The natural history of drug addiction

The natural history of drug addiction The consequences of drug use change over time. Initially, there is a “honeymoon” period in which few, if any, of the costs of getting high have had time to emerge. But, as drug use continues and becomes more frequent, the consequences begin to include direct negative effects, such as tolerance and withdrawal, and indirect, socially mediated penalties, such as criticism from friends and family, legal problems, financial problems, workplace problems, and the like. Over time, the negative effects accumulate and the positive effects weaken (e.g., tolerance) so that, eventually, there is a period in which drug users often claim they want to stop using but keep using anyway. This is often described as loss of control. Day-to-day patterns of use. Regular drug use requires planning and subterfuge. Drugs are often hard to come by and, if illegal, purchases must be made with care, planning and duplicity. To a lesser extent, legal addictive drug use comes with the same challenges. Implicit in these observations is that even the heaviest users are not high all the time. Indeed, many addicts have regular or part-time jobs and families that they tend to (e.g., Courtwright et al. 1989; Hanson 1985). Thus, addicts are not without opportunities for non-intoxicated reflection on whether to continue using drugs (e.g., Toneatto et al. 1999).