One of the greatest misconceptions about substance abuse is that it’s a matter of willpower and poor choices. While willpower certainly comes into play for recovering addicts, the condition is much more complicated. Substance use disorders are psychological disorders that alter brain chemistry and function, and when taken to a certain extreme, become as physically dangerous as any other medical condition requiring professional help.
The problem is that for many, it’s hard to differentiate casual substance use from dangerous substance use levels. Unfortunately, many addicts do not wake up one day and realize they need help; they’ve slowly degenerated into a dangerous pattern and denied it all the way through. Knowing the parameters of when medical treatment becomes necessary can save lives.
When Physical Dependence Is Present
The problem with substance abuse is that when humans’ bodies become physically reliant on a specific drug, quitting becomes more medically dangerous than continuing use. We’re no longer talking about willpower and discomfort. We’re talking about withdrawal symptoms that can be fatal.
For example, the only substances that will ever kill you when quitting are alcohol and benzodiazepines; their withdrawal can result in seizures, hallucinations, delirium tremens, and, in extreme cases, death. Opioids rarely present life-threatening withdrawal symptoms, but are so physically uncomfortable (nausea, vomiting, sweating, uncontrollable body movements) that those without assistance cannot manage the side effects necessary to quit.
Furthermore, physical dependence manifests in direct consequence. People begin experiencing withdrawal symptoms after hours or days of not using: increased anxiety, tremors, sweating, and inability to function normally. They need the substance to just feel “normal” instead of feeling high. Tolerance builds where they need extreme amounts to feel anything at all; these are signs that suggest the brain/body has been fundamentally altered.
Once someone reaches this benchmark, outpatient treatment or therapy groups are not enough. Medical detoxification is required to manage physical symptoms of withdrawal and prevent potentially fatal complications. In northern Nevada, there’s no shortage of facilities that offer drug rehab in Reno, NV, with medical detox programs that monitor patients’ vitals in addition to providing medication for problematic symptoms.
When Certain Behaviors Become Apparent
In addition to physical consequences and warning signs, certain behaviors become so incriminating that they indicate the person can no longer operate in society as they once could. These behaviors demonstrate loss of control in ways casual use never allows.
Losing a job and school attendance, in which substance abuse plays a role, is a red flag that requires immediate intervention. Missing too much work because someone is high, or showing up reeking of alcohol, or getting fired directly due to drug problems, shows that substance use trumps survival. Likewise, students who drop out of school because they’ve failed all classes due to excessive drug use demonstrate that school is no longer a priority or focus.
Legal troubles abound, DUIs, possession charges, stealing from family to support habits, and domestic disturbances while under the influence. Every arrest is a wake-up call; when someone continues to fail at the warning signs despite obvious consequences showing them otherwise, it’s clear their inclination for desire has trumped survival instincts.
Financial ruin happens quickly; money gets spent on drugs rather than bills or rent until it runs dry, at which point possessions get sold. Some individuals resort to stealing from their family members or fraudulent schemes just to get their next hit. When someone is spending hundreds or thousands of dollars every week on substances and their rent still isn’t paid, it isn’t casual use; it’s a medical condition.
When Co-occurring Mental Health Disorders Are Present
Substance use rarely exists in a vacuum. The longer substances are used, the higher the likelihood that something will go wrong, and increasingly likely mental health conditions will develop or exacerbate themselves into serious concerns.
Depression, anxiety disorders (generally not anxiety unless they’re withdrawing), paranoia, and psychosis can all develop as a result of long-term drug or alcohol use.
For example, some drugs cause psychiatric symptoms all by themselves: methamphetamine induces paranoid delusions while excessive alcohol use creates the same depressive symptoms as major depressive disorder. Some people, who use marijuana excessively develop anxiety disorders; this is not an indication of addiction tolerance; it merely showcases how drugs exacerbate unfortunate mental health development.
Complications arise through dual diagnoses (co-occurring substance use and mental health disorders). For example, someone may drink to cope with anxiety; the depression becomes worse, which results in more drinking, which makes the anxiety worse, leading to more drinking. This is a cycle no one can endure without professional help.
Most importantly, suicidal ideation represents the utmost emergency. Substance abuse increases suicide risk substantially. When someone expresses active harm toward themselves, medical intervention isn’t optional; it’s lifesaving.
When Attempts to Quit Don’t Work
Addicts who enter medical treatment often do so after multiple attempts of quitting on their own first. However, failed attempts, and multiple ones, aren’t personal defects; they’re marks that highlight how addiction has overtaken something beyond recovery capacity.
A pattern forms. A person decides they’re ready to quit; they might throw away what they have or give it to a friend on standby; they inform loved ones they’re done. They may go days, weeks, or even months without using. But relapse occurs with such vengeance, it could be pent-up desire, significant stress around a current engagement that requires avoiding using, or even psychosocial trauma from quitting, that leads people back into their old habits.
Over time, and multiple relapses, hopelessness sets in; they think they cannot recover, and this becomes a self-fulfilling prophecy. This is when professional intervention is best; they’ll no longer beat themselves up for trying but failing, since professional treatment renders access impossible for relapse.
When Interest in Activities Dwindles
Gradually, severe addiction helps people lose everything they once loved. Hobbies dissolve into nothingness; friendships disappear unless they’re centered around using substances; family members disown those who wouldn’t even go to dinner with them anymore, since appearance means nothing anymore.
Failed attempts at medical treatment mean people need drugs more than they need relationships; it’s not apathy, it’s the brain ranking obtaining drugs as the only necessity for brain response. When balance should exist between drug use and healthy living, and reward systems should respond positively to food accomplishments and relationships alike, addiction hijacks any sense of normalcy since dopamine response comes only from the addictive system.
When someone’s world becomes so small solely focused around drug use, to the exclusion of everything else, they’ve lost jobs and relationships and appearance and hope and outgrown outpatient treatment or weekly counseling sessions with psychologists necessary at this point it’s clear that self-will has done nothing to help them, that extreme intensive medical treatment is necessary to reverse brain functioning patterns gone awry.
The Medical Understanding of Extreme Addiction
Understanding extreme addiction means acknowledging it’s more of a medical phenomenon than any moral failing with which to punish people with substance abuse problems. Brain imaging shows physical changes to those who have severe substance use disorders; areas of the brain required for impulse control do not activate as expected, while other areas become hypersensitive for added anxiety response levels that develop unrelated emotional symptoms.
These are not actions someone can think their way through, or decide will change effective functioning; this process requires medical treatment, medications to normalize brain chemistry, and psychotherapeutic interventions to establish alternative coping mechanisms, and time in professional settings where brains can relearn functional patterns without access to immediate triggering problems.
The good news is brains can bounce back with neuroplasticity, helping support substantial improvements after proper treatment is facilitated following consistent extended recovery over time, yet immediate support during complex withdrawal essentials is most critical during this process, where risks are paramount.
Making the Call
Understanding when medical treatment becomes necessary is often the hardest part for families involved. The addicts themselves are almost always in denial, and fear of treatment (or their life without drugs) helps offenders continue down their path of destruction longer than needed.
Yet obvious awareness from outsiders offers glaring realities—physical dependence develops (should someone try), they’ve tried multiple attempts already (as marked by failure), consequences develop to detrimental extremes, while mental health issues complicate any decisions.
These prolonged red flags do not merit further consideration or waiting efforts, these flags represent caution: physical dependence symptoms emerging after extended recreational use show chemical imbalance develop, failed attempts mean addicts want help but how sad for them since they’ve taken it upon themselves to destroy themselves; devastating consequences reflect individuals in denial while mental health exacerbation suggests whatever needs help isn’t possible due to stigma attached to subsequent actions has left them vulnerable only for action, but the action that’s required doesn’t justify outpatient treatment or counseling sessions once a week at a minimum, they need intensive medical treatment after long-term abuse has set in.
Hopefully all is not lost, but medical treatment means someone else must intervene for what self-will could not accomplish.
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