Gain a greater understanding of addiction

Modern Western societies often struggle to see people with addiction as just that:⁠ people. Instead, legal and social systems treat addicts as if they’ve “chosen” their lives of substance abuse, crime, and violence. 

This treatment masks an ugly truth – that none of us are all that different from the addicts we so often regard with contempt. Do you ever find yourself “unable” to resist a sugary dessert or coffee? “Couldn’t” stop yourself from purchasing a nifty new piece of tech or clothing? Or were you “compelled” to keep working long after your hours were technically over?

If any of these or other similar behaviors describe you – well, long story short, you’re an addict. You’re just at a less extreme end of the continuum than severe substance abusers. Not convinced yet? Just keep reading.

A quick warning before we begin: this content contains discussions of drug use, child abuse, sexual assault, and other sensitive topics, so please take care.

Who are addicts?

Serena is just over 30 years old and addicted to narcotics. She has lived in Vancouver’s Downtown Eastside since she was 15, when she gave birth to her daughter. The father was Serena’s auntie’s boyfriend, who had molested her and threatened to beat her auntie if she said anything about it. This, sadly, was part of a pattern. Serena had been sexually abused by both her grandfather and her uncle since she was seven years old. 

Serena’s experiences resemble those of many other addicts psychologists have worked with at the Society. There are societies across world where addicts are provided with medical treatment, clean rooms, food, and group activities like poetry readings and movie nights. There, patients are accepted, no matter how troubled they are – or how much trouble they cause. 

Claire, for instance, is no longer allowed into the reception area of the facility due to her outbursts. Seemingly without warning, she launches into tirades, screaming at other patients and breaking whatever she can get her hands on. Yet most of the time, she follows her attendant and other staff members in the street, asking for hugs.

So, yes, addicts look like Serena and Claire. But they also look like people we know and admire. The psychologist Sigmund Freud was a cocaine addict. William Stewart Halsted, a pioneer of modern surgical practice, was addicted to opiates for over 40 years. 

Addicts also look like a sophisticated intellectual persona. At face value, that doesn’t seem to be the case. He may live in a comfortable home in a nicer part of country, and he may not need illegal substances to get through his days. Yet nevertheless, he’s an addict –⁠ and his drug of dependence is classical music. 

In a little over a month, he blew two thousand dollars on classical CDs in spite of repeated promises to his wife that he’d stop binging. He frequently spends his days obsessing about what music to purchase next. He can’t walk the dog, read, or write without music in his ears – yet he has boxes of CDs he’s never listened to. When he goes on a spending spree, he shamefully hides his stash on the porch.

You might be finding it difficult to understand how his classical music obsession could be classed as an addiction. Let’s explain further.

The addicted brain

Like any music lover, a soul is moved by particular sounds. But the adoration for music is also accompanied by addiction. This means that no amount of listening will satisfy their cravings. Despite the fact that their obsession distracts them from their marriage, children, or profession, they can’t stop purchasing new CDs.

Any passion can similarly become an addiction, whether it’s for reading, working, painting –⁠ you name it. Put simply, an obsessive passion that a person can’t control, and that harms themselves or others, is an addiction.

That’s fine as a simple, working definition. But beneath the surface, addiction is a highly complex condition. It’s affected by many elements, including biology, emotions, and sociopolitical issues. For now, let’s stick to how it works within the brain.

One of the key brain chemicals involved in addiction is dopamine. Dopamine plays an important role in regulating our levels of motivation, incentive, and energy. In general, it makes us feel elated and full of potential. 

Stimulant-type drugs like cocaine increase the amount of dopamine available to our brain cells. Dopamine binds to our receptors, the molecules on the surfaces of cells where chemicals fit and deliver messages, and this causes the mood-altering effects. 

But there’s a catch. The more cocaine is used, the more dopamine receptors are damaged and lost – and the more the brain welcomes external sources of dopamine that can help increase the overall supply. 

See where this is going? To get the dopamine they lack, an addict will start depending on the substance more and more. It’s a vicious cycle. Without the drug, the addict will experience reduced stamina, incentive, and drive for normal activities.

Dopamine circuits are far from the only areas of the brain that are disrupted by drug addiction. Repeated drug use can also alter brain structures responsible for impulse control, self-regulation, and decision-making. For example, the orbitofrontal cortex, or OFC, often shows malfunctioning patterns in drug users. This causes users to accept short-term gain – like the drug high – at the expense of long-term pain. 

Given how deeply substance abuse impacts the brain, doesn’t it seem reasonable to rethink our stance on addicts “choosing” to be addicted? After all, no one blames a person with, say, arthritis for having a flare-up. In a similar way, addicts hardly “choose” to be addicted, because addiction disrupts the self-regulation circuits that the addict needs in order to choose not to be an addict. 

But the person who picked up pills, a needle, or a powder in the first place still chose to do so – right?

Trauma and addiction

To paraphrase Harvard Medical School psychiatrist Lance Dodes, addiction resides in people, not in drugs. Drugs alone are not addictive. If that were the case, it wouldn’t be safe to administer painkillers like morphine to anyone, because everyone would get addicted to them. So what determines who does get addicted?

The answer is, in a word, the environment. A predisposition for addiction is primarily established during the earliest years of a person’s life, beginning in the mother’s womb. Stress on the mother while she’s pregnant, for instance, results in high levels of the hormone cortisol reaching the baby. Chronically elevated cortisol harms important brain structures, many of which are implicated in addiction.

The process continues after the child is born. At this stage, their brain has many more neurons and connections than it needs. As the child takes in various experiences, their brain trims itself into the right shape to carry out the tasks it learns are necessary. 

Children who grow up around protective, psychologically present, fairly nonstressed adults will usually develop healthy brain structures. On the other hand, maldevelopment occurs when the child can’t, for whatever reason, consistently experience secure interactions. 

For example, complete separation of an infant and mother for just six days can cause major alterations of dopamine and other neurotransmitter systems. And separation is only one of many possible stressors. Children are constantly picking up on subtle emotional cues, such as tension in the arms that hold them, facial expressions, and tone of voice. Cues that show emotional disconnection create stress. This impacts the numbers of both opiate and dopamine receptors in the child’s brain and creates a greater probability of them seeking mood-regulating chemicals in drugs later in life. 

Given this, you might imagine –⁠ correctly –⁠ that drug addicts are more likely to have experienced extreme childhood trauma. One renowned piece of research in this area is the Adverse Childhood Experiences, or ACE, Study. It looked at the incidence of ten separate categories of painful circumstances in thousands of people. It found that every adverse childhood experience a person had increased their risk of early substance abuse by two to four times. 

This means that extremely traumatic experiences often lead to extreme drug addiction. With mild disruptions in childhood brain development come milder forms of substance abuse or behavioral addictions. Very few of us can say we’re totally addiction-free.

The War on Drugs

Ever heard a public figure advocate fighting addiction through “just saying no?” If so, you’ve come into contact with the War on Drugs, a set of misguided policies designed to curb and prevent drug use through harsh punishments. Despite its stated goal, the War on Drugs has had many tragic consequences – among them excess incarcerations, the ripping apart of families, street violence, political instability, and health disasters. 

More than that, the evidence shows it’s failing miserably at preventing drug use. Between the 1990s and the mid-2000s, the percentage of American high school seniors who smoked marijuana daily more than doubled. So did the rate at which Americans aged 15 to 24 died of drug overdoses between 1999 and 2005. 

The War on Drugs policies involve harsh penalties for people possessing drugs, meaning that addicts typically become criminals by default. Their status causes them to resort to violence, prostitution, and scamming as the only options available for surviving and obtaining their drugs of dependence.

The issue at the heart of the War on Drugs is that it doesn’t address the underlying reasons for drug addiction. It doesn’t understand that addicts aren’t deterred from drug use by “just saying no.” Addicts already experience countless negative consequences of their behavior, from losing their jobs to having their children taken away from them to seeing close friends die. Yet often, none of this is enough for them to abandon their addictive urges. 

So, what circumstances can be created to help addicts recover and regain their freedom?

A start would be to decriminalize all substances, which would mean removing legal penalties for the possession of drugs for personal use. Decriminalization would also allow for the medically supervised provision of substances to confirmed users under safe conditions.

Decriminalization would offer addicts the possibility of obtaining their substance of dependence under public authority and medical supervision. This would greatly reduce the risk of infection and disease transmission, as well as the possibility of overdose. It would provide comfortable and regular access to medical care – and would discourage crime, violence, prostitution, and poverty. As an added positive effect, bringing addicts into a supportive health-care environment would gently nudge them toward rehabilitation. 

In the absence of this enlightened reform, however, medical practitioners should focus on harm reduction. Harm reduction is not trying to “cure” patients of their addiction. Instead, it’s helping with their symptoms and reducing the harm done by their condition. 

It can take many forms, including helping a patient self-administer their substance of dependence or by offering needle-exchange services. Allowing people to trade dirty, used syringes for new ones limits the spread of HIV and hepatitis C caused by needle-sharing.

It’s important to recognize that harm reduction programs do not “fight” addiction. Instead, they “fight” to prevent the death, misery, and disease that result from the conditions addicts face under the current systems.

Toward sobriety

Notice how the last section ended with a description of “fighting” addiction? That wasn’t an accident –⁠ much of the language we currently use around addiction centers around war-like metaphors. We think we can “beat,” “triumph over,” or “defeat” addiction. But metaphors are fundamentally unkind. Waging a war against addiction would mean waging a war against parts of ourselves.

Instead of harsh judgments and self-hatred, what we as addicts require to address our condition is compassionate curiosity. It’s simple: just be genuinely curious about your own actions and behaviors. 

Say you hurl accusations at yourself, like “I’m so stupid – why can’t I just learn?” You might try replacing that with the question, “Why did I do this again, despite my awareness of the negative consequences?” You don’t have to be happy about your behaviors –⁠ just open-minded, even scientific in your self-inquiry.

This process helped one of my friends to understand why he felt like he always had to have a book in his pocket. It was an emergency kit he could use anytime he found himself stuck waiting somewhere. He was too terrified to spend a moment alone with his own thoughts, so he always needed a ready escape from the present moment. Once he’d examined this behavior, his need to escape didn’t automatically disappear –⁠ but it was diminished. 

And what if you’re a family member, friend, or partner to someone with addiction? It’s natural for an addict’s loved ones to want to reform them. But this is impossible –⁠ too many powerful psychological factors cause addicts to respond poorly to any sense of coercion. Instead, the motivation must come from within the addict themselves.

So what can the loved ones of an addict actually do? Sometimes, the only decision to make is whether to be with the addict as they are or not. It’s perfectly reasonable to accept the other person as they are without staying with them under all circumstances. You don’t have to sacrifice yourself or tolerate constant broken promises, and you shouldn’t stay only out of a sense of guilt.

If you do choose to stay in the relationship with the addict, understand that when you’re critical of them, your criticisms are really ultimately about yourself. If a wife constantly tells her alcoholic husband that he’s bad, what she’s really saying is that she is good. And maybe she’s in denial about her own addictions –⁠ to self-righteousness, say, or perfectionism. 

She could instead say something like, “I’m feeling good today, honey. I only obsessed about your drinking once. I’m really making progress on my addiction to self-righteousness. How are you feeling?” This honest, genuine way of approaching her husband could promote the development of a healthy attachment relationship. 

Dropping self-righteousness in your interactions with an addict is really key. Any conversation about the addiction must be an invitation, rather than a demand –⁠ an acknowledgment that the person had reasons for “choosing” their addiction, and that it has helped them in some way.

Addicts are very often people who have experienced enormous tragedy and depend on a substance to help them cope with their pain. Most hardcore addicts experienced forms of abuse and neglect in childhood that led to dysfunctional neurological development. This in turn caused them to seek out chemical satisfaction from drugs later in life. Although severe substance abusers are the most “visible” addicts among us, in reality, almost everyone lies somewhere along the spectrum of addiction – and there’s an endless list of behaviors we use to distract us from the turmoil within.