Lance M. Dodes, M.D.

How do you explain recreational chemical abusers that have a compulsion to get high on the weekends? Is it possible that emotional issues of helplessness are not the cause of their compulsive behavior? (Of course they may not see the emotional issue).

Thanks for your question. The key issue is in the word "compulsion". People who get high on the weekend as a truly recreational activity aren't compulsive. If they had a good reason to stop, such as adverse medical or social effects, they could. Compulsive actions on the other hand are driven by inner emotional factors, so stopping them isn't a matter of simple willpower in response to adverse effects. Figuring out whether an action is compulsive or not usually requires an investigation -- an interview with someone trained to make the diagnosis, for instance. Or, people can challenge themselves by placing a limit on their own behavior (no more than 3 drinks in an evening, for example) and see if they can stick to it. If they can't, that's suggestive of a deeper drive.