Post No.: 0359
Sufferers of both substance-based/drug addictions (e.g. cocaine, heroin, nicotine, alcohol) and behavioural addictions (e.g. gambling, pornography or sex, shopping, eating, working) feel unbearable cravings, feel out of control, can get into financial dire straits for their addiction, are extremely preoccupied with whatever they’re addicted to, can hide their addiction in secrecy and often feel an immense shame over it.
With substance-based addictions, there’s a tolerance effect i.e. addicts feel the need to have more and more of the substance to feel the same hit as before, as well as withdrawal symptoms, which include a growing anxiety if they don’t access the substance for a while. Drug addiction withdrawal can lead to sleep deprivation, and the stress of sleep deprivation increases the risks of a relapse back to addiction, resulting in a difficult vicious cycle to break out of.
There are sometimes disputes about whether something like wanting too much food or wanting too much sex should be classed as addictions – but I’d say the real issue is whether the person experiences many of the above symptoms and it sufficiently negatively impacts their life for a few weeks or longer. In other words, do they suffer in terms of their physical, mental, social and/or financial well-being?
Addiction is not a moral failing and should not be stigmatised. Addicts should be treated with compassion. Specific genes have been identified as playing a critical role in both the development of drug and behavioural addictions. It is a complex disorder, a disease of an organ – mainly the brain in this case – like other diseases that affect other organs. People with hypertension or atherosclerosis, for instance, have these respective diseases chronically, and often frequently ‘relapse’ in their lifestyle habits too.
With a physical blow to the head, it’s not the bruise on top that primarily matters but the messed-up effect on the brain inside. Addictive substances don’t leave an external bruise for us to superficially see but directly mess up the brain inside. On this basis, it’s therefore difficult to blame addicts for being addicted, especially if they were misled or misinformed when taking their first dose. Post No.: 0337 explained how the likelihood of drug dependency increases the earlier one’s first recreational drug experience or exposure was.
I fortunately don’t know firsthand what addiction feels like but maybe fighting withdrawal symptoms is like being set on fire yet trying to resist jumping into the water? Like a fire, it’s ‘just a chemical reaction’ too, except an addiction is one happening inside the brain. Some are luckier than others regarding their genetic risks, upbringing, surrounding culture and temptations in their current environment.
Drugs, of any kind, don’t give people ‘extra powers’ per se – they only either stimulate or depress already existing functions (e.g. one’s heart rate, serotonin re-uptake). And because the body naturally tries to maintain homeostasis, the expectation of a drug can somewhat suppress or compensate for the effect of that drug – so when someone overdoses on a drug, that dosage may not be greater than a dosage that they’ve had many times before if they’ve become to some degree tolerant to that drug, but their body may not have been simply expecting such a dosage at that time (e.g. it was taken at a time of day or place they don’t normally take that drug). Similarly, if your body doesn’t have a chance to learn about the effects of a drug (gradually) then it cannot easily compensate for that drug to maintain homeostasis. But if your body does then this is how one can develop a tolerance to a drug over time. ‘Tolerance’ is therefore highly specific to the conditions one has developed that tolerance.
After abstinence of an addicting source or behaviour that affects D2 dopamine receptor levels, these receptor levels very slowly return to normal but this can take many months or even years (brain scans reveal that brains physically take a very long time to heal from drug abuse or dependency, and brains are of course physically the sources of our very thoughts and choices), which reveals how tough it is to wean off drug or other addictions completely. The lesson it seems, and the best thing, is to not ever take them or get into the habit in the first place! The rate of recovery depends on the individual but it’s typically very slow. It does indicate though that recovery is a realistic outcome – it just might be harder for some compared to others; but don’t ever give up because recovery is less a question of ‘if’ but ‘when’. Woof!
Never giving up on treatment despite any relapses predicts eventual successful recovery. Those who believe that their addictions can be overcome fare better at eventually overcoming their addictions. And if we can be more mindfully aware of how our cravings are developing then we can hopefully ride them out until the urge naturally subsides again.
Understand that seeking and getting help is confidential in many countries, unlike a prison record acquired via committing drug-related crimes such as driving under the influence or stealing for the purpose of funding a drug habit, or divorce from a relationship breakdown due to drug problems; for which these may be stigmatising (especially drug-related crimes).
Addictions are health issues hence many people argue that we should concentrate on treating drug use/abuse itself as a public health issue. But if a related crime has been committed (e.g. supply, driving under the influence, stealing to fund a habit) then treat that as a crime. Well things can be a public health issue as well as a criminal issue so it’s a false dichotomy to think that it can only be one or the other. For example, punishment can be in the form of being in prison and having certain rights removed, yet also having treatment during this time so that one will be released as a better and healthier person. Any measures that serve the prevention of future problems in society are a good idea whether something is classed as a public health or criminal issue.
Reducing the stigma of addiction will help addicts to come forward to seek treatment, which will benefit all of society in the bigger picture. Such help and support given to drug abusers or addicts should be non-judgemental. Calling people ‘losers’ or similar doesn’t help them and makes them feel even more disempowered to change. We should blame their actions rather than their characters, and should not presume their destinies because many people who have been in their situation have recovered when given enough patient support.
However, harsh treatments like punishments or penalties are sometimes not contradictory to harm reduction if they work to disincentivise and deter drug taking. But the question is whether such punishments have worked so far? And, for various types of crimes and not just drug-related ones, there’s strong evidence suggesting that punishments like prison or even capital punishment don’t reduce recidivism or deter crime effectively at all. Now this doesn’t necessarily mean that we should legalise everything as a result – but certainly a different approach must be tested. In this case, a more compassionate approach based on rehabilitation perhaps?
General policies that are compassionate include treating drug abuse as a public health issue rather than itself a criminal or morality issue, reducing demand via education, prevention (which includes controlling the availability/supply of substances on a substance-by-substance or class-by-class basis via laws and enforcement) and treatment (which includes court mandated treatments as well as voluntary treatments), reducing drug-related illnesses such as AIDS and hepatitis (which includes providing clean needles where this is a problem), enacting other laws that support drug use reduction/restriction (which includes ‘no smoking’ in indoor public or shared spaces), avoiding harsh laws for small possessions of drugs and non-supply, and funding more research into treatment and prevention.
Drug courts are examples of ‘problem-solving courts’ that approach and address the underlying problems that contribute to criminal behaviours. In this case, they take a public health approach in which various elements, such as law enforcement, the judiciary, criminal law, probation, mental health, social service and rehabilitation communities, work together to help addicted offenders enter into long-term recovery.
Environmental risk factors for substance abuse include stress (a common trigger), perceived low social status (in old experiments that would be considered unethical today, drug abuse risk is greater amongst less-dominant monkeys within a group), peer pressures to take drugs, the availability of drugs, and even the advertisement of (legal) recreational drugs (such as alcohol and nicotine). Trauma is a highly common factor, thus addressing a person’s historic trauma event(s) is needed to tackle their addiction. Environmental protective factors include actively compensating for the above environmental risk factors, such as restricting the advertisement and availability of such drugs, promoting more positive/healthful pastimes or activities, and the teaching of the long-term risks of substance abuse to people starting from as young as possible.
Rates of alcoholism and other forms of drug abuse are far greater amongst those with lower socio-economic status, and this shouldn’t really be surprising because being poor is very stressful, and it’s often a strategy for self-medication when living a very stressful life – a highly misguided strategy but a strategy that may provide repeated short-term moments of escapism nonetheless. But if people use drugs as an escape then they can end up depending on them to get them through the days in the mid and long-term i.e. they might get addicted to them.
So there’s the chemical addiction of drugs, as well as the psychological/emotional dependence on such drugs, which in many cases can be the harder part to fix. People who have drug dependency addictions may believe that the drug makes them ‘complete’ and so it becomes a part of their identity, thus taking away the drugs will be like taking a piece of their strength and identity away. One needs to attend to the original/root stressor or insecurity (e.g. one’s broken family or debt problems), with the support of others if necessary, and solve or learn to accept that situation to prevent or stop this habitual prop or crutch of depending on drugs to feel good or powerful.
Well there once were distinctions made between ‘abuse’, ‘dependence’ and ‘addiction’ but nowadays, substance use disorders are classed as mild, moderate or severe. Defining it as a ‘substance use disorder’ hopefully means that, whatever the level of one’s use, one can come forward to seek help and be given help. One doesn’t have to be labelled as ‘addicted’. And we know that, like with most diseases or disorders, the sooner a person gets help, the better their chance of a swift and full fluffy recovery. So even if you think you only experience mild symptoms – at least acknowledge you’ve entered that spectrum, and get support. Don’t wait until you consider yourself an ‘addict’.
Removing people from the environments that remind them of when they took drugs helps too. Of course, most of these solutions cost money. Collecting taxes from the legal sale of some recreational drugs could help fund it, but it’ll probably have to be quite a high tax rate, and it could be absurd to promote the sale of something just to get some money to try to solve a problem that the sale of that something creates or exacerbates(!) Various countries or states around the world are experimenting with various changes of laws and taxation regarding recreational drugs like cannabis, and I guess we await the long-term results of these experiments…
Woof. If you’ve recovered or are recovering from an addiction of any sort then do you believe that it’s an ongoing fight or there’s such a thing as total recovery? And in your experience, do you think there’s an ‘addictive personality’ or it’s only the case of being addicted to certain substances or behaviours? Please share your wisdom by using the Twitter comment button below.