According to Nevid et al (2008:292), a person who is dependent on substances does not just come to the point where they depend on the drug in the click of a finger, but they go through a long process of using and abusing the substance until they reach a point where they cannot control their craving for the substance; the substance then takes control of them. This is the stage where the substance user/abuser is fully aware of the damage that the particular substance is causing to their character and health, but they
―feel helpless or powerless to stop using drugs, even though they may want to.‖
Nevid et al, (2008:292) Louw et al (2005:194-195), Reisser (2006:492-493) and Visser (ed. 2007:205) give the following as an outline of how the process leading to dependence progresses:
1. Experimentation/occasional use: The user may feel good and excited;
they may even feel in control and have a belief that they can stop using the
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substance anytime. The user feels that the substance cannot control him/her.
2. Routine use: As the user continues his/her use of the substance, they get to a point where their whole life is spent on pursuing and using the substance. During this stage, the substance user hides the negative results of his behaviour from himself and others; they look at themselves as a person who is not in danger of losing control over their destructive behaviour. They (the substance users) now reach a point where whatever used to be important in their life becomes less and less important and the substance starts taking centre stage. The substance users at this stage get to the point where they will do anything to support their behaviour; they can borrow money, sell valuable items, steal from their own families, and tell lies and even manipulate others.
3. Withdrawal syndrome: As substance use takes centre stage in the life of the user (when the user becomes dependent on the drug); they come to a point where they ―abruptly‖ stop using the substance by taking a break from using it. Every time the substance user takes a break from the use of the substance, they find themselves developing some physical and psychological symptoms101 of withdrawal. Some of the withdrawal symptoms that can occur in substance users include: diarrhea, vomiting, hot and cold flushes, muscle pains and spasms, increase in body temperature and increase in the rate of breathing. Even though withdrawal syndrome is often left untreated, it may be fatal in some of the people suffering from it and according to Hunter (2005:97), up to 15% of those suffering from withdrawal can die in the event that their condition is left untreated.
101 According to Visser (ed. 2007:205), the withdrawal symptoms can be physical, psychological, or both. Visser describes physical symptoms as those that take the form of feeling ill, and psychological symptoms such as those that may lead the user to develop anxiety and other disturbances when the drug use has been reduced or stopped altogether (ibid.).
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According to Nevid et al (2008:293), those who experience withdrawal symptoms after stopping the use of substances ―often return to using the substance to relieve the discomfort associated with withdrawal‖.
Nevid et al, (2008:293) give the following substances as the ones that may lead to withdrawal syndromes: alcohol, opioids, cocaine, amphetamines, sedatives and barbiturates, nicotine, and anti-anxiety agents (minor tranquilisers).
4. Tolerance: Regular users of substances can a reach a point where they start taking larger amounts of the substance in order to achieve the same effect. In some instances, substance users may not even get larger amounts of the same substance but may go to the extent of using much stronger drugs to achieve the same effect. This may happen as the user may consider the previous substance as failing in helping him achieve the same effect the substance was giving him before.
5. Addiction or dependence: Routine use of a drug/substance turns into addiction102 or dependence when the drug user reaches a point where they no longer have the power to stop using the substance, either because they feel helpless without using the drug or because they need to experience the substance‘s effects or ―the consequences of withdrawal‖.
This dependence/addiction happens in two forms, namely physiological and psychological103.
102 Ellison and Maynard (1992:167) explain that addiction in a person starts when the particular person makes an attempt “to avoid pain” with the hope of experiencing “well-being”. Ellison and Maynard (1992:167) further argue that addiction comes about in a person when the particular person begins to get emotionally attached to
“an object, event, person or experience” as a way of fighting “stress and emotional pain”, so as to reach personal goodness. As the behaviour gets repeated, the person involved in the behaviour reaches a point where they get attached to the behaviour because of the “psychological and biochemical reinforcement” that arises from “the association between particular actions and the desired mood elevation” (Ellison & Maynard 1992:168).
103 Nevid et al, (2008:294-295) explain that in physiological dependence, the substance user’s body changes “as a result of the regular use of the substance” and the major signs of the dependence are “tolerance and a withdraw syndrome”. In psychological dependence, the substance user uses the drug to “meet psychological needs” for example to “cope with daily stress”. Nevid et al further explain that it is possible for one to be psychologically dependent on a substance “without becoming physiologically or chemically dependent”, for example, someone can use marijuana to cope with stress but may not necessarily become a compulsive user of the drug.
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