Need to know
Alex, a 28-year-old paramedic, finds himself drinking more than he used to after long days at work. He’s recently had a hard time coping with his feelings. He is irritable most days and brings his frustration home to his girlfriend. Like many people, he has blamed the COVID-19 pandemic for his increase in alcohol use and overall bad mood. His drinking is just a way to unwind, he thinks. Is that true, or is it possible that he has an addiction?
Zoe, a 44-year-old English teacher, has been drinking and smoking cannabis for years. In the past, it was enjoyable, and she usually did it while socialising after work. But since her divorce two years ago, she drinks and smokes at home alone until she falls asleep on the couch with the TV on. She feels increasingly disconnected from others. She has a sense that things have gotten out of hand with her alcohol and drug use, and that it might be time to deal with it.
These specific cases are fictional, but they are based on the experiences of people I have seen over the course of more than 20 years in my work as a clinical psychologist. If you, too, have found yourself using substances more than you used to, you might be wondering whether your behaviour is turning from a casual pastime to an addiction. I have written this Guide to help you find an answer to that question.
What is addiction?
Addiction can be defined as a persistent, compulsive need to use a substance, despite the negative consequences to you or others.
Problematic or unhealthy drinking or drug use does not always signal an addiction. For instance, binge drinking in college is troublesome, but it doesn’t inherently amount to an addiction. Increased substance use on weekends might indeed be an unhealthy way to cope with stress, but one that recedes after new or different coping strategies are employed. It’s more likely to be an addiction if you don’t care whether you are hurting yourself with your behaviour, or if you are causing distress in your relationships. An addiction can interfere with achieving your goals, and people who have an addiction have often experienced other difficulties along the way. They might feel that ‘bad things always find me’ because they are haunted by legal troubles, job problems, school difficulties, family strife or significant health concerns.
If you are beginning to notice some negative consequences of using substances, there is a good chance that your casual use has become chronic use. Another important piece of the puzzle is an inability to stop or cut back on using the substance – that is, you’ve tried to stop but it just doesn’t work. Someone with an addiction needs more and more of that substance to get the same high that they felt when they first started using drugs or drinking. This need for more is called tolerance. When they stop using a drug or drinking alcohol, an addicted person will most likely experience a physical and/or emotional crash. This crash is called withdrawal, and it plays a role in motivating continued substance use.
Addiction – which falls under the formal medical category of substance use disorder – is a prevalent problem. According to a report by the US Substance Abuse and Mental Health Services Administration (SAMHSA), in 2020, more than 40 million people aged 12 or older had met the criteria for a substance use disorder in the prior year – that’s 14.5 per cent of the US population. These included more than 28 million people with an alcohol use disorder, and more than 18 million with an illicit drug use disorder, involving the use of drugs such as cocaine, heroin, hallucinogens, cannabis, methamphetamine or misused prescription drugs. The stresses of the COVID-19 pandemic appear to have encouraged increases in various types of substance use. Behaviours such as online gaming and gambling, central concerns in what are called ‘behavioural addictions’, have also recently increased. People often use alcohol and drugs or engage in other addictive behaviours when they feel stressed, bored, depressed, angry or without control over their circumstances. (This Guide focuses on drug and alcohol addictions, though their symptoms – such as repeated, unsuccessful efforts to control the behaviour – overlap to an extent with other conditions, such as gambling disorder.)
Drinking and drug use often begin as a way to connect with others and have fun. For many people, it might have started during the teen years. Because using substances has become such a part of everyday life for so many, it can be hard to know if you have crossed the line into addiction. But, together, we can start to figure this out.
What to do
Accept the challenge of facing a possible addiction
If you find it difficult to think about the possibility that you might have an addiction, you should know that this is incredibly common. There is still a stigma around addiction, and it doesn’t feel good to think that a behaviour of yours could be out of control. The idea of not having drugs or alcohol in one’s life can feel overwhelming, too – many people in recovery from addiction have commented that alcohol or drugs have been like their ‘best friends’, always there to celebrate with and pick them up when they get low. There is a psychological as well as a physical component involved in the repetition of behaviours that are unhealthy for you.
Yet there is much to be gained by asking yourself if a habit is causing you harm, or if it is causing harm to your loved ones. It requires honest self-reflection – but you are worth the effort it takes to get a clearer picture of what is going on. Many people who have given up their alcohol or drug use have acknowledged that they feel better overall. Benefits such as waking up without a hangover, remembering what you did the night before, being clear-headed, and being able to have more honest connections with loved ones cannot be underestimated. Facing a possible addiction brings with it incredible opportunities to better know yourself and what you want your life to look like.
Learn the cornerstones of addiction
There are several cornerstones to consider if you are wondering whether you are leaning into addiction. If you recognise these core components of the addiction process in your own behaviour, it is more likely that it constitutes an addiction. The first cornerstone is cravings. Cravings are feeling a strong need to engage in the addictive behaviour.
The second cornerstone is triggers. Addiction triggers can include strong emotional states – such as depression, anxiety, anger or grief – that might lead you to gravitate back to your drug of choice to cope. Physical illness and pain can also be triggers, and lead you down the road to using and overusing drugs or alcohol to manage the discomfort. Even positive life events, such as a new relationship, a new job or a promotion, might make you feel like you want to celebrate with heavy drinking or drug use. Hanging out with people you have tended to be with while drinking or using drugs, or visiting places where you have done so, can also trigger your brain to think it’s time to engage in these behaviours.
The third cornerstone is relapse. If you have made attempts to stop using drugs or alcohol and been successful for a while, only to find yourself back at square one, that is called relapse. Relapse is common among people who are recovering from addiction, and many addiction professionals believe that it is part of the recovery journey. (Indeed, I find that it’s more helpful to call any setback a lapse, rather than a relapse.)
See if you detect the common signs
Let’s unpack some of the typical signs of addiction. As you read about them, reflect on whether you have recently experienced any of the signs listed below in your own life. While noticing any one sign is not necessarily a cause for alarm, if you have experienced two or more of these 15 signs in recent weeks, that might signify a problem that requires your attention.
It would be a good idea to track your behaviour in a notebook or on your smartphone to determine whether you experience any of the signs. Note which signs ring true for you, along with the dates on which they appear. Remember, honestly tracking your behaviour is a great way to determine if your use has become a problem for you.
Reflect on urges and motivations
Explore your motivations for using drugs or drinking alcohol, including whether you are feeling intense urges to do so. You might also experience withdrawal symptoms if you stop using drugs or drinking, which can make it difficult to quit and can tend to feed into the motivation to use once again. Withdrawal symptoms are different for different drugs but often include emotional symptoms such as anxiety or depression, physical symptoms such as trouble getting to sleep or staying asleep, and cognitive symptoms such as difficulty concentrating or problems with memory.
Do you recognise your feelings and behaviour in any of the signs below?
- You need an increasing amount of alcohol or drugs to feel a buzz or high.
- You feel an urgency to get the first drink or drug of the day.
- You experience a loss of interest in other activities and an increased desire to get ‘high’ or ‘buzzed’.
- You try to quit or cut down on the use of alcohol or drugs but can’t.
- You will do almost anything to get the drug or alcohol.
Think about social settings and your relationships
Sometimes, taking a closer look at how you are interacting (or not interacting) with other people in your life can help you determine if your use is sliding into addiction. The way you engage in social settings and in your relationships is linked to how you are feeling about yourself and your behaviour. Are you able to be honest and transparent with others about your drinking or drug use? Ask yourself if any of these signs apply to you:
- You hide all evidence of your drug or alcohol use.
- You make excuses to others for your drug or alcohol use.
- You are unable to talk about your alcohol or drug use with others.
- You avoid family and friends, especially if they express concern about your drug or alcohol use.
- You feel unable to enjoy social gatherings or events without using drugs or alcohol.
Identify any negative consequences of your behaviour
If you are using drugs or drinking to excess, you might also be experiencing adverse consequences in one or more areas of your life. For example, are you going through significant difficulties at work? Have you recently had legal problems related to substance use? Are you taking risks that could cause harm? Take a look at the signs below and see if you agree with any of them:
- You experience blackouts, or memory lapses, during or after excessive use of alcohol or drugs.
- You neglect important family or work responsibilities in order to use drugs or alcohol.
- You have financial, legal, medical, family and/or work problems that have developed due to your alcohol or drug use.
- You are doing things under the influence of drugs or alcohol that cause you shame or regret later on.
- You take risks that could be harmful to you or to others, such as having unsafe sex or driving while you are high or drunk.
Consider the risk factors of addiction
Along with understanding the basic mechanisms of addiction and its common signs, it’s worthwhile to think about some of the biological and environmental factors linked to an increased risk of addiction. One major risk factor is genetics. People who have addiction in their family are at a much greater risk of developing one than are people with no family history of addiction. Take a moment to reflect on your family members – it might be helpful to draw a family tree here. As far as you know, has anyone in your family struggled with substance use problems? It could be useful to ask your parents or other close relatives about their family members, too.
Another important risk factor is your environment growing up. A person who has experienced early childhood trauma, bereavement or poverty might be at a higher risk for overusing substances as a way to cope with re-experiencing difficult situations as an adult. Be kind with yourself here, and reflect on whether an adverse childhood experience is one of your potential risk factors.
Genetic and early environmental risk factors will sometimes emerge in the course of treatment for an addiction. Someone who is working with a professional therapist after struggling to control her drug use might reveal, for example, that she was physically abused in childhood, and that one of her parents drank excessively. A person does not need to have had these specific kinds of experiences or other clear-cut risk factors to develop an addiction – but when such factors are evident, it can help one gain a fuller understanding of their behaviour.
If you reflect on your own life and notice some of the common signs of addiction that I have described above, and perhaps one or more of the risk factors, this could be a great opportunity to talk to a professional about how things are going for you. Your doctor, a clinical psychologist or another qualified expert can make an assessment using the formal criteria for substance use disorders and can provide further guidance. In the Learn More section below, we’ll cover some of the first steps toward change.
Key points – How to know if you’re addicted
- It can be difficult to know if you have developed an addiction. Drinking or drug use that started out as a casual, social practice can become more chronic and problematic over time.
- Not all unhealthy drinking or drug use spells an addiction. Addiction can be thought of as a persistent, compulsive need to use a substance despite the negative consequences.
- Accept the challenge of facing a possible addiction. Thinking about whether you have an addiction – and contemplating change – can be uncomfortable, if not overwhelming. But the potential rewards for your wellbeing and your relationships are well worth it.
- Learn the cornerstones of addiction. These include cravings, a strong need to drink alcohol or use a drug; triggers, feelings and circumstances that encourage use; and relapse, a return to using a substance after trying to stop.
- Reflect on urges and motivations. Ask yourself whether you need increasing amounts of a drug or alcohol to feel an effect, have a diminished interest in other activities, or struggle to reduce your use. Do physical and emotional crashes after not using make it harder to stop?
- Think about social settings and your relationships. Are you open and honest about your substance use, or do you conceal it, make excuses about it, or avoid discussing it? Can you enjoy social activities without drinking or using a drug?
- Identify any negative consequences of your behaviour. Honestly consider whether your use has led to work-related, medical, legal or other substantial problems, or caused you to be neglectful, take dangerous risks or do things you regret.
- Consider the risk factors of addiction. People who have family members with addiction are at greater risk of developing one themselves. Early adverse experiences, such as childhood trauma, are also linked to increased risk of addiction.
If you think you might have an addiction
If it does seem that you might have an addiction, you now get to decide what is best for your mental, physical and spiritual health. You will be trying new things here. Can you begin to imagine a new identity that might not include the behaviour to which you have become attached? Envision that this new identity has the ability to cope, in a reflective and self-compassionate way, with whatever life deals out. Developing your self-compassion muscle – treating yourself how your best friend would treat you – is one of the best ways for you to start feeling better. Encouraging words go a long way if you’ve been beating yourself up for your behaviour.
When someone decides to change a behaviour such as drinking or drug use, a natural tendency is to resist the change. Instead of fighting with yourself, invite in any resistance. See if you can determine why you might be struggling against change. And begin to take small steps in the direction of your own healing.
Explore your resources
A valuable step toward change is to explore your community for substance abuse professionals and/or mental health professionals who focus on substance use problems. Websites such as Psychology Today and SAMHSA offer ways to search for a therapist in your area. If you have health insurance in the US, you can use your insurance company’s website to find behavioural health professionals. Many therapists worldwide are now providing online as well as in-person counselling. If you are in college, you might access your school’s counselling centre.
When speaking with a professional, you can write down some of the concerns you have about your behaviour and how it is impacting on your life and the lives of your loved ones, and then bring it to the first appointment. Here is an example of what the first conversation could look like: ‘I’m here to talk about my alcohol use. I’ve been drinking socially for years but recently I noticed that I have been drinking alone, I drink every day, and I’m drinking more over time. I’m arguing with my partner all the time. I don’t know how to stop, and I’m not sure I want to stop.’
There are multiple types of therapy that can be very effective in helping you make good decisions about a future without addiction, and they are utilised by many mental health professionals. One major example is cognitive behavioural therapy (CBT), a short-term therapy that focuses on problem-solving and learning how your thinking impacts on how you respond to situations. Another is acceptance and commitment therapy (ACT), which teaches you skills to help you behave in ways that are more aligned with your personal values, and helps you to develop a flexible way of thinking about problems. Motivational enhancement therapy (MET) is an additional expert-recommended approach that can help facilitate change, especially if you are ambivalent about stopping.
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are free, nonprofessional, multicultural groups available almost everywhere. AA and NA groups are for anyone who wants to do something about their drinking or drug use, respectively. Gamblers Anonymous also offers free groups and hotlines for people who need help due to gambling. A recommendation here is to choose a few different groups to attend (and when you first go, please just listen, don’t say anything); it might take a few tries to find a group that you click with. Self-Management and Recovery Training (SMART) is another option for you: these free groups offer self-empowered recovery skills and support, and there are opportunities to join any of these groups virtually, too. In addition to these groups, keep in mind that your social supports – family and friends – will be important too as you tease apart your behaviours and begin the process of making healthier choices.
Re-engage with your mind
Mindfulness, consciously focusing on the present moment without judgment, can be a quietly powerful way to calm down the mind after years of substance use. When alcohol or drugs are removed from the brain, mindfulness is a compassionate technique to bring the mind back into balance. Mindfulness meditation, spending time (usually 10-20 minutes) each day allowing your mind to slow down and not attach to any particular thought, is also helpful. Of course, at the beginning it will feel like a storm has been kicked up in your head. Meditation enables you to let your thoughts move like leaves down a stream. (See the Links & Books section below for some resources on practising mindfulness and meditation.) Some recovery centres have incorporated these techniques along with yoga, tai chi and the arts to help heal the mind and develop alternative ways to cope. Why not try one of these skills and see how it goes?
Take time to FLOAT
We’ve all heard of the fight-or-flight response to stressful situations. I want to offer you a third choice when you get in a rough spot and have tough decisions to make about your drug or alcohol use. It’s called FLOAT. Introduced in The Mindfulness Workbook for Addiction (2012), which I co-wrote with Julie Kraft, FLOAT is the idea of taking a moment to rise above the challenging situation you are in and observe what’s going on, without judging the situation or yourself. It’s an opportunity to quiet your inner critic (that voice in your head that dispenses negative commentary about you). Here is how you do it:
- Find your silent place. Even in the midst of crisis or conflict, there is a quiet place where you can go in your mind. You can get to this place by imagining yourself taking a step back from the conflict. Here, there is no rush of emotion, there is just you observing without reacting. Going to this quiet place allows you to breathe and regroup.
- Let go of judgment. Holding on to judgment of yourself or others has a way of holding you back from being in the present moment. If you are about to judge, take a moment to release the judging thought. One way to do this is to acknowledge to yourself: I am judging, I now allow myself to let go of the experience of judging. Be kind to yourself and return to your calm mind.
- Observe your thoughts. An important thing to remember about thoughts is that they are not permanent. Observe your thoughts and notice that they come and go. Reminding yourself of the temporary nature of your thoughts, including the difficult ones, empowers you to make choices based on a clear, calm mind.
- Awareness of your environment. When you are feeling agitated, angry or disappointed, take a moment to look around, notice your feet on the ground, notice the space around you, and become aware of your body. This allows you to slow down, be in the moment, and reassess the situation.
- Thankful for the experience. In every experience, even the bad ones, there is a lesson to be learned. Instead of berating yourself and dismissing the experience, take a moment to be grateful for what life has put in your path as you choose a healthier direction.
The next time you are in the middle of a stressful situation, try to FLOAT – and add this skill to your wellbeing toolbox. And as you take the next steps toward a healthier life, remember to be kind and compassionate towards yourself. You can feel better; your wellbeing is in your hands.
Links & books
There are plenty of terrific podcasts to jumpstart your thinking about whether you might have an addiction, including The Addicted Mind, That Sober Guy Podcast, Seltzer Squad and the Recovery Elevator. I recommend choosing one of these to start with, to learn how others who have used drugs or alcohol engage in their daily wellbeing.
The podcast Ten Percent Happier with Dan Harris brings together experts in the field of mindfulness and meditation. Mindfulness meditation has been shown to help with cravings and withdrawal from substances. I recommend this podcast for new or seasoned meditators to add moments of calm into your day. Another podcast that might be helpful if you want to explore meditation a bit more is Men Talking Mindfulness, which offers both short meditation sessions (if you have only 5 or 10 minutes) and longer interviews with experts.
Two hopeful documentaries give insight into the experiences of people who are facing the struggles of recovery: A New High (2017) follows a group of people in Seattle who undertake to climb a mountain as they wrestle with their addictions, and Generation Found (2016) explores the lives of teenagers in Houston who are caught in the addictive cycle and who find a path forward by attending a ‘recovery’ high school.
All journeys toward new behaviours are aided by companion books. Take a look at the workbook I wrote with the marriage and family therapist Julie Kraft, The Mindfulness Workbook for Addiction: A Guide to Coping with the Grief, Stress, and Anger that Trigger Addictive Behaviors (2nd ed, March 2022). This workbook offers more than 60 worksheets and exercises to explore your emotions, thoughts and the reasons behind your behaviours.
Our book The Gift of Recovery: 52 Ways to Live Joyfully Beyond Addiction (2018) is a pocket coach helping folks and their family members tackle the challenges of early recovery with mindfulness skills and daily affirmations. It is also available as an audiobook.
Other favourites of mine that focus on self-compassion in recovery are In the Realm of Hungry Ghosts: Close Encounters with Addiction (2008) by the physician Gabor Maté and Yoga for Addiction (2020) by the yoga teacher Katy Cryer. I’m a big fan of reassessing and reengaging with what you value most in life: take a look at Cravings and Addictions: Free Yourself from the Struggle of Addictive Behavior with Acceptance and Commitment Therapy (2022) by the clinical psychologists Maria Karekla and Megan M Kelly. And one of my favourite books on developing a robust way to cope with stress is Resilient: How to Grow an Unshakeable Core of Calm, Strength, and Happiness (2018) by the psychologist Rick Hanson and his son, the writer Forrest Hanson.