We're ALL Drug Users
Hello! Welcome to Overdosed a weekly newsletter on drug policy and people who use drugs by me, Diane Roznowski.
The first few weeks of Overdosed will be a different format from the newsletter generally. They will be longer, but I hope you find them helpful. This will be a way for you to get to know me and for us to learn more about the underlying issues that the newsletter will cover. This week we’re talking about how we’re all drug users.
It took me much longer than I would like to admit to realize that we’re all drug users. Whether it’s nicotine, alcohol, prescription or recreational drugs, we all use drugs at different points in our lives.
When I was seventeen and learned that my sister was addicted to heroin, I became terrified of alcohol and other drugs. I was sure that if my sister was an “addict” that I must be one too. I had heard that addiction was a genetically based ao I decided to stay away from anything that could possibly hurt me.
The reality is that I had already been prescribed powerful opioid painkillers more than once, and when I finally started drinking, I never noticed a problem.
So what makes some of us like me and others like my sister? And are there people between these two extremes? Last week, we talked about language and why it matters. We learned that the medical term for “addiction” is a substance use disorder (SUD), but what exactly does a SUD entail?
Most of us recognize that not all drug use becomes a substance use disorder and that there are things between experimental or recreational drug use and “problematic” drug use or a substance use disorder. There are three different and important terms that are necessary for effectively and accurately communicating about drug use and substance use disorders. These terms are tolerance, dependence, and substance use disorders.
Tolerance
Over time, your body will develop a tolerance for certain substances. This means that you need more of it to get the same effect a lower dose used to give you. Let’s think about it in relation to my favorite thing: coffee. When I first started drinking coffee, one cup was enough to make me feel wild awake for the whole day. Now it takes at least two cups of coffee to make me feel that way. This is because over time I have built up a tolerance for the caffeine in coffee. When it comes to more powerful drugs, tolerance is what requires people to use more to feel high.
Dependence
After your body builds up a tolerance to a drug, it can become dependent on it. Dependence means that when you stop using the drug, your body goes into withdrawal. Withdrawal includes physical and mental symptoms and can range from mild to fatal. Being dependent on a drug isn’t necessarily a bad thing, and can be beneficial. For example, chronic pain patients can be dependent on their pain medicine, and if they stop taking their medications suddenly they may go into withdrawal. But this doesn’t mean they have a substance use disorder.
Substance Use Disorder
The National Institute on Drug Abuse defines substance use disorders as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” You can have a high tolerance for a drug or be dependent on it without having a substance use disorder. Substance use disorders are distinct because they require continued use despite negative consequences. Pain patients don’t typically have negative consequences from using their pain medications so they do not have substance use disorders.
Further Reading
If you want to learn more about substance use disorders (SUDs) and the science behind them, there are tons of resources out there. Some of my favorites include:
Addiction Policy Forum’s “What is Addiction?” video, if you have less than five minutes to spend learning more, this is perfect for you.
The American Psychiatric Association’s “What Is Addiction?” explainer.
NIDA for Teens “Tolerance, Dependence, Addiction: What's the Difference?” this post is geared toward teens and has many helpful links in it.
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Until next Friday,