Are you addicted or not addicted? For years, the general public and health experts have regarded these as two distinct conditions—either you were on the side of the door that meant you were living a healthy, nonaddicted life…or you had walked through the doorway and into the “addiction room,” unable to function without your drug of choice, whether it be alcohol, prescription painkillers, anxiety drugs, sleeping pills, or pot or street drugs.

But now experts are realizing that the space between the nonaddicted state and the addicted state isn’t so black and white. It’s more like a gray hallway that links two rooms. People in this area use drugs in ways that, while not fitting the clinical definition of drug abuse or addiction, are nonetheless taking subtle or substantial tolls on their lives. This gray area is known as almost addiction.

“Even if you don’t have a full-blown addiction and you haven’t had major difficulties because of substance abuse, your drug use can still negatively impact your life. You can still have a ‘drug problem.’ Indeed, I believe that there is a huge swath of people out there who are almost addicted,” said Harvard psychiatrist J. Wesley Boyd, MD, PhD, coauthor of Almost Addicted—Is My (or My Loved One’s) Drug Use a Problem? (Although this article focuses on drugs, people also can be almost addicted to alcohol. For more on that topic, click here.)

While there are no exact figures on how many people are almost addicted, an estimated 16 million Americans admit to using prescription drugs for nonmedical purposes, and 22 million use illicit drugs. Occasional users probably have few negative effects—but among regular users, the majority fit the definition of almost addicted.


A variety of factors can put a person at increased risk for becoming almost addicted, said Dr. Boyd. These include…

  • Easy access or frequent exposure to the drug.
  • A perceived need to self-medicate to escape difficult situations or to numb painful emotions.
  • A family history of substance abuse. Note: Research indicates that genetic factors may be responsible for 30% to 60% of the overall difference in the risk for drug addiction among different people, Dr. Boyd said.

The first step toward fixing a problem is to acknowledge that there is a problem. Unfortunately, denial is a hallmark of addiction…which is why almost addicts also may have difficulty recognizing that they are getting into trouble. In fact, many almost addicts are convinced that their lives actually are better because of their drug use, even if those around them have told them otherwise.

Helpful: Remind yourself that making a strong effort to see past the denial can pay off hugely. “Understanding that you are almost addicted offers a precious opportunity to turn your life around before you slide into the full pathology of true addiction,” Dr. Boyd said.

Study the warning signs below for both addiction and almost addiction, being as honest as you possibly can in assessing whether you fit into either category.

Someone who is truly addicted shows five key warning signs…

  • Growing tolerance for the drug, which leads to a need for ever-increasing amounts in order to feel “buzzed.”
  • Withdrawal, a physical and/or emotional response to the drug leaving the body.
  • Loss of control, with the addict using more of the drug or using it for a longer period of time than he/she intended.
  • Inability to stop, with the person failing to reduce or halt usage despite attempts to do so.
  • Obsession or preoccupation, with much of the addict’s time spent thinking about getting and using the drug.

If you are almost addicted, your drug use almost certainly…

  • Causes you to behave in a way that falls outside of what is regarded as normal—even though it doesn’t quite meet the criteria for a diagnosable substance use disorder. “Although many people use drugs to obtain a buzz, relax or otherwise feel good, people who are almost addicted go beyond occasional use and cross a line. For example, they may feel good only when under the influence and get irritable when they don’t have access to drugs,” Dr. Boyd said. While they can get by without their drug of choice, they sometimes find themselves “gritting their teeth” in order to stick to the limits they’ve set.
  • Is causing small but significant problems—for you, your loved ones and/or other people in your life. Examples: Even if your drug use has never caused you to lose a job or get arrested, it has sometimes interfered with your ability to meet your daily responsibilities at home or at work…and/or has caused strain with your family, friends or coworkers.
  • Has the potential to progress to full-blown drug dependence.

If you’re not sure where you stand, ask your family members, trusted friends and your doctor to be frank with their feedback about your drug use. But understand, just because they haven’t noticed or mentioned a problem doesn’t mean that no problem exists—because the signs of almost addiction are fairly easy to cover up, Dr. Boyd said.


The good news is that addressing the problem is likely to improve the health and quality of life of the almost-addicted individual and/or the quality of life for others around him. According to Dr. Boyd, it is possible—though not easy—for some almost addicts to get their drug use under control without fully stopping. However, it’s important to understand that this is more the exception than the norm. In most cases, he said, it is necessary to stop using drugs entirely.

Many almost addicts benefit from working with a therapist or counselor who is knowledgeable about substance abuse. “If there is an underlying problem driving your substance abuse, your odds of successfully addressing your problem increase dramatically if you also address any underlying issues,” Dr. Boyd said. If you determine that you’ve been using drugs to “self-medicate” because of depression or anxiety, speak to your therapist and family doctor about how to address these problems at their roots—not just cover them up—with lifestyle changes and, if appropriate, with prescription medication. In addition, you may find it helpful to participate in organizations such as Narcotics Anonymous ( or Alcoholics Anonymous (

“Change is never easy, and it is especially hard for people who are even partly under the grip of an intoxicating substance,” Dr. Boyd said. “Nevertheless, if you are an almost addict, it is possible to modify your behavior—and to bring about dramatic improvements in the overall quality of your life and the lives of those around you.”

For more information: To learn more about what can help when you or a loved is struggling with a substance use problem, read…

The Painkiller Trap

Addiction: It’s Not What You Think

Kids Are Getting Their Drugs from You

Drink Too Much? Have a Drug Problem? Warning Signs and What to Do

Who Could Develop a Drinking Problem?

Alcoholic? AA works—But It Helps Men and Women Differently

How Former Heavy Drinkers Can Protect Their Health Today

Helping Others Helps the Helper