What’s the difference between type 1 diabetes, liver disease, heart disease, high blood pressure, asthma and drug addiction? All are diseases, as defined by the World Health Organisation, with similar adherence/non-adherence to medication and behavioural change. But drug addiction, which is largely negatively stigmatised by society, actually has comparable if not lower rates of relapse than the others.
Surprising? Now some people will immediately say that drug addiction is a choice and the others just kind of happen to you if you’re unlucky. But, really? All of the other diseases can be caused by poor lifestyle choices. Not asthma I hear you scream! Indirectly, lifestyle choices can contribute to asthma.
A disease is characterised by a ‘pathological change in the organ’ i.e. the organ stops working in the way it is supposed to in order to maintain the best standards of living. With addiction, the brain is reprogrammed through a variety of genetic and environmental interactions – just like asthma – as well as choices brought about by negative lifestyle experiences.
The brain takes around 30 years to fully mature and the front of the brain, where we have inhibitory control, planning, judgement and moral reasoning, is unfortunately the last bit to mature fully. The bit where our reward patterns are programmed is deeply ingrained relatively early on, so, as is the case with a lot of substance use, when people start to use any kind of substance from early teens or younger the brain is already saying, ‘Right! If we take this substance then we feel amazing’ or ‘if we take this substance we can escape all these uncomfortable emotions – I’ll remember that for the future, that could be quite useful’. So the part of the brain telling the addict this is the same part telling the diabetic they like doughnuts or the guy with heart disease that he could murder a full English breakfast right now or the guy with high blood pressure that his dinner really could do with a bit more salt.
Like all the other diseases mentioned, addiction is treatable. Most people know about the opiate substitutes methadone or buprenorphine but assume they’re just for heroin addicts. Wrong! It can be used for any kind of opiate addiction such as codeine based painkillers. Despite what the media might tell you, the aim of substitute opiates is to stabilise from the problematic use and then reduce from the substitute safely, so people no longer take any substance. Did you know that people with a long history of stimulant use such as speed or cocaine may be self-medicating for undiagnosed ADHD? Many people booze to counter anxiety when there’s an abundance of anti-anxiety medications available. Eagle-eyed readers will have noticed that addiction, like the other diseases, is intertwined with lifestyle factors, so medication alone is never the answer and the first thing recovering addicts need to be is trigger happy…
What is a trigger? Something that makes you feel or think about someone or something. That Avicii song that makes you remember Magaluf 2013 with the boys? That’s an auditory trigger. The boredom and stress from being unemployed? That’s an emotional trigger. That coffee shop where you met the girl who was the most athletically experimental nympho in the sack imaginable? That’s a visual trigger that initiates euphoric recall – remembering past experiences in a positive light – and the thing with triggers is unless you have control and understanding, then they won’t also remind you that she was actually a complete psycho texting every hour on the hour telling you how she ‘wuv ickle Andy pandy sexy pants’ and drove you to leave your phone off for 10 hours a day.
Without an understanding of the personal triggers driving an individual’s substance use, that person is likely simply to follow the trigger and have a negative experience, i.e. being covered in glow sticks and novelty sunglasses, necking Jaeger trains at the age of 35 along with 18 year olds in Magaluf, as it dawns on you just how out of place you look and feel; or spending more and more time having a few beers with unemployed mates because ‘they understand’ and thus putting off applying for jobs or having to explain yourself with a banging headache – again – that this just isn’t going to work out, it’s not you it’s me…
So, by now you may be wondering whether those Saturday afternoons down the pub playing pool, betting on football scores and supping a few pints of falling-over-juice is avoiding your triggers, or, similarly, maybe continually playing video games with your online squad of pals smoking a few spliffs isn’t helping you to be the man you want to be. But does that mean you have a problem?
You don’t need to get the shakes or sweat like a sumo wrestler in a sauna to have an unhealthy relationship with substances. The bottom line is if any substance taken in any quantity is getting in the way of your health, relationships, employment or anything else that you value then it may be time to speak to someone.
Even if your friends don’t fully understand, your local drug service will. The local Alcohol or Narcotics Anonymous meetings will (oh, and these are NOT reliant on religious belief contrary to popular understanding!), and the local SMART Recovery meetings will understand how unbelievably difficult it is at times and equally how re-energised and alive it feels to overcome problematic substance use.
The thing with addiction is that you are never, ever alone. Even at your lowest your drug service is there to help because, unlike mainstream society, they understand that you have a brain disease.
Ben Houghton is a Recovery & Engagement Worker for the IRiS Drug Treatment agency in Reading, with an MSc in International Addiction Studies.
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