Understanding addiction

Our DPSN theme for June is “debauchery” – yikes!  Debauchery is usually defined as excessive indulgence in behaviours that are considered immoral.  Some people might think “sex, drugs and rock n’ roll” while others might reflect on what defines our morality in the first place.  As usual we gave our bloggers free reign to share their thoughts on the idea of “debauchery”. We’d like to hear your views too, so let us know in the comments below, or jump over to our Facebook page to join the conversation.

What do you think of when I talk about addiction?  Maybe wild parties, immoral people without boundaries, illicit drug use, a debaucherous lifestyle?  Perhaps you imagine the popular idea of an “addict” – someone who either can’t control themselves or makes a choice to take drugs to the detriment of their own wellbeing.

And what do you think of when I say that I work as a therapist in addictions?  Do you imagine a person who goes around policing drug and alcohol use, telling people to stop, telling them all the reasons why they need to change their behaviour; why it’s bad, immoral, or hurting everyone around them?  

Neither of these ideas have so much as a grain of truth in them.  However, doing the work that I do, I come across them all the time – from lay-people to other mental health professionals (the latter of which scares me the most!)  So I thought today I would bust a few (more) myths about addiction as well as what I do as a psychologist who works with people who have drug and alcohol use problems.

I’ve written before about addiction being a mental health issue, not a moral one.  In fact, although we call the sector I work in “mental health and addictions”, I don’t actually use the term addiction with clients.  Partly because it’s so loaded with stigma and misunderstanding, and partly because I don’t think it accurately describes the problem for a lot of people that I see.

People come to our service for help when they find they have a problem with their alcohol or drug use (either prescription or otherwise).  They often come when they have realised that their pattern of using used to be fun, and now it’s not. For some people it might be that they’ve gotten to the point where they’re now physically dependent on a substance, so they go into withdrawal if they try to stop on their own.  For others it’s because they’ve realised that there is some kind of negative consequence in their life caused by their pattern of use – maybe they don’t like who they are when they’re drunk/high, it’s impacting on their work, relationships, parenting, or sometimes there have been legal consequences.

Usually they’ve noticed this, decided it’s not working for them, and ask for help.

But there is no one idea of the “addict” – we see people from all walks of life coming to our service.  And there is no one pattern of addiction – it’s different for everyone.

As a therapist I also don’t tell people what to do!  Even if I did, we know that it’s not an effective way to help people change.  Rather, I ask them what their goals are. Whether their substance use is moral or immoral, legal or illegal, is irrelevant to me.  I want to know what they want to change in their lives and how we can support them to achieve it.

I’ve been working in this area for nearly five years now and there is not a single person I have seen where drug or alcohol use is the only problem.   Anxiety, depression, social isolation, relationship difficulties, family difficulties, work problems, trauma, identity issues, low self-esteem, lack of support – the list is endless.  These are the things that we talk about. If someone is using alcohol or other drugs, in a way that is causing harm to themselves or someone else, it’s usually a symptom, not the root cause of the problem.

We also talk about the popular ideas of the addict and addiction.  We talk about the shame and the stigma and the guilt associated with it.  These are often powerful maintaining factors. If you have been using a substance to cope with uncomfortable emotions or situations in life, and people keep making you feel bad for doing it, of course you are likely to use it again!  It’s much harder for any of us to experience those feelings, or to learn different ways of dealing with them. We acknowledge this and we work on understanding the behaviour for what it is – a coping mechanism that’s no longer working well for them, a means for connection, or an escape.

Part of my work is also about the physical side of addiction, because substance use is not just a psycho-social problem but a biological one as well.  I provide information on tolerance and withdrawal, and what this means in terms of someone trying to stop. Sometimes medical intervention is needed for them to stop safety.  This is important to understand, because people who have tried to stop or reduce and find that they can’t often then internalise the idea that this is a moral failing – that it’s their fault for not being able to change their behaviour.  Which of course it isn’t – just like not being able to get better from a chest infection is not your fault, you just need antibiotics.

So that’s what I do.  I don’t tell people to change, I ask them what they want to change.  That might be their drug or alcohol use itself, or it might be about wanting to manage other parts of life differently.  Some people want to reduce what they are using, or change the pattern of their use – others want to stop altogether. Some people I work with don’t want to make any changes to their substance use at all, but sometimes have to because it’s caused consequences that they would rather be without.  And then we talk about how to reconcile these two ideas, and which is more important to them going forward.

People who experience addictions are people who are struggling with life, and it can happen to anyone in the right circumstances.  I believe we need more compassion, more understanding, and less stigma in this area – more than in any other area in mental health.

What do you think?

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