Many people believe they need to hit “rock bottom” before getting help for a drug or alcohol problem. Often, they wait for things to get so bad they can no longer handle it – a loss in their job, a break in a relationship, a run-in with the law or, even more significantly, an overdose – before reaching their turning point. However, this does not have to be the case. 

Although it’s easy to assume a drug problem isn’t “bad enough” to get help, the truth is that it is never too early to seek professional support. A person does not need to wait until there are clear signs of a substance use disorder—one can get treatment at any stage of the addiction cycle. Counselors, therapists, support groups, and clinicians are available to help at any point. 

However, we don’t always talk about this. We hear about substance addiction and drug rehab all the time, but very rarely are informed about support for those with early, frequent, and/or problematic substance use.  

Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), recognizes this gap in awareness. In a recent article, published July 2022, she explains: 

“Far too often, the expectation is that someone must hit ‘rock bottom’ before treatment can work. But this is a myth that can have dire consequences. By then the damage is consequential and the road to recovery much harder. Factually, the best time to get help is as soon as possible. Yet frequently when a person asks for help early on, society—friends and family, coworkers, health care systems—do not recognize it as a serious issue. They may ignore or deny it.” 

Dr. Volkow, along with Tom McLellan of the Treatment Research Institute, and George Koob, National Institute on Alcohol Abuse and Alcoholism Director, are working to spread awareness about a new topic – pre-addiction – and the need for support among those who do not yet meet the diagnostic threshold for a substance use disorder. The group aims to develop a plan for better detection of early stages of addiction, and provide support before individuals develop a severe substance use disorder. 

What is Pre-Addiction? 

“Pre-addiction” is a new term created by Dr. Volkow to describe the early stages of problematic substance abuse. Specifically, it is an early condition of addiction that can be addressed and treated, before escalating into a substance use disorder. If pre-addiction is detected early, preventative care measures can be used to avert the serious consequences of a substance use disorder. 

Pre-Addiction vs. Substance Use Disorder 

The DSM-5, a manual for the assessment of mental health disorders, sets a standard of criteria for providers to diagnose a substance use disorder. According to this text, a substance use disorder is characterized by clinically-significant impairments in health, social functioning, and control over substance use. In other words, a person cannot control their behaviors and thought patterns as it relates to their substance of choice. This, in turn, has an effect on their social, emotional, physical, and mental health. Those battling a substance use disorder show multiple of the following symptoms:  

• Taking substances in ways other than directed, i.e. in larger doses or for longer periods of time. 
• Expressing a desire to reduce or stop substance use, but not being able to do so. 
• Experiencing uncontrollable cravings and urges to use the substance. 
• Spending the majority of their time obtaining, using, or recovering from the drug. 
• Spending less time on priorities at work, home, or school. 
• Giving up on important things in life, such as academics, a career, or once-loved hobbies. 
• Having difficulties in relationships due to the substance use, and still being unable to stop. 
• Facing dangerous consequences due to the substance use, but continuing to use. 
• Experiencing physical or psychological problems caused or exacerbated by substance use. 
• Developing a tolerance to the drug of choice (i.e. needing more to feel its effects). 
• Experiencing withdrawal symptoms, which are only relieved by taking more of the substance. 

Two to three of the above symptoms can exhibit a mild substance use disorder. Four or five symptoms indicates a moderate substance use disorder. Six or more of the above symptoms underlines a severe substance addiction. A severe substance use disorder is generally when people seek help. 

However, as noted above, this indicates a need for change. Anyone, exhibiting any of these symptoms, deserves help and prevention measures. For this reason, Dr. Nora Volkow is proposing we consider the criteria for “mild” and “moderate” substance use disorders to define what “pre-addiction” means.  

When facing pre-addiction, an individual may still have some control over their drug abuse. They may have seen some negative effects in their school or work performance, or even relationships, but they may still feel they can stop at any point. Similarly, a person may be facing constant urges to use a substance, but may not have felt the consequences of drug use on their physical and social health. They too may lack a motivation to stop using. 

Now, consider this: If users are to be alerted about the potential dangers ahead, the more severe effects of substance abuse and addiction, would there be more of a motivation to stop? To stop while they are still exerting control over their substance use? 

This is exactly what Dr. Volkow proposes. By implementing preventive measures to detect and treat substance use issues earlier, we can help reduce the severe consequences of substance addiction. On top of this, we can also reduce the number of overdoses affecting communities.  

Volkow explains, “A diagnosis of pre-addiction could similarly serve as an alert to the individual about a behavioral pattern with potentially major—but also very preventable—health and life consequences down the road.” Users would not need to hit “rock bottom” in order to recognize their problematic behaviors. Early detection and alert from a clinician, before things get bad, could create a different “inflection point,” she says, one that allows the patient to actively take control over their wellness. 

How Do We Support those with Pre-Addiction? 

In order to formalize a plan for those with pre-addiction, or mild substance use problems, it would require new definitions to be introduced and new standards to be set in medicine. Measures would need to be created to effectively detect substance use that is clinically significant for early intervention. 

Existing screening tools can be leveraged in primary care and preventive health facilities, but more research is needed to identify the different types of substance abuse and the precursors or risk factors that can signal a future addiction. 

Clinicians would also need to know how to deliver pre-addiction criteria and how to direct patients to the appropriate specialists for treatment.  

Further, there would need to be greater advocacy – both publicly and clinically – about substance addiction as a disease, and how it develops from repeated drug use. Because the fact of the matter is: mild and low-severity substance use disorders are always a risk for a more severe addiction down the road. Severe substance use disorders do not simply happen—they progress. They start as drug use and worsen, as the symptoms start to stack up. Many people are not educated or aware of the addiction cycle, which is an important factor in the pre-addiction concept. 

While pre-addiction is not yet a formally coined term, Dr. Volkow believes this term and, more broadly, a reframed focus on pre-addiction, will help to normalize the need for substance use treatment. Today, the idea of going to “drug rehab” carries a certain stigma. Many are ashamed to seek help. By making pre-addiction screenings common in medical facilities, Volkow believes that we can destigmatize rehab and show that anyone can benefit from specialized interventions. Further, she believes that we can raise awareness about the dangers of substance use, in turn preventing health conditions and fatal overdose. 

To learn more, visit Dr. Volkow’s original published article here: https://nida.nih.gov/about-nida/noras-blog/2022/07/time-to-start-talking-about-pre-addiction  

If you believe you are facing a drug use problem and would like to speak with a specialist, know that Turnbridge is here for you. You may call 877-581-1793 to learn about our programs for young people facing drug and alcohol disorders. Remember that it is never too early to reach out and ask for help. In fact, early intervention can be a significant component of successful recovery.