The Middle Stages of Addiction: Substance Abuse

This is part two of the four-part series, The Stages of Addiction. Read part one, The Early Stages of Addiction: Initiation and Experimentation

The middle stages of addiction are marked by problematic use of drugs or alcohol, which is known as substance abuse. Substance abuse isn’t the same thing as addiction, but it can lead to addiction.

During the middle stages of addiction, problem-free social use transitions to abuse. Substance abuse is defined as using drugs or alcohol in a way that causes problems in your life. These include:

  • Relationship problems. Substance abuse often leads to interpersonal problems with friends, family or co-workers. Deteriorating relationships due to substance use may occur when others have to take over the substance abuser’s responsibilities; when drinking or drug use leads to arguments or even physical or emotional abuse; or when others see the abuse as problematic but the substance abuser does not. Interpersonal problems resulting from substance use are an important indicator that use has transitioned to the middle stages of addiction.
  • Financial problems. Financial problems can result from substance use in the form of lost time at work or job loss; the expense of buying drugs or alcohol; or costly legal issues resulting from drug or alcohol use.
  • Health problems. Both physical and mental health problems often result from substance abuse. Heavy use can lead to mental illnesses like depression or anxiety. Physical health problems caused by substance abuse often begin in the middle stages of addiction. These include high blood pressure, abnormal heart function, digestive problems and infections.
  • Legal problems. A variety of legal issues may stem from substance abuse in the middle stages of addiction, including charges of driving under the influence, public intoxication, drug possession and domestic abuse.
  • High-risk situations. If your substance use puts you in high-risk situations, it’s considered substance abuse. High-risk situations include things like walking alone in a dangerous area, having unprotected sex and engaging in illegal activities or activities that may lead to personal harm or harm to others.

Types of Substance Abuse

There are several different types of substance abuse associated with the stages of addiction.

Alcohol abuse. Alcohol abuse is the most common type of substance abuse in the U.S. The most common form of alcohol abuse is binge drinking, which occurs in the middle stages of addiction and is defined as consuming enough alcohol in the space of two hours to bring your blood alcohol level up to .08 percent. For women, this is typically four drinks, and for men, it’s typically five.

Prescription drug abuse. Prescription drug abuse is the use of prescription drugs in a way other than exactly as prescribed by a physician. This includes using other people’s prescription medications, taking larger doses than prescribed and using prescription medications to get high.

The most commonly abused prescription medications are:

  • Opioid painkillers, including OxyContin, hydrocodone and Fentanyl
  • Central nervous system stimulants, including Adderall, Ritalin and Concerta
  • Central nervous system sedatives, including benzodiazepine drugs like Klonopin, Valium and Xanax

Legal drug abuse. Legal drug abuse is the act of using legal drugs, such as over-the-counter medications, in a way other than as directed. It also includes using inhalants. In states where marijuana is legal, using this drug in a way that causes problems in your life is considered abuse.

Illegal drug abuse. Any use of illegal drugs is considered drug abuse. Illegal drugs include heroin, cocaine, meth, ecstasy and—in most states—marijuana.

Read part three of this four-part series, The Late Stages of Addiction: Addiction and Dependence, or download the entire series as a fully illustrated eBook, The Stages of Addiction

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