DEAR DOCTOR K:

I think I may have a drug problem. But how can I tell if I'm truly addicted?

DEAR READER:

The world is not divided neatly into those who are "addicts" and those who are not. More and more, doctors are viewing substance use as a spectrum.

Imagine that spectrum as a straight, horizontal line. At the left end are people who have do not use potentially addicting substances. Just in from the left end is a group that uses a potentially addicting substance regularly but only in small amounts -- and never feels pressure to use that substance.

At the extreme right end are people who need to use a potentially addicting substance every day, and do. They do whatever it takes to get that substance. They are addicted to it, and they:

-- need ever-increasing amounts of the drug in order to get high.

-- experience unpleasant physical and emotional symptoms when the drug is leaving the body.

-- use more of a drug or use it for a longer period of time than intended.

-- are unable to stop using the drug, having repeated, failed attempts to stop or cut down.

-- spend a lot of time obtaining, thinking about or using the drug.

Just in from the right end are those with substance abuse. This is milder than addiction; it describes those who have experienced significant impairment or distress because of their need to use a potentially addicting substance. One or more of the following is also true:

-- They are failing to fulfill major obligations at home, school or work.

-- They have repeatedly used substances when doing so may be physically dangerous.

-- They have recurrent legal problems as a result of substance use.

-- They just can't stop using the substance despite the problems it is causing them.

Colleagues of mine at Harvard Medical School think there is yet another group: the "almost addicted." On the spectrum, this group lies right in the middle. They're to the right of those who regularly use addicting substances without a problem. And they're to the left of those with substance abuse. For the almost addicted, substance use:

-- falls outside normal behavior, but is short of meeting the criteria for addiction or abuse.

-- causes problems for the person using drugs or for loved ones or other bystanders.

-- has the potential to progress to a diagnosis of drug abuse or drug dependence ... but even if it doesn't, it can still cause substantial problems.

At my website (AskDoctorK.com), I have a list of 20 questions to help you determine if you or a loved one might be almost addicted. It comes from a new book, "Almost Addicted: Is My (or My Loved One's) Drug Use a Problem?" by Harvard Medical School's Dr. J. Wesley Boyd and Eric Metcalf, MPH.

If you think you may have a problem, try to begin the journey away from drug use. One place to start is with your doctor. He or she can help you find the resources you need to help you quit.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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