A simple definition of addiction is continued use of a substance in spite of repeated negative consequences.

When a person discovers, and eventually admits, having a problem with alcohol or other drugs, the best solution is to quit entirely. Half-steps or efforts to control or “cut down” drinking or use after addiction has taken hold will lead to more severe problems.

A decision to quit using alcohol or other drugs only occurs when a person decides that the negative consequences outweigh any remaining limited benefits of continued drinking or use. There is no need to wait for catastrophic events—sometimes called “hitting bottom”—to quit. There is no time better than now to weigh the benefits of continued alcohol or drug use against the risks.

Addiction to alcohol and other drugs is accurately described by medical and legal authorities as a disease. It is chronic, like asthma and many other diseases. It is a long-lasting condition that can be managed but not cured. When suffering addicts and alcoholics admit to themselves and then to others that they have a problem, and comply with treatment, symptoms of the disease will get better. Addiction is a progressive disease, meaning that its course is predictable and its effects will get incrementally worse if left untreated. The ultimate consequence of untreated alcoholism and other drug addiction is death.

Fortunately, several treatment approaches are known to work. All require long-term follow-up, relapse prevention planning, and continuing self-care. These can range from outpatient to short-term inpatient, or long-term residential programs. Any one of these approaches works for many, but none is for everyone. If one has had no prior treatment, the place to start is with a personal interview with an alcohol- and substance-abuse counselor, either in a clinic setting or a private practice. A treatment plan will be recommended based on the person’s past history and needs.

As with survivors of cancer or other diseases that include the possibility of remission, the best hope for recovering alcoholics and addicts is to live long productive lives and to one day in the distant future die of something else. This requires letting go of shame and stigma; and it requires careful planning.

Any relapse prevention plan must be individualized to take into account the triggers—recognized as people, places, or things (including feelings, thoughts, or situations)—that cause the idea of using to re-enter a recovering person’s mind. A recovering lifestyle requires a network of sober supports including peers who are successfully getting through life every day without falling back into old patterns that could lead to a downward spiral.

A stable home living situation is crucial to sustained recovery. The importance of committing to a program of recovery and supportive fellowship cannot be over-emphasized.

To head off a relapse, each recovering person needs to be able to identify what he or she is doing to maintain physical, mental and spiritual health. A personalized roadmap is needed, with boundaries marked not only by compliance with laws and good ethical judgment, but also goals with educational, vocational and financial landmarks.

[Tom Rue is a licensed mental health counselor and credentialed alcoholism and substance abuse counselor in New York State. He is certified as a clinical mental health counselor by the National Board of Certified Counselors. Contact him at 845/513-5002 or www.choicesmhc.com.]

Preventive screening and referrals

Despite the frequency of mental health and substance use problems, too many Americans go without treatment. Healthcare providers use standardized screenings with people of all ages, even the young and the elderly, to identify mental health and substance use problems, which translates into earlier care. The CAGE-AID questionnaire is a commonly used simple tool to recognize drug or alcohol abuse.

Start by asking yourself:

• Have you ever felt you should CUT DOWN on drinking or drug use? □ YES □ NO

• Have people ANNOYED you by criticizing or complaining about your drinking or drug use? □ YES □ NO

• Have you ever felt bad or GUILTY about your drinking or drug use?□ YES □ NO

• Have you ever had a drink or drug in the morning (EYE OPENER) to steady your nerves or get rid of a hangover? □ YES □ NO

If you answered “yes” to two or more questions, an assessment with a substance abuse counselor is suggested.

Other screenings can be found at www.integration.samhsa.gov/clinical-practice/screening-tools.