There’s a fine line between substance abuse and dependency, so how do you know when you’ve crossed it? Laurel Hermanson candidly discusses her personal vices—alcohol, cigarettes, and pain pills—and the difference between habits and addictions.
I love coffee. Sometimes at night when I’m watching TV and a character sips coffee, I think, Ooh, I get to do that in the morning. I used to drink about half a pot but that made me twitchy, so I’ve cut back to one cup. I didn’t drink coffee at all until my early 30’s when my brother came to live with me in Portland. He brewed a pot every morning and it smelled so good I thought, Why not? After all, I was living in a city known for its love of good coffee.
I love Vicodin, too. Like coffee, it makes me a more agreeable person, and when I have a prescription I look forward to the next dose. Unlike coffee, proclaiming my love of Vicodin is not socially acceptable. But I’m getting ahead of myself.
My brother also moved in with a serious smoking habit. I often joined him on the back patio to bum a cigarette, but I could take it or leave it. When my brother and I talked about our different smoking habits, he said I was lucky I didn’t have the “addiction gene.” I questioned whether or not genetics had as much to do with addiction as he believed, since we were born to the same parents and raised in the same household.
We both started smoking as embryos. Our mother, like many women of her generation, was unaware of the risks of smoking while pregnant. Our parents smoked in the house and in the car when we were growing up. I hated it. I taped a “No Smoking” sign to my bedroom door. My brother started smoking in high school. The first time I saw him with a cigarette, I cried.
I started smoking during my freshman year of college, the same year my mother quit. Maybe I was rebelling, or trying to seem cool, or just looking for something to do with my hands while binge drinking, but I wasn’t a heavy smoker. I was a “social smoker”—when smoking was still social and the most interesting people at parties were out on the back balcony puffing away. (That’s what we told ourselves.)
For many smokers, cigarettes and alcohol are inseparable friends. I used to joke that I liked to indulge my self-destructive habits simultaneously, but there is science behind that tendency. Studies show that “people who smoke are much more likely to drink, and people who drink are much more likely to smoke.” And the news gets worse:
“Dependence on alcohol and tobacco also is correlated: People who are dependent on alcohol are three times more likely than those in the general population to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol.”
Dependence is a loaded (ha ha) word for people like me, people who believe they are not addicts or even predisposed to addiction. Dependence and addiction, however, are not synonymous. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), addiction is not listed as a disorder. Instead, the DSM-IV includes “dependence” and “abuse” as distinct disorders which, when coexistent, indicate addiction.
(The more recent DSM-V combines dependence and abuse into “Substance Use Disorder.” This has created confusion and controversy even among addiction specialists, so for my purposes I’ll maintain the distinction.)
Dependence occurs when the use of a substance causes one to exhibit physical symptoms such as increased intolerance or withdrawal. Abuse describes a person who uses a substance excessively, either regularly or periodically, without yet showing signs of dependence.
I recently told my doctor that I fantasized about a posh rehab facility, an environment free of temptation that would help me kick my lingering addictions. He laughed and told me I was not a candidate because I’m a piss-poor addict. Despite my history of substance abuse and dependence, not once have those two “disorders” overlapped.
I mentioned my brother’s “addiction gene” theory, wondering aloud if he was right. My doctor was skeptical, disputing conventional wisdom that addiction is a hereditary predisposition passed from one generation to the next. He supported his skepticism with science, something about neural pathways and the developing brain. He said the younger a person starts using a substance, the more likely they are to become an addict later in life.
Before I had my daughter, I was rarely concerned about addiction. I kept smoking after my brother moved out, stepping it up to a daily habit. Not surprisingly, I found new friends, people who smoked and drank, which was a convenient excuse to revisit my college and post-college party girl behavior. I drank excessively, usually just on weekends.
I still considered myself a social smoker and drinker, because I could give up cigarettes and alcohol for weeks with little difficulty and no withdrawal. I was aware of the difference between a drinking problem and a problem drinker. I thought of myself as the latter. I didn’t drink every day, and I knew I could avoid getting stupid drunk by limiting myself to two drinks, or better yet, no drinks.
When I got pregnant, I quit everything except Lexapro (to avoid postpartum depression) and a tiny bit of caffeine. No alcohol, cigarettes, Diet Coke, clonazepam (an anti-anxiety drug), prescription migraine or allergy medications, or over-the-counter drugs. A quick taper off clonazepam wasn’t fun, but the rest was easy.
After pregnancy and a year of breastfeeding, I slowly resumed taking only medications needed for migraines, allergies, and anxiety. Coffee and Diet Coke once again became staples, but I didn’t pick up all my old bad habits. I enjoyed an occasional cocktail, but I wasn’t interested in taking care of a toddler while hungover. I never even thought about smoking.
Pregnancy notwithstanding, basic physiology and routine hormonal fluctuations cause addiction to manifest differently in women and men. Researchers have learned that gender plays a role not only in a person’s susceptibility to addiction, but also in chances of recovery and risk of relapse. While men are almost twice as likely as women to become addicts, addiction tends to present unique challenges for women.
Specifically, “Women develop medical or social consequences of addiction faster than men, often find it harder to quit, and are more susceptible to relapse.”
Research also shows that stress can lead to addiction in certain individuals, as well as an increased risk of relapse during recovery. (I suspect few addicts need science to verify that vulnerability.)
I mention hormones and stress because when my daughter was almost 3, all of my happy hormones were long gone and I was dealing with overwhelming stress. My marriage was spiraling toward divorce. My initial response was to start drinking again, at times heavily, although not nearly as often.
I caught a nasty strain of food poisoning that persisted beyond any medical explanation other than stress. My gastroenterologist prescribed Vicodin—for six months. When the 5/300 dose (5mg hydrocodone and 300mg acetaminophen) didn’t work, he bumped me up to 10/600 tablets. Perhaps I should have sought a second opinion, but I was tired of tests, and Vicodin was something I was not willing to give up. It relieved my pain and made life more bearable, not just for me but for the people around me. I loved it. I set a pill on my nightstand before bed so I could take it as soon as I awoke and let it kick in before I got up.
On more than a few occasions, I mixed Vicodin and alcohol. Since I was also taking an SSRI and clonazepam, I knew I was straying into dangerous territory. Lucky for me, the worst consequences I suffered were days spent vomiting, hating myself for being so stupid.
After six months, my inability to become a proper addict asserted itself. I had rarely exceeded my prescribed dose, but I had developed a tolerance to Vicodin, and that made me nervous. I quit cold-turkey over three miserable days.
I wish I had learned from that experience, developed healthier ways of coping with stress. But once I emerged, divorced and drug-free, a whole new world of stress awaited me. The stress of single motherhood, unemployment, depression. When it all became overwhelming, I turned to my old friends, drinking and smoking. I hadn’t smoked in six years, but once I started again, I was all in.
I found a whole new group of friends who shared my vices. During the next few years, I didn’t give a shit about addiction. I joked about how a 750ml bottle of wine was a cute single serving, about how a cigarette and a Diet Coke was the breakfast of champions. In my mid-40’s, I was partying harder and more frequently than ever before.
Even after the major life stressors dissipated, after I remarried and started working and overcame depression, I zeroed in on stupid daily bullshit to justify my behavior. My daughter’s sick, too needy, won’t do her homework? Mommy needs wine and a cigarette. Can’t quite finish that project on deadline? Might as well get drunk and smoke. Nailing an assignment by working my ass off? I deserve to celebrate—with wine and cigarettes. And hanging out with friends who are all drinking and smoking? Fuck yeah.
At some point this summer I recognized the foolishness of the path I was on. I quit drinking and smoking, but just long enough to reassure myself that I could. I’ve eased back into these vices in moderation. I’m more mindful of moods or situations that leave me vulnerable to overindulgence. But even moderate smoking is too risky. I need to quit, and in order to do that I need to quit drinking, too.
So why am I not, technically speaking, an addict? Why won’t my doctor send me to rehab or even recommend I use the patch to quit smoking? Because while my mind embraces substance abuse, my body rejects dependence. This has nothing to do with character or willpower or anything over which I have control.
Maybe there is something to my brother’s theory of an addiction gene. Or maybe science is correct in its assertion that early substance abuse shapes the immature brain’s developing neural pathways. Maybe it’s a combination of both, but the semantics don’t really matter to me, or to anyone fighting substance abuse, or dependence, or both.
I know one thing for sure: As my brother said 20 years ago, I’m damn lucky. But I need to take advantage of that luck. I may not be an addict, but I don’t want to be a substance abuser, either. I want to be healthy. I want to be a positive role model for my daughter.
Most of all, I want to live to see her grow up.
Role/Reboot contributor Laurel Hermanson is a freelance writer and editor in Portland, OR. Her first novel, Soft Landing, was published in 2009. She is currently working on her second novel, Mommune. She blogs about almost everything at Disgrace Under Pressure. Find her on Facebook and Twitter.