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Our understanding of addiction is limited and damaging

This is the first part of a new series about addiction

In Ireland, addiction is evident in all social classes and age groups. Photograph: Prostock-Studio

Geraldine Walsh's face
Geraldine Walsh
Thu Oct 5 2023 - 06:01

Some consider addiction to be a sign of weakness, a judgment of character, or a deliberate unwillingness on a person’s part to control their behaviour.

Part of an Irish Times series about addiction

This stigmatised narrative of addiction can hinder a person’s recovery with poor understanding of what addiction is, questioning and judging a person’s behaviours, and creating an atmosphere of hypervigilance. It evokes shame, devalues a person and heightens misunderstanding, resulting in a keen lack of awareness of the emotional and physical reality of addiction.

As addiction is complex, various addictions can fall into two generally recognised types of addiction. These are chemical addiction which involves the use of substances, and behavioural addiction which involves compulsive behaviours that are persistent and repeated without any real benefit to the individual.

Overall, addiction is defined as being unable to control behaviours that could be harmful to you. Mostly associated with drugs, alcohol, smoking and gambling, addictions are varied – for example, exercise, work, stress and gaming are also among potentially addictive behaviours.

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In Ireland, addiction is evident in all social classes and age groups. Dr Colin O’Driscoll, chartered counselling psychologist and Psychological Society of Ireland fellow, says that “we have a particularly high level of alcohol consumption, and of course, as a consequence, addiction, compared with European averages. We also have a higher-than-average level of drug use and in particular drug-related deaths. Cocaine increase is of particular concern in Ireland at the moment. This increase tends to mirror economic performance and is now the most common drug used by those presenting for treatment in Ireland.”

[ ‘It’s everywhere. Cocaine is a drug that cuts across every age group, every gender, every area’ ]

Yet, our understanding of addiction is limited and damaging to the social narrative that is needed to support recovery.

“For a country that has a very unhealthy relationship with alcohol in general, we have a poor understanding and tolerance when people become addicted,” says Dr O’Driscoll. “Nobody really asks why people are addicted. Shifting the narrative from ‘what’s wrong with him or her’ to ‘what happened to him or her’, would be much closer to understanding the nature of addiction and how people are struggling.

“We are even more intolerant of drug addiction and have, in general, little or no understanding of the nature of drug addiction, and the responsibility of social isolation and inequality as a core cause.”

This stigma comes from a societal belief that an addiction can be easily stopped or cured, highlighting that there is a general misunderstanding about what addiction is or how a habit can become an addiction. The short answer is no, there is no cure, and the long answer comes with a bit more hope as treatment and support are available.

“People with a diagnostic level of addiction change their patterns of behaviour every day, and many do without treatment also,” says Dr O’Driscoll. “Evidence-based treatment for addiction is effective, as is individual determination. The ‘cure’ for addiction lies within the individual, and effective support to facilitate this change is an effective and important thing to provide.”

When it comes to habit forming leading to addiction, Dr O’Driscoll says that “in general, when we engage in a behaviour or take a substance in a way that is used to treat emotional or physical pain or discomfort, we tend to change our relationship with that behaviour or substance. When this continues in spite of unwanted consequences, this is where we may consider addiction having been established.”

[ Women in addiction: ‘He got me in on the coke and the MDMA. ... I ended up in the heights of prostitution’ ]

Addiction can become a problem as a result of many different factors, including a combination of genetic, environmental, and psychological factors.

“Research has shown that genetic predisposition plays a role in addiction vulnerability,” says Dr Sarah-Anne Bennett, GP with Webdoctor.ie. “Certain genes may increase the likelihood of developing addictive behaviours. Addiction over time involves changes in the brain’s reward system and neurotransmitter pathways.

“When individuals engage in rewarding behaviours, such as consuming drugs or engaging in addictive behaviours, the brain releases dopamine, reinforcing the behaviour and driving the desire to repeat it. It is not solely a behavioural issue; it has a strong neurobiological basis, and over time, the brain’s reward system undergoes adaptations.”

Dr Bennett highlights other concerns such as social exposure to drugs, a history of trauma, peer pressure, and a lack of a strong support system, can also contribute to the development of addiction, as can psychological factors, such as stress, mental health disorders, and a history of adverse childhood experiences. “Addiction is not merely a lack of willpower but a complex interplay of biology, psychology and the environment.”

[ Life after addiction: ‘I met the garda who arrested me. She was genuinely delighted for me’ ]

As there are many different kinds of addictions with varying behaviours, the signs of addiction can be diverse.

However, Dr Bennett recognises that indicators of addiction often include:

  • Loss of control: inability to limit or stop substance use or engagement in the behaviour despite negative consequences.
  • Increased tolerance: needing more of the substance or behaviour to achieve the same effects.
  • Withdrawal symptoms: experiencing physical or emotional discomfort when not using the substance or engaging in the behaviour.
  • Neglecting responsibilities: prioritising the substance or behaviour over work, family and social obligations.
  • Failed attempts to quit: unsuccessful efforts to cut down or quit despite wanting to do so.
  • Continued use despite harm: using the substance or engaging in the behaviour even when it causes health, relationship, or legal problems.
  • Secrecy and deception: they may hide their substance use or behaviour from others, leading to secretive and dishonest behaviour.
  • Financial issues: the person might experience financial difficulties due to spending a significant amount of money on the substance or behaviour.
  • Changes in appearance: physical changes, such as sudden weight loss, bloodshot eyes, or poor personal hygiene, can be indicative of addiction.
  • Mood swings: the person may experience frequent mood swings, irritability, or anger when they are unable to engage in the addictive behaviour.
  • Loss of interest: they may lose interest in activities, hobbies, and relationships that were once important to them.
  • Risk-taking behaviour: engaging in risky behaviours while under the influence or to obtain the substance, such as driving under the influence or participating in unsafe activities.

“If you or someone you know is displaying these signs, seeking early intervention can lead to better outcomes for recovery,” Dr Bennett advises.

General practitioners (GPs) play a vital role in supporting a person addressing their addiction. Considered the first point of contact, a GP will assess and diagnose addiction to determine the seriousness and urgency of the problem. They provide interventions for various forms of addiction, including substance abuse and behavioural addictions, which may include medical advice and treatment, counselling and, when necessary, referrals to specialised addiction treatment services.

As recovery is often not a linear journey, a GP will provide ongoing support and monitoring for patients ensuring a safe path to overcome their addiction.

“It is a safe and non-judgmental environment where patients can openly share their concerns and feelings,” says Dr Bennett. “Struggling with addiction can be an incredibly challenging experience. Recognising the courage it takes to seek help, GPs offer vital guidance and understanding during a very difficult time in someone’s life. Given the significance of the patient’s health and wellbeing, the presence of medical supervision can be of vital importance.”

Without treatment, addictions can become all-consuming, damaging lives, relationships and causing serious health issues. There is hope, however. Addiction is highly treatable. Treatment is highly individualised, meaning patients work closely with care providers, GPs and counsellors to find the right treatment options necessary to support their individual circumstances. It is important to talk to your care provider and seek treatment.

Resources

HSE Addiction Services

Addiction Counsellors of Ireland

Family Addiction Support Network