Dr. Jeremiah Weinstock is the chair of the Department of Psychology at St. Louis University.
He’s spoke about some of the defining characteristics of substance use disorders, as well as reflected on the difficulties his patients face while in recovery.
For the month of September, we’re focusing on substance use disorders and some of the treatment options that exist for Missourians.
Dr. Jeremiah Weinstock: So, it's a maladaptive pattern of use — so, you continue to use a substance, or in the case of gambling, engage in a behavior that is maladaptive. It is causing you problems in your social relationships, at work, education.
And the hallmarks of addiction — you don't have to have all of these, but if you have one or more of these; they are suggestive — is loss of control, right?
You say I'm never going to drink again after a bad night of drinking, and then you drink a week later, right? That's loss of control.
Or I really need to cut down or stop, and you're not able to do that, and then there's when you do stop or cut down, there's withdrawal.
With alcohol and other substances like opioids, there's a physiological dependence that's going on, right? And so, your body is expecting this, and when it's not there, it reacts very adversely.
"Don't quit on quitting. That's always my line, right? It may not stick the first time, but that is — well, as a psychologist, what I'd like to say is — that's a failure of your coping skills, it's not a failure of you, right?"Dr. Jeremiah Weinstock
And finally, you know, the third hallmark is tolerance — so, you need more and more of the addictive substance or behavior to achieve that desired effect, right? And it's this really self-perpetuating cycle that takes on a life of its own.
I think that's the one challenge that many people have who don't suffer from addiction. [They’ll] say, “Well, why don't just stop using? Like just stop. Then all your problems are solved.”
And it's hard to understand that your brain has been rewired. That the only thing it knows to do is to use more substances, right? That's what it expects. That's what it needs, and so, therefore, it's not a volitional act anymore.
By the time you meet criteria for a substance use disorder, this has become a biological process and a habitual process. Both of those processes together in one that really compel future use.
Don't quit on quitting. That's always my line, right? It may not stick the first time, but that is — well, as a psychologist, what I'd like to say is — that's a failure of your coping skills, it's not a failure of you, right?
That somehow, you know, you have to kind of you kind of have to a little bit — when you enter treatment, some people will talk about it as a demon.
Some people will talk about it — in some ways just to externalize it from yourself — that you're trying to excise, for lack of a better word, a cancer from your body, right?
And it's hard and it's challenging, and so, it takes time and effort to change that wiring. I liken it to that you have this carpet that's been installed, and you've walked over that same piece of carpet for 20 years.
It's like when you go into grandma's house, and that carpet's worn from the sofa back to the kitchen, or from the sofa back to the bathroom, you know, and you have to rip out that carpet and install a whole new carpet, and that's not a quick and easy process.
