhancement strategies, clinicians have gotten better at helping clients “where they are” rather than expecting them to have already changed.
If you are blocked trying to figure out the end to your novel, that is exactly where you are; you can’t be expected to know how to end it until, miraculously or through some practice you have cultivated, the ending does come to you. Similarly, if you are stuck abusing alcohol, you can’t be expected to understand how recovery is going to work; rather, you have to be helped—and maybe coaxed—into recovery, so that in recovery you can acquire the actual experience of recovery.
This is all by way of saying that people are exactly where they are—including exactly where they are along the abuse continuum—and they need to met there by a clinician, a sponsor, a friend, or whomever. This also means that you need the self-awareness and patience to meet yourself where you are. If you are already chemically dependent, it makes no sense to wish that you were only a casual user: you or you and your clinician both have to deal with your precise reality.
For those of us who hear countless stories about peoples’ relationships with mind-altering substances or with addictive behaviors like gambling or compulsive sex, predictable levels of use emerge. It is common for people to enter and exit different levels depending on life circumstances, sometimes fluidly and rapidly moving up and down the abuse continuum. However, once a person has graduated to the dependence level of use, they will almost invariably return to that level if the continue actively using.
The following are the levels of use found along the abuse continuum:
+ Abstinence. You do not use a given addictive substance at all or engage in a given addictive behavior at all. (This stage obviously does not apply in the same sense for something like a food addiction, where “abstinence” would amount to starvation. In that case, “abstinence” refers to maintaining a healthy diet.)
+ Experimentation. At the experimentation level, you have limited exposure to a given addictive substance or behavior. You may experiment with a substance out of curiosity or peer influence but you do not continue to use. Experimentation rarely results in serious negative consequences; and if you do experience some negative consequences, you discontinue use accordingly.
+ Social use. Your use of a particular substance or your engagement in a particular behavior is infrequent, does not establish an ongoing pattern, does not have substantial impact on your life, and is primarily recreational in nature. Social users take the initiative to use and, unlike experimenters, anticipate a known desired effect. It’s like the difference between experimenting with watercolors and not finding it to your liking versus returning to watercolors every so often because you like the “risky experience” of having to deal with colors that drip.
+ Habitual use. With habitual use, you have established a regular pattern of use and you are now at least to some extent controlled by the substance. Some people stay at this level without negative consequences and without further progression. There is both a clear positive sense and a clear negative sense to having put a habit in place: getting in the habit of working on your novel every day is a good thing, if you intend to write, but getting into the concurrent habit of relaxing after you write with a few beers is less clearly a pure positive, especially depending on your personal risk factors for moving from this innocent-enough habit to abuse or dependence.
+ At this level, you experience clear negative consequences of your use but continue to use anyway. The negative consequences can be obviously use-related (such as a DUI arrest) and difficult (but not impossible) to deny, or subtler (such as feeling chronically unmotivated in response to a marijuana habit). In the latter case, if your goal is to continue using, you have a golden opportunity to misattribute that consequence to something other than the use. For example, you can blame your lack of motivation on your lousy job. This is how denial typically works at the abuse level: you admit to certain consequences but are reluctant to connect the dots back to the cause, your now-abusive use of a substance or your now-abusive engagement in a behavior.
+ Becoming dependent means that you’ve experienced a compulsive “loss of control” related to your use in addition to all the negative consequences of using. Typically, the addictive substance or behavior has become the organizing principle in your life, pushing other people or activities, including your creative efforts, to the sidelines.
The more you pay attention to the distinctions that these six stops on the abuse continuum represent, the better you will be able to prevent a slide down the continuum or, if you have already slid into abuse and dependence, the better you will be able to climb back up. To begin with, think about these six words and phrases: abstinence, experimentation, social use, habitual use, abuse and dependence. Each is rich, interesting and resonant and should pique your creative imagination.
Is abstinence the same sort of thing as it applies to not using heroin, not having sex, or not going to the mall to shop? When is daily Internet surfing more like a not-too-worrisome habit, more like abuse, and more like dependence? Spend a little time thinking through these distinctions. They will help you understand your situation and alert you to the possibility that it is time to engage in a real recovery program.