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People use drugs...

Most people at least occasionally use mood-altering drugs for social or recreational reasons, usually alcohol. Nearly all adults in the U.S., 87%, have drank alcohol at least once, and 56% have drank within the last month. It's so ubiquitous that we wonder which rock the other 13% grew up living under. 49% of Americans 12 and older have tried marijuana, and 7% have used it within the last month. 16% of Americans have tried cocaine, 1.5% have tried heroin. These drugs and many more are readily available, and anyone with the motivation, regardless of age, can get them regardless of legal status. We all know this.

Many mood-altering addictive drugs are prescribed to us by doctors, too. Hydrocodone pain relievers, derived from opium poppies just as heroin is, is the single most prescribed class of drugs in the U.S., and undoubtedly the most abused. Benzodiazepines such as Xanax, amphetamines like Adderall, and other potentially addictive drugs like Ritalin are commonly prescribed and commonly used recreationally too.

Using drugs including alcohol carries risks. We can overdose and die, we can get arrested and be sent to jail, we can be robbed or killed by criminals, we can kill ourselves or other people by driving under the influence, we can lose our jobs, or we can simply embarrass ourselves. But responsible and occasional use is the norm in our society, whether for social or medical reasons, and by itself this is not necessarily a bad thing.

But sometimes use leads to abuse...

For some of us, occasional social or recreational use, or use following doctor prescriptions for specific purposes, isn't enough, and we want more. Why do we want more? Again, there are many reasons, including some of the same reasons we used in the first place, but taken to another level.

Why? There are many reasons...

With alcohol, one of the most important reasons is social influence. The alcohol industry is very wealthy indeed, and drives content in television and movies as well as commercials. It becomes expected that we drink alcohol on social occasions because that's what we grow up with. It's what adults do. How many of us drank for the first time because we felt we were grown-up enough to behave like adults? This influence can't be overstated, and we have only to look at the tobacco industry since the 1960's for an example of what happens when an industry drives social influences (more people smoke), and what happens when media restrictions are put in place (fewer people smoke).

Curiosity is another reason. Humans are curious, it's part of our nature, and when we see and hear and read about drug use and the effects of drugs, particularly when it is glamorized or tied to role models, many of us will explore it ourselves. Many of us tried drugs for the first time because we were simply curious. Some of us liked the effects and used the drugs again, some of us did not like the effects and never used the drugs again.

Peer pressure is another reason. In a group of young people, often all it takes is for a few in the group to want to drink or use drugs, and many of the rest of us will follow because we don't want to feel left out or stigmatized. But this continues as we grow older. How many of us have been asked and even pressured to join our co-workers for a round of drinks at the bar after a long day? If we don't join the group, we feel left out, or we feel that others will look at us differently and negatively. Peer pressure isn't restricted to youth, it's just that our peers change as we grow older.

Sometimes we drink or use to loosen inhibitions. Drugs can be a social lubricant, no question about it, though the effects are temporary and can be embarrassing. And all it takes is one bad outcome, where we drink too much and act in ways that cause us embarrassment later, to dilute these desired effects. And, sometimes we drink or use to relieve stress. This works temporarily, but the more we drink or use as a stress reliever, the more we come to rely on it, and the more anxious we feel when we aren't drinking or using (the vicious cycle).

*Peer pressure.
*Stress relief and relaxation.
*Growing up in a home where alcohol and drug abuse is considered normal behavior.
*Self-medication to deal with mental illness or as part of a personality disorder.
*Relationship and financial problems.
*Low self-esteem (escape or loosening inhibitions).
*To forget normal life.

Often we see ourselves in several places on lists like this.

Use, abuse and addiction are part of a continuum, and there are no sharp borders. However, professionals like to categorize people and put them in boxes, and have developed various criteria to help judge where we are on the continuum. The American Psychiatric Association publishes periodic updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the latest (DSM-5, 2013) categorizes people on the basis of how they answer a list of questions. For alcohol use disorder (AUD), these are listed in the table;  other substance use disorder (SUD) tests are identical except for the name of the drug.  Normal use is defined as less than 2 "yes" answers, mild SUD is 2-3 "yes" answers, moderate SUD is 4-5 "yes" answers, and 6 or more "yes" answers puts you in the severe SUD box. Somewhere on this mild-to-severe continuum, we move farther away from normal use and into chemical dependency, which is addiction. 

How did you score? 

If you had 0 or 1 "yes" answers, you're probably among the large majority of people who are normal drinkers (or perhaps you just don't drink), or perhaps you occasionally use other drugs socially.  More than that and you may have a problem, but only you can say for sure because only you can answer these kinds of questions honestly.  As the number of "yes" answers grows, paradoxically sometimes we try to minimize the number so we feel better about ourselves.  What does "important" really mean, or "persistent", or "strong"?  Can I spin the questions in such a way so I can answer "no" to more of them?  This is denial, an almost ubiquitous symptom of a serious addiction problem.