Addiction Isn't the Only Type of Drug Problem
The premise of the book is important in the current climate, in which people tend to underestimate the harms caused by alcohol and drug use because their behavior does not fit that of the stereotypical addict. According to the authors, there are four aspects of being "almost addicted:"
- The problem falls outside of normal behavior but falls short of meeting the criteria for a diagnosis of substance dependence;
- The problem is currently causing identifiable issues for individuals and/or others in their lives;
- The problem may progress to the full blown condition, meeting accepted diagnostic criteria, but even if it doesn't, still can cause significant suffering;
- The problem should respond to appropriate interventions when accurately identified.
But is "Almost Addicted" a Useful Concept?
While it is true that many people go through a prodromal phase, in which their alcohol or drug use become more central to their lives, but they don't quite meet the criteria for substance dependence as defined by the DSM-IV, many people use drugs or alcohol sporadically, or in binges, without necessarily being on the path to addiction.
This doesn't mean that their use isn't harmful. And one of the difficulties with working with people who use alcohol or drugs is the way they use the concept of dependence as a yardstick by which to measure whether or not they have a "problem." So the concept of being "almost addicted" may reinforce the idea that if you fit the definition, you "almost" have a problem, and that the problem will become real only when you progress to "full blown" addiction. This could keep people hanging on to the idea that they don't need to change until they cross over into the "addict" category. In the meantime, they may be experiencing many physical, emotional, social and financial problems that they don't even recognize, because the only important problem is addiction.
The other difficulty with the "almost addicted" idea is its position between so-called "normal feelings and behaviors" and "the condition meets diagnostic criteria for full-blown pathology." This is useful in that it recognizes that addiction is on a continuum with healthy behavior, but that continuum is not necessarily linear. Some substance use, such as the use of medical marijuana, is healthy. Some behaviors, such as daily alcohol or caffeine consumption, is normal, in that it is common and socially acceptable, but it is not healthy. So it creates a one-dimensional perspective of substance use in terms of addiction and "normal" behavior, when that dimension is not very accurate in the first place.
The book does actually go into a lot of the complexities of substance use and related problems beyong a pathological, one dimensional view of addiction, including the causes of problematic substance use, concurrent mental health problems, and the impact of substance use on the family. But the title frames it in terms of addiction being the central problem.
Drug Use is Varied and Drug Users are Diverse
The book does a great job of illustrating the huge variety of different types of drug use that exist in modern society, as well as breaking down the stereotype of drug users by showing the diversity of different drug users. For example, we see how marijuana users rarely recognize the problems their drug use causes them, especially when they can hold down a job. We see how medication abuse can develop both by those for whom these drugs are prescribed, by those purchasing medications on the black market, and by medical professionals who have access to medications through their work. And we see how illicit drug use can happen in a variety of different circumstances, with people of all socio-economic backgrounds.
This is an important concept for people to know about when they are thinking about their own or their loved ones' drug use, because many still tend to think of drug users as poverty stricken illicit drug users who can't hold down a job.