Substance Use Disorders—Impaired Control

We’re talking about Substance Use Disorders again today. If you missed my first post on this topic, you can check it out here. Today, we’re going to get more specific about symptoms and what they look like in people’s everyday life.

So, impaired control. Seems pretty easy to conceptualize, but we’re going to use some real-world examples. One of the best accounts I’ve heard about this particular set of symptoms comes from the book Empowering Your Sober Self: The Life-Ring Approach to Addiction and Recovery. The author, Martin Nicolaus, discusses his attempts to cut down on his drinking. He looks at himself in the mirror each morning and asks:

"What happened to the dreams you had for your life? Do you even remember your dreams, asshole? If this keeps up, there’s going to be a funeral soon, yours, and there won’t be a lot of people crying. You need to stop drinking. It’s a monkey on your back. A ball and chain. Get free of it!”

Nicolaus, Martin (2013-11-21). Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

He then goes on to say:

At the end of the day I would head home filled with good intentions. But there was something wrong with my car. I’d be driving past the Jay-Vee Liquors or the Safeway and some remote power would take control and turn the wheel into the parking lot. Wires from a spaceship seized my limbs and paraded me like a puppet into the market. I’d check out with some bread, eggs, milk or other groceries and – oh yes, almost forgot! – a supply of alcohol.

Nicolaus, Martin (2013-11-21). Empowering Your Sober Self: The LifeRing Approach to Addiction Recovery

Nicolaus goes on to describe how this pattern repeated itself day after day, week after week, month after month for years. This is a great example of one of the ways impaired control is defined.

There is a persistent desire or unsuccessful efforts to cut down or control substance use.

When I was in my early twenties in the Navy, I reached a point where I was drinking so much that it was starting to cause problems in my life. I remember thinking, “I shouldn’t drink like this anymore.” And then I didn’t drink like that anymore. The story is in the non-story. No drama. Bad stuff happened. Behavior changed*. It’s that easy for some people, but for others it can feel impossible.

Nicolaus also describes the elaborate rituals he would go through in order to make his drinking seem normal. He talks about his evening routine of making a show of a few drinks to wind down, then a few glasses of wine to go with the elaborate meal he cooked, and putting a great deal of effort into justifying the amount he was drinking in his own mind, and ostensibly in the minds of his family until he could put his kids to bed and drink until he passed out. This speaks to another way impaired control is defined:

A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of a substance.

Of course this one can look different depending on your drug of choice. It could look like hangovers that make you have to call in sick. It could look like trying to find a new connect for whatever illegal drug you’re using when your dealer goes to jail. For some drugs, use can be almost ritualistic, and is a time-consuming undertaking like an elaborate Japanese Tea Ceremony. Whatever the drug is, a significant amount of time is spent to get it, use it, and hide the effects of its influence from the people you don’t want seeing it.

Yet another way impaired control is defined has to do with planning. It’s not that planning to use a substance is in and of itself is bad. It’s actually good. Harm reduction, a form of substance use treatment, would actually encourage it. Planning leads to designated drivers, and clean needles, and that buddy that doesn’t trip acid while you trip acid so that he can point out the dinosaur you see crossing the road is actually an armadillo. Planning is good. But, if every time you plan to use substances, your plan goes awry it should tell you something. Specifically, if you plan to use for a weekend, or just tonight, or only have two beers and you end up awake for a week on a meth binge or so drunk you can’t walk with no way to get home. The clinical criteria is:

Substance is often taken in larger amounts or over a longer period of time than was originally planned.

And finally there is:

Craving. A strong desire or urge to use the substance.

If you have never experienced this, I am super happy for you. This is not like the craving I had over the weekend for a cupcake.

Red Headed Stranger from Hey Cupcake! Lemon cake with strawberry buttercream. It was delicious!

Red Headed Stranger from Hey Cupcake! Lemon cake with strawberry buttercream. It was delicious!

The kind of craving I'm talking about is a physical, mental, and emotional urge to use. It feels like nothing is more important in that moment than getting your fix. This is a Pavlovian-on-steroids-mouth salivating-irrational-get-the-fuck-out-of-my-way-HULK-SMASH kind of craving. I might be overstating it. Everyone experiences them differently. But, they’re no joke, and they are based in behavioral conditioning/neuroscience. That is definitely a topic for another post, but they’re strong enough that a flippant comment about self-control or will-power only shows a lack of understanding from the commenter.

So there you have it. Impaired control. Just two of these criteria are enough to diagnose a Substance Use Disorder.

So what do you think? Do any of these sound familiar to you? Chances are they do. We've all been there, but remember, we're looking for persistent patterns. Not your 21st birthday. As I said earlier, Martin Nicolaus's account in Empowering Your Sober Self: The Lifering Approach to Addiction Recovery is an awesome book if you're struggling with your own substance use or even if you're worried about someone else's. It also talks about Lifering, a support group that can be great if you've looked into Alcoholics Anonymous, and found it's just not for you. Empowering Your Sober Self also has a companion workbook that I'll link to below. Also, rest assurred, I'm not hating on A.A. folks. Everyone I love who has gotten sober, has done so through A.A. It's just not for everyone.

If you're interested in these books click the link below to check them out on BONUS! If you buy them I get a kick-back! Until next time.