Addiction
What is addiction?
Addiction can be defined as developing “psychological dependence” to substances or drugs (Centre for Addiction and Mental Health [CAMH], 2016). Generally, it can be said that a person develops an addiction to a drug, if the drug becomes the primary focus of their thoughts and actions (CAMH, 2016). Addiction should not be viewed as a poor choice, but rather as a complex health challenge that can be successfully managed or treated (CAMH, 2016).
What are the risk factors for addiction?
People who develop a drug addiction are highly stigmatized and the factors that contribute to developing an addiction in the first place are often overlooked.
There are a number of social, environmental and biological risk factors that may contribute to developing an addiction to a substance. They include:
Genetics - Some people’s genes are structured in a way that makes them more likely to develop an addiction to a drug (CAMH, 2019)
Mental Health Challenges - Adults and teens with an existing mental health challenge are more likely to use drugs and develop an addiction compared to others (CAMH, 2019 as cited in National Institute on Drug Abuse [NIDA], 2018)
Family, School and Childhood - Early childhood factors such as not having a supportive home, or having family members who use substances increase the likelihood of a child developing substance use problems later in life (as cited in NIDA, 2018). Also, failing to do well in school and lack of social skills can put a child at an increased risk of developing substance use problems (CAMH, 2019, as cited in NIDA, 2018).
Coping Mechanism - People who experience severe trauma, marginalization, or are isolated socially may use substances to cope with their challenges (CAMH, 2019).
This is why experiences of trauma - such as colonization, homelessness, poverty, violence, and abuse, as well as experiences of oppression related to racism, sexism, sanism, ableism, homophobia, transphobia, and stigma - contribute to the likelihood and severity of addiction.
Addiction and Substance Misuse as a Symptom of Social Dislocation and Trauma
The concern is often raised that if drug users are supported rather than punished, and if drugs are decriminalized and/or legalized rather than being prohibited, then we will see a sharp rise in drug use, overdoses, and addiction. However, if we look at data from countries and states where these policies have been implemented, we see the opposite trend (Hari, 2015). For example, after decriminalizing all drugs in 2001, Portugal experienced a decrease in drug-related deaths and HIV infection rates, a decline in “problematic” and injection drug use (Shepherd & Caldwell, 2017), a decrease in youth drug use, a decrease in crime and incarceration rates, an increase in public money for prevention and treatment, and an increase in community trust of police (Hari, 2015).
The logic of harm reduction may seem counterintuitive, but begins to make sense when we recognize that the desire to use psychoactive substances is intricately linked to stress, trauma, and social connection (Hari, 2015; Maté, 2008). It is important to note that not all substance use is directly linked to adverse experiences and that not all substance use is problematic, such as in the case of having a cup of coffee, taking a painkiller, or occasionally taking alcohol or other drugs to relax, experience pleasure, cope with negative emotions, or experience an altered mental state. However, the majority of people who use substances “problematically” and who have severe addictions that lead to self-harming behaviour, have experienced significant adversity.
Trauma, such as being abused as a child or having faced significant loss, is a common factor in addiction (Maté, 2008). Often intersecting with individual trauma, are the effects of collective trauma, poverty, racism, sexism, and sanism, that contribute to the desire to numb emotional pain (Maté, 2008). There is also a significant correlation with substance use and social isolation, whereby people without meaningful social supports are much more likely than others to develop and sustain an addiction (Hari, 2015; Hart, 2013). It becomes clear then that the very methods that are commonly used to deter people from using substances, such as punishment, social stigma, isolation, and confinement, are actually more likely to contribute to addiction rather than alleviate it.
Also troubling, in addition to the criminalization of people who use substances, is the medicalization of them. It is increasingly common in clinical settings to challenge the notion of drug-user criminality with the notion of addiction as a disease (Brocato & Wagner, 2017). While the disease model is less dangerous than the criminal model, it has the effect of pathologizing substance users as people that can be broken or fixed on a biological level (Bertram, Blachman, Sharpe, & Andreas, 1996 as cited in Brocato & Wagner, 2017). While some long-term, frequent substance use can cause brain damage and affect individuals’ ability to exercise self-control (Maté, 2008), the disease model can be used as a scapegoat to avoid addressing deeper and more challenging historical, structural, and social problems.
How can people get help?
It is important to treat people who struggle with substance use challenges with empathy and compassion. Although addiction is treatable, not everyone wants to be sober, and the road to sobriety can be filled with challenges.
A harm reduction approach to addiction recognizes the inherent dignity and worth of people who use drugs, and their right to self-determination. People with addictions can have their health and wellbeing be supported through harm reduction approaches and public health interventions, to reduce the harms associated with unsafe drug use.
If someone wants to stop using substances, having a support group of family, friends and peers, as well as medical specialists, will make the road to sobriety a bit easier.
You can visit our resource pages to find harm reduction services and counselling supports.
References:
Brocato, J. & Wagner, E. (2017). Harm reduction: A social work practice model and social justice agenda. Health and Social Work, 28(2), 117-125.
Centre for Addiction and Mental Health (CAMH). (2019). Addiction. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/addiction
Centre for Addiction and Mental Health (CAMH). (2016). Opioids and addiction A primer for journalists. Retrieved from http://www.camh.ca/-/media/files/5217-opdsaddic_primer-pdf.pdf
Hari, J. (2015). Chasing the scream: The first and last days of the war on drugs. New York: Bloomsbury Publishing.
Hart, C. (2013). High price: A neuroscientist’s journey of self-discovery that challenges everything you know about drugs and society. New York, NY: Harper.
Maté, G. (2008). In the realm of hungry ghosts: Close encounters with addiction. Toronto: Knopf Canada.
National Institute on Drug Abuse (NIDA). (2018, July). Drug Misuse and Addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
Shepherd, S. & Caldwell, J. (2017). Toronto overdose action plan: Prevention and response. Toronto Public Health. Retrieved from https://www.toronto.ca/wp-content/uploads/2017/08/968f-Toronto-Overdose-Action-Plan.pdf