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Almost Addicted

“Almost addicted” is a phrase coined by Dr. J. Wesley Boyd.  Why people get addicted to drugs, alcohol or behaviors varies.  So who does this label apply to? Does neuroscience addiction research support the model?  And should we even be using the idea of “almost addicted” at all? We explore here and invite your comments about “almost addiction” at the end.

Who is J. Wesley Boyd, MD, PhD?

This blog post is about someone who is extremely important to the field of addiction research; J. Wesley Boyd, MD, PhD.

Just how important? Well … he:

  • belongs to the faculty in psychiatry at Harvard Medical School.
  • is a staff psychiatrist at Boston Children’s Hospital (BCH) & at the Cambridge Health Alliance (CHA).
  • is co-founder and co-director of the Human Rights and Asylum Clinic at CHA.
  • works in the Adolescent Substance Abuse Program at BCH.
  • teaches medical ethics and the humanities at Harvard.
  • is a graduate of both Yale and the University of North Carolina at Chapel Hill.
  • penned the book “Almost Addicted: Is my (or my loved one’s) drug use a problem?”

That’s a pretty impressive list of accolades and it’s obvious that Dr. Boyd knows what he’s talking about when it comes to addiction. But if that’s so … how the heck can someone be ‘almost addicted’ to something?

What does “almost addicted” mean?

Fortunately, a friend recently interviewed Dr. Boyd about his book and he explains the phenomenon of being ‘almost addicted.’

It turns out that Dr. Boyd and his colleagues coined the term ‘almost addicted’ to “describe individuals whose drug use does not rise to the level of a formal diagnosis of either substance abuse or substance dependence but who nonetheless are suffering to some extent from their drug-related behaviors.”

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Dr. Boyd says that even if someone doesn’t have a full-blown addiction or hasn’t had major difficulties in life because of substance abuse, that person’s drug use can still have a negative impact on their life.

And he adds that if you can catch a person at this almost addicted stage, when the difference between dependence and addiction is subtle, but before their substance abuse becomes a full-on addiction, you might be able to prevent their almost addiction from becoming an actual addiction.

Who’s at risk of “almost addiction”?

While Dr. Boyd says that all demographics are at risk, he specifically points to young adults, noting that their frontal cortex is not fully developed until the mid-to-late 20s, so people in this age range might be more likely to make bad decisions without considering the possible consequences of those decisions. He also points out that using drugs while the brain is still developing can influence how it develops and result in moderate to significant problems in the future. Youth can also be less susceptible to the sleep inducing effects of some drugs and more susceptible to the euphoria certain drugs produce, making them more at risk than older adults of using more drugs.

Prescription pain medications: a national epidemic

In Dr. Boyd’s book, he tells the story of a person whose use of opiates was considered to be in the almost addicted range for a long time and how it went unchecked and eventually led to a full-on addiction with dire consequences for the person.

Dr. Boyd specifically talks about prescription drug abuse in his book and calls it the fastest growing drug problem nationally, noting that the Centers for Disease Control and Prevention (CDC) has classified it as an epidemic.

And he provides the stats to back up the epidemic claim, citing a 2009 survey called Monitoring the Future. According to that survey, “16 million Americans in 2009 used prescription drugs for non-medical purposes at least once in the previous year.” Also, 2.7% of eighth graders and 8% of twelfth graders abused Vicodin in the year prior to the survey and 2.1 percent of eighth graders and 5.1 percent of twelfth graders abused OxyContin.

Eighth graders abusing Vicodin and OxyContin?!? These are 13 and 14-year-old kids we’re talking about here! Yeah, I’d say that’s an epidemic.

And here are more statistics that make Hollywood’s scariest monsters look like your neighbor’s new puppy: 70% of people 12 years or older who abuse prescription drugs obtained them from friends and/or family as opposed to strangers, drug dealers, or others. And almost one third of people who abused drugs for the first time did so by abusing prescription medications in a non-medical manner.

Why are so many people taking prescription drugs?

Dr. Boyd attributes the rise in prescription drug abuse to a number of factors. He says doctors might be prescribing more of these drugs than is warranted, which then makes it easier for them to be diverted away from their legitimate medical uses. He also says that because these drugs are prescription medications, they are seen by people as being less dangerous to abuse than illegal drugs (as absurd as that sounds to anyone with common sense). Lastly, drug use seems to be more socially acceptable than in the past. (Thanks for staying classy, mass media.)

Aside from the assumption that these drugs might be somewhat safer than illegal drugs, the actual dangers are pretty much the same; possible overdose, potential for physical dependency, increased potential for driving while intoxicated. But Dr. Boyd doesn’t see them as a bigger problem than illegal drug abuse. They are both huge problems that need to be addressed.

It isn’t all bad news, however. Dr. Boyd says the problem of prescription drug abuse is well known to authorities and addiction experts and the Drug Enforcement Administration (DEA) tracks the prescribing practices of certain physicians and tries to ensure that pain medications are being prescribed legitimately.

In the case of Suboxone, he gives as an example, the DEA began doing random audits of Suboxone prescribers a couple of years ago to try to ensure that Suboxone (which has significant street value) is not being diverted or misused otherwise. Many communities also now have locked drop off facilities in which residents can deposit prescription medications that they are no longer taking in an effort to get more bottles of prescription pills out of medicine cabinets and properly disposed of. (In fact, New Jersey just passed legislation to target prescription drug disposal by health care facilities.)

An “almost addict”?

Re-reading the interview with Dr. Boyd made me think of a friend of mine from college who abuses drugs. (Yes, I still consider him a friend.) The thing about Nick is that he prides himself on not getting into what he calls ‘the hard stuff.’ He’s mostly talking about heroin and meth when he says this (although he has done cocaine, crack, numerous prescription drugs, MDMA/ecstasy, LSD, psychedelic and lots and lots of marijuana). He also avoids injecting anything, preferring instead to smoke, ingest or snort his drugs of choice.

He’s not what I would call a traditional drug addict. For example, he is capable of quitting drugs for several weeks or months at a time (usually to bypass pre-employment drug testing) yet he always goes back. Whenever I see him, he looks and sounds healthy (even becoming pleasantly plump at times) so it’s hard to imagine him as a drug addict. He has lost jobs due to going on drug binges, though, so there’s that.

I think Nick fits into this almost addicted category that Dr. Boyd is talking about, but I have to admit that I’m not totally comfortable with this category even existing. I mean, if your significant other consistently drinks each night but it’s not to get drunk, maybe just to get a nice, lightheaded buzz before bedtime, are they almost addicted to alcohol … or are they addicted? I was a lot more comfortable prior to this whole grey area. Now with this almost addicted label, there is no more just being an addict or not. I guess there isn’t supposed to be anything comfortable about drug addiction (or almost addiction), though.

“Almost addicted”: what do you think?

What do you think? Do you think people can be ‘almost’ addicts or do you think Dr. Boyd is just playing with semantics here? And do you know anyone who fits into Dr. Boyd’s ‘almost addicted’ category? Share your thoughts in the comments section.

Photo credit: pareeerica

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5 Responses to “Almost Addicted
Joel B.
10:51 am February 1st, 2013

I’m with you in that the grey area makes me uncomfortable. It has the potential to give an “out” to people who are addicted. They can claim being in this almost addicted category, therefore not needing treatment. I tend to rely on step one of the 12 steps – admit that I’m powerless over _____ and my life has become unmanageable. It’s that unmanageability that verifies the addiction to me. Either you have your life under control, or the need for your fix has become more important than taking care of yourself.

Bird Martin
3:43 am February 17th, 2013

I think I am an “Almost Addict”. I’ve periodically, over the 44 years I’ve been on this earth, had drug binges and alcohol binges that would last a few months, and then I just decide to stop. They always coincide with really, really painful things happening in my life. I’ve quit for years and then picked it up again. My doctor told me once that I was “self-medicating”. I am always worried that if I use it one more time, I’ll lose all control.

I’m ridiculous.

1:38 pm February 18th, 2013

Hi Bird. Not ridiculous. Just missing a few life tools. I wonder if you’ve ever considered psychotherapy to address the reasons which compel you to drink or use drugs? Talk therapy from a trained professional can help you figure out why it is you continue to go back to drugs and to take steps to change your life for the better.

Bird Martin
2:44 pm February 18th, 2013

I have tried counseling a few times. Once I quit because we discussed their strict payment policy for the first 20 minutes of the hour I paid for. I lost the nerve to open up in that time, and never went back. The second time, I went twice, but it was in the middle of the breakdown of my marriage, and I no longer wanted to talk to anyone about anything anymore. I know if I could get over the initial start, it could probably help, my I can’t talk about some things. They just won’t come out. I read a lot, and I try to get routines in place that don’t trigger my mind, and usually that stuff works for long periods of time.

Stan M.
9:51 pm February 26th, 2013

I don’t think that the term “almost addict” is meant to give addicts an “out.” Instead, it’s meant to cut the other way– that even if you aren’t an addict, your alcohol and/or drug use may be unhealthy. This way, it is encouraging people who don’t meet the full criteria for addiction to get help early on, rather than waiting until they *do* meet all the criteria, and it is more difficult to clean up.

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About Lena Butler

Lena Butler is a mom, health blogger and customer service representative for TestCountry. TestCountry is a San Diego based point of service diagnostic test service provider that offers a wide range of laboratory and instant testing kit solutions including drug tests, metal toxicity, DNA paternity, food and water tests and hundreds more. TestCountry's tests are easy to use and can be performed at your home or workplace.

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