The 4 L's

The 4 L’s that define our personal harms

July 5, 2023

Personal harm by substance abuse is rampant in Australia. It’s not unique to our country, but the stats are still fairly alarming. Around one in 20 Aussies will have substance abuse problems or addition-forming habits. One in ten are regular smokers, and one in six drinks excessively and dangerously. Almost half of all Australians (43%) have tried illicit drugs.

While we may argue about the exact effects of drug use, even the milder forms, such as alcohol and marijuana, can cause life-long habit-forming problems. The initial use, typically for pleasure or as a form of escapism, becomes necessary as the brain adapts to repeated drug use. At this point, the enjoyment factor decreases while dependence increases, often altering the brain permanently over a longer exposure period. 

Depending on the severity of the addiction, and the drug, the resulting behavioural changes can have incredible psychological and physical implications. These are often seen as the ‘knock-on effects’ of substance abuse, or what is sometimes described as the ‘Roizen’s four L’s’.


Ron Roizen: American sociologist. 

In the late 1960s, Ron Roizen was touring alcoholism treatment facilities in a survey headed by the NIMH (National Institute of Mental Health). The federal-backed program was part of a government-wide effort to understand better how facilities in the U.S. were treating recovering alcoholics. Through his involvement in this study and later work in the Social Research Group, Ron came to talk with scores of alcoholics about their experience.

This study matters because Ron, through his interaction with substance abuse victims, began to see alcoholism as a disease, with the knock-on effects being psychological and physical damage.* While he wasn’t the first person to do this, his analysis and later writings helped form the core system of harms that come from substance abuse, which support workers have since been using for decades to help young people transcend from pre-contemplation to contemplation regarding their addiction problems.


The 4 L’s and personal harms.

The 4 L’s aren’t specific diagnoses but help explain the four key areas that signify a substance abuse problem. They’re also useful for helping recovering or newly committed substance abusers understand and become aware of how their consumption has affected their lives and those of others around them. The 4 L’s can be described as follows;



Lover describes how drug abuse affects the relationships around us. These aren’t necessarily sexual relationships but refer to familial and friendship groups. A problem is apparent when we see a marked change in these relationships, such as self-distancing, abuse, neglect and even cohesion by one partner to join in with substance abuse activities. 



The liver symbolises the physical and mental decay which can arise from substance abuse, including cirrhosis, depression, anxiety, psychosis, infection, fever and, of course, liver damage. The liver forces the substance abuser to confront their mental and physical condition, including deterioration from substance ingestion. 



This L is in recognition of the ways one’s lifestyle changes due to substance abuse. Perhaps they’ve given up work, recreational activities, socialising, and sleeping. When one or more major lifestyle changes occur with deteriorating effects, the liver or mental health of the abuser is generally affected as well. Mental illness can also prevent the abuser from feeling able to engage in their normal activities.



While lawful drug use is a contested subject, substance abuse can lead to more unlawful activities, including obtaining drugs illegally. If the abuser has a history of law enforcement trouble, the issue may stem from a wider drug problem. Observing one’s relationship to the law forces the substance abuser to reflect on their relationship with drugs and subsequent behaviour, especially as it also affects their lifestyle and relationships.


What to do with the 4 L’s.

The four L’s aren’t a clinical analysis but a tool that anyone can use to measure their behavioural patterns and the consequences of their actions. Each of the four L’s speaks to an integral part of human identity and health that, under normal circumstances, are usually safeguarded against danger. When one of the L’s is placed in danger, or the substance abuser suffers from increasing urges, their values realign due to the addiction and/or a shift in their personality and priorities. 

By considering the changes in one or even all four of the L’s, the substance abuser is confronted with the way in which their addiction has changed their behaviour and lifestyle. While this may not be enough to overcome addiction alone, it’s a useful exercise for reevaluating how small decisions have led to large, negative consequences that impact one’s mental and physical health, relationships, position in society and standing with the law.


Getting help.

If any of these behavioural or mental problems sounds like something you’re undergoing, please phone the alcohol and drug hotline ADIS (Alcohol & Drug Information Service), especially in the case of an emergency or relapse. The hotline can be reached here; 1800 250 015. 


*Ron’s definition of these effects came from his analyse of Marty Mann, who coined the concept of ‘alcoholism’ as a disease in 1939, based on her own experience.


Sources cited:

  • Garth, Aaron. “Roizen’s 4 L’s helping young people begin to deal with substance misuse” on Ultimate Youth Worker. Date Accessed: 16th June, 2023. Site Link:
  • “Illicit use of drugs” on AIHW. Date Accessed: 16th June, 2023. Site Link:
  • “Is marijuana addictive?” on NIH. Last Updated: 16th June, 2023. Site Link:
  • “Substance abuse” on healthdirect. Date Accessed: 16th June, 2023. Site Link:  
  • Roizen, Ron. “Merging alcohol and illicit drugs: a brief commentary on the search for symbolic middle ground between licit and illicit psychoactive substances” on Date Accessed: 16th June, 2023. Site Link:
  • Roizen, Ron. “Where Did Mrs. Marty Mann Learn Alcoholism Was A Disease and Why Should It Matter?” on Chestnut Health Systems. Date Accessed: 16th June, 2023. Site Link:
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