One of the first symptoms of addiction is, ironically and tragically, an ability to increase drug intake and still function “normally.” It is ironic because most diseases incur immediate and obvious penalties, not benefits, and result in reduced functioning rather than improvement in functioning. But in the early stages of addiction, the addict is not sick, in pain, or visibly abnormal. In fact, the early, adaptive stage of addiction appears to be marked by the opposite of disease, for the addict is “blessed” with a supernormal ability to tolerate drugs and enjoy its euphoric and stimulating effects. This improvement in functioning is tragic because the addict has little or no warning of the deterioration inevitably to follow. In the early stage, the disease is subtle and difficult to recognize. It is characterized by adaptations in the liver and central nervous system, increased tolerance to drugs, and improved performance when using. The early stage of addiction is characterized by Adaptation, Tolerance, and Improved Performance: Adaptation: A general biological rule holds that when any bodily system is under stress it either adapts or suffers damage. Adaptation is actually a tool of survival, helping the body endure stressful changes in internal or external environments. Adaptational responses occur rapidly, spontaneously, and in most cases, without the person’s conscious knowledge. Tolerance: Every user has a specific tolerance to drug. Below his tolerance level, the user can function more or less normally; at levels above his tolerance threshold, he will act intoxicated. Tolerance is therefore a condition that can only be measured accurately in a laboratory where the user’s blood level and behavior can be carefully monitored. Addicts typically experience a dramatic climb in tolerance in the first stage of addiction and can often use huge amounts of drug without showing obvious impairment of their ability to walk, talk, think, and react. Anyone who observes the early- and middle-stage addict’s using behavior is familiar with the fact that the typical addict can use as much as a liter of wine, a dozen beers, or even a bottle of whisky without acting high. Improved Performance: In this early, hidden stage of addiction, the only visible difference between the addict and the non-addict is improved performance in the addict when he uses and a deterioration in performance when he stops using. Addicts in the early, adaptive stage of their disease also show improvement of functioning as the blood drug level begins to rise. But unlike the non-addict, this improvement continues with additional using. Even when blood drug levels remain fairly high—levels that would overwhelm the non-addict, causing him to stumble, stutter, and sway or become immobilized—the early addict is often able to talk coherently, walk a straight line, or skillfully maneuver a car. Only when the addict stops using and his blood drug level (BDL) descends, does his performance deteriorate—and it does so very rapidly. Tragically, the addict can only temporarily control his using behavior. Over a period of years, the cells’ dependence on drug becomes more firmly entrenched until, at some point, the addict no longer has a choice. He needs drug to function, and he suffers terribly when he stops using. The benefits of adaptation are gradually overshadowed by the penalties of deterioration.
