It's not how much or how often you drink or take drugs that determines if you are addicted. It's a set of criteria that includes the 3 Cs: Consequences, loss of Control, and Compulsion.
Negative consequences
Early in the course of addictions, relationships are affected: family becomes concerned, relationships become strained, there may be a change in friends and later a tendency to isolate. The addicted person engages in behaviors that contradict their values or sense of right and wrong. This causes feelings of anxiety, guilt, and anger. Addiction to alcohol and other drugs has been called the great psychiatric impostor, mimicking mood disorders, manic depression, personality disorders, and even some types of psychosis. Sometimes there are injuries due to impairment and expressions of concern from the attending physician because of elevated blood pressure or other medical problems caused by increased alcohol or other drug use.
Legal consequences
Roadside suspensions, impaired driving charges, assault, or disorderly conduct occur during early and mid-stage addictions. Usually the last area of the substance dependent person's life to be affected is the workplace. Feeling guilty and anxious, they often overcompensate at work, appearing to be model workers, despite being moody, irritable, and sometimes inconsistent. However, as the disease progresses there is increasing time loss, especially around weekends, and more sick days and injuries. Interpersonal problems develop, leading to complaints, grievances, or disciplinary action. As already happened to close friends and family, those working with the addicted person become negatively affected.
Loss of control
The most important diagnostic sign of addiction is the fact that, once the drug-dependent person starts using their drug, they are never able to be completely sure how much they will consume. It may only happen very occasionally, but sometimes after one or two drinks or doses an overwhelming urge to keep on drinking or drugging occurs (it's called "priming" and is believed to involve the neurotransmitters: beta-endorphins and dopamine). Despite other commitments, the addicted person keeps right on using their drug.
Compulsion
Compulsion, unlike craving, is an unconscious drive. Compulsion to drink or use drugs means the drug-taking behavior becomes of such a high priority that it crowds out or endangers other, previously important priorities. The alcoholic may go back to drinking even though it could end the marriage; the marijuana-smoking attorney will continue even though it endangers her career; the drug-dependent physician will once more divert drugs for his use, knowing that severe disciplinary action could result. It becomes the most important activity in the life of the addicted person.
Physical dependence
At one time, the phenomena of increased tolerance to a drug and withdrawal symptoms upon stopping were considered necessary signs of addiction. Although tolerance and withdrawal are often present, more so with some types of drugs than others, they are not necessarily present in substance dependence. The binge alcoholic is still alcohol dependent a month after her last binge. Early in the course of addiction to alcohol, cocaine, and marijuana, physical dependence is not present, yet a clear diagnosis of drug dependence or addiction may be made.
Ray Baker, MD