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Emily is a model of early addiction. We mean that literally – she is a composite of many people we know. Her problems haven’t escalated to a point of crisis yet, and she is unlikely to seek treatment at this point – though treatment now could prevent many more problems later.

Emily is currently in college and works part-time as an intern in a law firm. She is maintaining her grades and work responsibilities, but she knows she could do better.

Emily tries to reserve her drinking to the weekends because she’s learned she has trouble functioning the next day if she drinks during the week. She did this a few times early in her college career and found she was typically too hungover to go to class or work the next day. But she enjoys drinking with friends and “parties hard” almost every weekend. She tries to give herself Sundays to recover. This is college life, she tells herself and feels there is nothing unusual about her behavior. A few times, she has blacked out and woken up in a stranger’s apartment.

When Emily was a teenager, she was sexually assaulted. That led to a year of depression, anxiety, and suicidal feelings. She started self-medicating, drinking heavily and using pills she found in her parent’s medicine cabinet. When her parents realized what was going on, they helped her get treatment and she started seeing a therapist. Emily started showing interest in school and activities again. She graduated from high school with honors and was accepted into a good school.

College was intimidating for her at first, but she found a group of friends and learned to navigate her new environment. Though she had stopped drinking after the therapy, it became easy to slip back into it with her friends. Emily did not like to talk about what had happened to her when she was young and believes her drinking is controlled and normal.

Occasionally she experiences anxiety and feelings of panic, especially if she has a big project or exam due. She usually handles this by taking a Xanax from her roommate’s prescription. She does not go to therapy anymore and is resistant because she believes she has left her past behind. She’s afraid if people found out she went to therapy they would think something was wrong with her, especially at the law firm. But as graduation approaches, she’s finding it more difficult to concentrate and complete her papers on time. She feels more and more restless and irritable. She believes the pressure to finish school is causing the anxiety and assumes this is just how it is. She spends more time planning her weekends with friends, and looks forward to “cutting loose” more and more each week.

Emily would score relatively low on the assessment test, and doesn’t believe she has a problem with drugs and alcohol. But she could benefit from addressing her substance use habits now. Though relatively controlled, she still uses alcohol and pills to deal with overwhelming emotions, and her weekends are dedicated to drinking, which is the primary focus of any fun she has planned with friends. She occasionally does things when she’s drinking that she later regrets. There are signs of compulsive thinking as she finds herself more and more impatient for the weekends. She is still haunted by underlying trauma, but she refuses to talk about it, preferring to utilize someone else’s prescription to calm her anxiety. She doesn’t do that very often, she tells herself, justifying her behavior. But those excuses could be a warning sign that she may be in the early stages of addiction. There is no need for Emily to let these developing patterns progress, and early treatment could help her learn more effective ways of coping before these indicators develop into problems. Emily doesn’t have to “hit bottom” to get help; she can decide anytime to begin the work to get free of the feelings and behaviors that lead to suffering.