Different types of drug use

This is a diagram of drug use that I came across the other day.



The explanation for it follows:

"The road to addiction is different for every person. Some people take their time while others go from zero to 60 in a short period of time. No matter how long your journey is, most rehabilitation counselors agree that there are five main stages of drug addiction: experimentation, regular use, risky use/abuse, and drug addiction and dependency. Not everyone in the first two stages will develop a drug addiction, but individuals in the third stage of drug abuse are very likely to progress into full-blown addicts. Here’s a closer look at the five main stages of drug addiction.

Experimentation is defined as the voluntary use of drugs without experiencing any negative social or legal consequences. For many, experimenting may occur once or several times as a way to “have fun” or even to help the individual cope with a problem. For many, experimentation can occur without any desire to continue using the drug. For others, it can start to become a problem when it moves into the next stage of addiction.

Some people will be able to enter the stage of regular use without developing a dependence or addiction. These people will be able to stop the drug use on their own. The problem with regular use is that the risk for substance abuse greatly increases during this stage. It also increases risky behaviors such as driving under the influence, unexplained violence, and symptoms of depression and anxiety.

Many people stay in the stage of regular use for months or years. Some may not develop a problem but many may not be able to stop by themselves. This is ordinarily the period of time where the consequences of using drugs and/or alcohol regularly begin to show up. Some will completely stop at this point. Others will stop for a period of time in order to get back into the good graces of loved ones or possibly the law; for example if someone gets a DWI and is put on probation they may quit drinking completely or agree with their family never to drink and drive again but as soon as they complete their probation they feel they are “off the hook” and can finally return to their old behaviors. 

Characteristics of dependence include constant use of alcohol or other drugs that lead to the inability to take care of major responsibilities related to work, family, school and other roles. Repeatedly using drugs in situations that are physically hazardous, such as sharing needles or driving while under the influence, repeated legal problems, or any combination of these. Their risky behavior may also escalate to things such as prostitution and stealing from society because they can no longer take from their family. Many dependent people could be categorized as functioning, and are able to work, maintain family relationships, and friendships. They will attempt to limit their use of alcohol or other drugs to certain times, such as evenings or weekends. 

The last stage of persistent abuse of substances is addiction. At this point they have been addicted for some time but this is the point where change is inevitable because continued use will only lead to a few places. Addiction is a disease involving serious psychological and physical changes from constant heavy use of alcohol, drugs, or both. Symptoms include withdrawal and uncontrollable alcohol use and/or other drug craving, seeking, and use that continues even in the face of repeated negative consequences. Addiction is a progressive, chronic, and fatal disease. If left untreated, it can only lead to jails, institutions, death, and dereliction, in no specific order". (End of explanation)

My response

I find this has some accuracies or parts I would agree with. It also is an interesting statement because it typifies some of the ways misconceptions about drug use are presented to the public. I discuss these below:

It says that not everyone in the first two stages will develop a drug addiction. The majority or even the vast majority do not develop a drug addiction. The largest group by far are the social (recreational) users. The dependent users are quite a small group in number.

It kind of implies the gateway drug use scare tactics approach by saying there are 5 main stages to drug addiction from experimentation to dependency. This is true but again it is only quite a small group of users who go through all the five stages and most stop at stage 2. It is like saying eating leads to obesity. Yes it does for a small group but the vast majority of eaters do not become obese. 

To quote them, “Some may not develop a problem but many may not be able to stop by themselves.” This is a typical media driven statement that is using scare tactics. A more correct statement would be - Most will not develop a problem but a few may not be able to stop by themselves.

If these five women all took drugs. Only about one tenth of one of them would ever develop a drug dependency. Four of them would only ever remain recreational users.

It says many stay at the stage of regular use for months or years. As I say in my book - Working with drug and alcohol users - if this happens then a move on to dependent use is unlikely. Most dependent users when they begin using their drug of choice the escalation to dependent use is rapid, within months. It most often does not develop slowly over time. So when they hit what the diagram calls social use they quickly skip to dependent use. If they stay in social use or regular use for months or years then they are unlikely to develop to dependent use.

It says addiction is a disease. This is one view of addiction and is commonly the psychiatric view of addiction. There are other views which see it resulting from adverse psychological development and is not a disease in the medical sense of the word. This psychological view is a widely held view of addiction around the world. 

It says addiction is a progressive, chronic and fatal disease. For the vast majority of dependent uses this is not so. The vast majority do not die when addicted. The  average time of use for the dependent user is 10 years and then they stop using. The vast majority do not die by overdose or due to medical problems when addicted. It may shorten their life span in the long term in varying degrees when they get old but the vast majority will not die when using drugs.

It says that if left untreated it can only lead to jail, institution, death and so forth. I have spoken about the death statement above. In addition research shows that only 40% to 50% of dependent users will ever do any prison time. For at least half or for a small majority, it does not lead to jail.

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