The stigma around substance use disorders still persists.

We’ve come accustomed to the influential nature of blame, stereotypes, and negative portrayals when it comes to addiction. Less often are we interested in seeing substance use as a symptom of mental illness, and rather question the character and mental toughness of individuals stuck in the devastating cycle of addiction.

While running seminars on substance use, I’m often asked the following question:

 “But if you’re mentally unwell, why would you turn to substances and make things worse?”

My response is often curt and to-the-point:

“If you’re miserable, see no point in life, can’t function in society, and substances provide a sense of normality or joy you simply can’t get from anything else, let me answer your question with another question – why wouldn’t you?”

Why wouldn’t you. It’s a powerful question; one that we should be asking more often. Asking this question might actually help rather than hinder our capacity to smash through stigma and actually provide assistance to those who desperately need it. It’s easy to point fingers and play the blame game. It’s much harder to try and understand. Ultimately, I know I can’t change your mind – I can only offer a different perspective. But if you do find yourself passing judgement on addicts, I implore you to ask this very simple question:

Has blaming, judgement and stereotyping helped us to solve the problem of addiction?

Make no mistake, substances are powerful self-medicating tools. Addicts often report that substance use gives them a sense of normality, or a sense of pleasure they have never been privy to before. It’s like being offered something that fills the giant gaping hole inside you, where nothing else has worked.

I’ve been there myself.

When I was severely ill young man faced with two options – continued drug abuse or suicide – I made the decision I thought was right. A different option was then presented to me, one that I had not considered:

That I was worthy of being helped.

Fortunately for me, I got the help that I needed. And I dare say I wouldn’t be here without it. We aren’t all so lucky.

In approximately 90% of cases, addicts are found to have underlying mental health conditions. Significant childhood trauma further plays a huge factor in addiction. And the more severe the mental illness, the more likely you are to use and abuse substances. It’s not a surprise then that people who suffer from schizophrenia (which is as disabling a diagnosis as dementia) are four times more likely to have a drug problem, and six times more likely to be alcoholics. You might then be thinking – why don’t they just get on medication? Well in the case of psychotic illnesses, three out of five people have hugely impactful side effects which severely limit their daily functioning – such as type 2 diabetes, crippling fatigue and in some cases, neuroleptic malignant syndrome; a condition characterized by fever, muscle rigidity and autonomic dysfunction. So, there’s that.

It’s also important to understand that simply quitting a substance when things go to shit is not as easy as it seems. The use of substances secretes an extremely powerful neurotransmitter and hormone known as dopamine. Dopamine, in simple terms, is our pleasure giver. Generally speaking, addicts are deficient in dopamine – leading to feelings of depression, anxiety, worthlessness, and anhedonia. This can be caused by a multitude of factors such as trauma, genetics, environment etc. but is rarely, if ever, the fault of the person who is deficient. We would never blame a child for being abused; yet we happily blame the behaviours of people who have altered brain chemistry. Strange, isn’t it?

Once our reward system experiences that initial dopamine rush (the thing we are fundamentally addicted to) pandora’s box is opened – and it is never truly closed again. Your brain will naturally return to its inefficient dopamine production after the cessation of this rush (deficiency) which urges every cell in your body to recreate the incredible feeling to experience the overwhelming sense of pleasure or relief once again. Over time, an addict will be unable to recreate the initial high, leading to the increased use of substances to achieve the same fix. This is called tolerance. Tolerance is the difference between a person who can achieve the same feelings over and over again from drinking one beer a night, and the person who needs to continually up their intake of beers to achieve the same pleasurable feelings they got from their first beer. In simpler terms – these two beer drinkers have vastly different brains.  

Substance abuse over time will fundamentally alter the way in which your reward system perceives feelings of pleasure. When an addict ceases the use of substances, their brain will stop producing dopamine – changing the way they think, feel, and behave. Psychological and physical withdrawal symptoms often lead to a significant worsening of underlying mental health conditions, whereby the addict will employ the use of substances to overcome the worsened negative sensations. This is the negative feedback cycle. Having both positive and negative feedback cycles working in conjunction with one another is what makes breaking an addiction so unbelievably hard. It is the reason why most addicts wish they could be sober but find it practically impossible to stop using. In other words, substance use becomes a need, not a want.

It’s so important to remember that addicts are people too. They bleed red just like you and I. Demonising the user hasn’t helped the problem of substance addiction, so let’s think about taking a different approach. Rather than turning our heads away from the problem, let’s turn our heads towards it. Instead of slapping their hands away when they reach out for support, let’s reach down and offer them ours.

They might be capable of incredible things.

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