Harvard Medical School’s “Almost Effect” series is increasingly valuable in a world where mental health issues are starting to be seen on a grayscale rather than in black and white. The series, which includes Almost a Psychopath: Do I (or Does Someone I Know) Have a Problem with Manipulation and Lack of Empathy? and Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem?, was created to give guidance on “common behavioral and physical problems that fit into the spectrum between normal health and a full-blown medical condition.”
In its latest installment, Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?, primary author J. Welsey Boyd and Eric Metcalf delve into the sensitive time when one’s drug use has become troubling, but has not yet reached the diagnostic criteria for addiction.
Is all drug use bad? How do we know if we need help and when or how to seek it? What can we make of the fact that two states recently legalized marijuana? Boyd sets out to draw a road map for these tough questions for both the substance user and his/her loved ones. A medical doctor and Ph.D., he uses his impressive list of credentials — including faculty psychiatrist at Harvard, staff psychiatrist at Boston Children’s Hospital Adolescent Substance Abuse Program, and co-founder/director of the Human Rights and Asylum Clinic. The end result is a useful guide — but with a few flaws.
Because the “almost” concept may seem foreign to someone who hasn’t read one of the previous books in the series, Boyd spends time going over exactly what this means. He writes that to qualify as an almost addiction, a behavior must fall outside of what is considered normal, but, at the same time, not meet criteria for a DSM diagnosis; that it’s causing identifiable problems; that it might progress to a full-blown condition or, at least, cause substantial suffering; that an intervention should be able to help; and that stopping the behavior will improve quality of life. The benefit of identifying drug-using behavior as “almost addicted,” he writes, is that it offers an opportunity to stop and turn your life around before a problem progresses into full addiction, which is much more difficult to treat. He compares the value of this early intervention to that of spotting glucose intolerance and pre-hypertension before they turn into diabetes, heart attack, or stroke.
There is a case study in each chapter to help reader determine if a drug use is an “almost addiction,” as well as to illustrate the points raised in each section in a relatable, anecdotal way. The book gives an overview of the classes of drugs and their effects, as well as the definition of addiction and how it differs from abuse. Later, it explores possible roots of addiction, including the role of one’s family history, a drug’s effects and initial appeal during a hard time, and self-treatment for a mental health issue.
One section is geared toward family members and friends who are concerned about another’s drug use. Boyd notes that almost addiction is especially hard to see in successful people, as the effects are not nearly as obvious as those of full-blown addiction. Even health professionals miss it a lot between their time constraints and the sensitivity of the issue, he writes. He also stressed that there are things you can and can’t do to help: for instance, you can cease enabling the behavior, but you can’t force a person to seek treatment.
Next, Boyd presents materials and resources aimed directly at the almost-addicted reader, including information on helping oneself and figuring out when it’s time to find professional help (there’s a helpful, if simplistic, chart on page 223). Boyd talks about the non-physical aspects of drug use, such as how it’s woven into a daily routine, and prepares the reader for what the recovery process could look like, and what to do afterward to continue living a drug-free life.
While Almost Addicted is, overall, a valuable addition to the literature on drug use and abuse, it does have a few issues. For starters, it is at once meant for an audience of almost-addicted readers and for an audience of concerned loved ones. Granted, Boyd does try to divide guidelines into separate sections, but it’s still difficult to distinguish the approach he intends for each group.
Boyd also attempts to mention and include all drugs, yet concentrates overwhelmingly on marijuana. Pot is becoming more and more accepted, though, and instead of scapegoating it as the source of all drug problems (which seems simplistic at best), I wondered why Boyd didn’t focus more on prescription drugs—especially since this is the fastest growing area of abuse and addiction.
Finally, there’s a bit of a problem in the last part of the book, where Boyd recommends seeing a primary care doctor to begin the recovery process: The suggestion comes after an entire section on how primary care practitioners don’t have time, motivation, or expertise to notice, let alone care about, the almost-addicted population.
Boyd himself identifies one problem with his “almost addicted” framework: “I wish I could offer some completely black and white advice about using drugs that would be applicable for everyone, but doing so would probably be intellectually dishonest,” he writes. “You’ll have to decide where to draw the line on what kind of presence that drugs — legal or not — can have in your life.”
Regardless of these issues, Almost Addicted is still a well-researched and cited work with information and advice for those who are verging on succumbing to addiction. The emphasis on early intervention, before one experiences traumatic consequences, is not only valid, but an essential concept that will hopefully push our notion of drug treatment forward.
Almost Addicted: Is My (or My Loved One’s) Drug Use a Problem?
Hazeldon Publishing (Harvard Health Publications), 2012
Paperback, 264 pages