If we use a substance repeatedly, our bodies and brains become habituated to it. Over time, if we are using a substance frequently, to get the desired impact from the drug we need to use more of it. The term for this is “tolerance” – it happens with any substance whether it is legal (alcohol, cannabis, tobacco) or illegal (fentanyl, crystal meth, or cocaine).
Tolerance sets the stage for using more and more of the substance, typically with reduced positive impacts. Cravings for the substance drive us to use it compulsively, until the point where we no longer experience control over whether or not we consume it. When we are caught in a problematic cycle of use, it is called substance use dependence or addiction.
After developing dependence on a substance, we go into withdrawal when we don’t use it. In the case of caffeine, withdrawal might look like a headache and lethargy. However, with some drugs, acute withdrawal is very intense, prolonged, and unpleasant. People who have experienced it typically have no desire to ever do so again, which locks them into a cycle of ongoing use. In order to avoid withdrawal, the person using the substance, needs to consume it regularly. Taking a day off from substance use is not an option.
If the drug we are dependent on is one that is purchased on the unregulated market and we are locked into using it even though it presents a potentially lethal risk, we are caught in a high-risk cycle of use. Either that, or we experience withdrawal. It’s a lose/lose situation.