1. Patterns of substance use
Mary Golding Lloyd

2. Outline Tacit assumptions about drug use Normal use patterns
Conclusions

3. Common assumptions about substance misuse - A “medicines analogy”
Dependence or habitual use typifies drug use
Dependence should be explained by neuropsychological mechanisms
Individual and situational differences are not primary

4. Normal use patterns Experimental Occasional, intermittent Recreational
Regular binge
Light habitual
Heavy habitual

5. Experimental
Drug taking on a few occasions and no more, with no signs of increase over time
Agreed that this can occur for all drugs
Most experimenters use other substances
Most experimenters do not increase their substance use
Experimental alcohol or cannabis use is largely confined to people opposed to their use

6. Occasional, intermittent
Use occasionally, with no regular annual pattern (often confused with experimental use)
Use may be purely opportunistic – the drug is available, or the drug may be deliberately sought out
Pattern continues for years without change
Most occasional users are more regular users of other substances
Occasional users experience no problems with use and if they do, they tend to stop

7. Recreational Use according to a reasonably regular pattern
Use is usually sought out deliberately
Use may go along with specific social events or occasions
Use may involve a specific social network
Use is generally moderate relative to norms for the substance involved
Recreational use episodes usually involve multiple substances
Weekend use is one classic pattern
Acute problems are accepted as minor and manageable

8. Regular binge Bingeing is like recreational use except that:
Quantities consumed are large relative to norms
The binge may be protracted, lasting more than 12 hours
Bingeing sometimes has adverse acute effects on the user
The user may be conflicted about bingeing

9. Light habitual
This involves use probably several times a week or more, even daily
But of relatively small quantities of the drug
Quantities taken may intoxicate, but will not affect behaviour
Light habitual users usually use other drugs occasionally, but use this drug most often
When they cannot obtain the drug, they miss it, may substitute others, but can go without
Light habitual users score low on measures of dependence and may not show tolerance

10. Heavy habitual
Daily use of large quantities of drug, with signs of tolerance
Few other signs of dependence
Health may or may not be affected
(Depending on quantity and substance)
Few difficulties quitting or moderating use if required

11. What is addiction?
Addiction is a pathological love relationship with a mood altering chemical, (or activity – i.e. gambling, sex)

12. BEHAVIOURAL SIGNS OF ADDICTION
Excessive need for privacy
Secretive or suspicious behavior
Chronic dishonesty
Unexplained need for money
Change in personal grooming
Sudden change in wardrobe, hairstyle, or jewelry

13. BEHAVIOURAL SIGNS OF ADDICTION
Forgetfulness and difficulty paying attention
Lack of motivation, energy, self-esteem… ‘I don’t care’ attitude
Sudden over sensitivity, temper tantrums
Moodiness, irritability, or nervousness
Silliness or giddiness
Paranoia

14. BEHAVIOURAL SIGNS OF ADDICTION
Change in attitude/personality for no identifiable reason.
Change in friends, new hangouts
Decreased performance at school, work and/or home.
Change in activities or hobbies
Change in habits at home
Loss of interest in family and family activities

15. ADDICTION - GRIEF REACTION
Grief is at the core of the recovery process. Much like the death or ending of a long-term relationship, the addicted individual has a committed, love relationship with their chemical, person, thing, and the discontinuation of this relationship causes a significant and very real experience of loss.

16. ADDICTION 5 STAGES OF GRIEF
Denial & Isolation
Anger
Bargaining
Depression
Acceptance

17. Conclusions
Psychopharmacology tends to conceptualise drugs as taken in regular dose and pattern
Dependence is an example of this, so is medical use
Recreational drugs are used in more complex ways
The ‘standard’ questions are
How is dependent use acquired and maintained?
What harm does the drug cause?
Additional questions could be
How can use patterns vary so much over time and from person to person?
How is harm avoided?
More work on ‘unobtrusive’ drug use is required