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There’s an old saying that when someone is “three sheets to the wind,” it means they are drunk. The original phrase was derived from sailing ships. It means that an intoxicated person is out of control and in danger of crashing, much like when the ropes of the sails on the ship are out of control. I have also had a few times in my life when I was “three sheets to the wind.” Now I am much more aware of my drinking habits, especially after all I have learned about addictions. What I have found after researching this topic has been eye-opening and informative.
Many people have lost their lives due to drugs, alcohol, or other substance addictions. People with behavioural addictions have lost their homes, families, and jobs. Multiple dependencies can also cause people to have problems in all areas and, ultimately, end in horrific or tragic circumstances. Many people addicted to illicit drugs end up in jail.
Over the past few months, I have completely immersed myself in learning about addictions and the abuse of substances. I have discovered many interesting facts and interviewed amazing people. I used to wonder why I didn’t see many of these issues with older adults. Sadly, I have discovered that many people who have addiction issues don’t make it to 65. I learned about a man who died at 72, from cirrhosis of the liver, even though he had been “sober” for 35 years. It appears that even after years of abstaining from drinking alcohol, it may not necessarily save one from the damage that is done years prior. It may extend one’s life, but the shortened lifespan is an unfortunate consequence.
I hope that by sharing what I have discovered, through my curious and caring nature, I can help someone seek treatment for what I now know is considered a chronic illness. Understanding more about alcohol, substance, and behavioural addictions, and providing you with heartfelt stories that some courageous people have chosen to share, will help shed some light on this stigmatized area of mental health. The more we talk openly about these issues, and the more we try to understand and support each other, the better off we will be.
What is Addiction?
My understanding of addiction is that it is a dysfunctional condition of the brain’s pleasure centre that affects one’s behaviour. What often starts as a harmless, casual, occasional activity, insidiously and slowly, can become a harmful craving or urge – escalating to emotional and physical needs. Cravings can be explained as intense, obsessional, emotional needs. Many say there are identifiable triggers. These needs cannot be resisted when our addiction is strong and deeply engrained. Our willpower is overcome by addiction cravings. Chemical and behavioural addictions fool our brain with large surges of dopamine, the pleasure hormone and transmitter. Our brain continuously seeks pleasure and what it needs to relieve stress. If this intense drive becomes dysfunctional and affects our daily living and health, it becomes an addiction. No addiction is positive.
A person with an addiction may have more than one substance or behaviour that they are chained to. For example, a person could have an alcohol addiction plus a gambling problem. The addiction often coincides with mental health problems such as anxiety, depression, and poor self-esteem. For some, the substance (e.g., drugs or alcohol) or behaviour (e.g., shopping, pornography, or gambling) becomes a way to help self- medicate. It could start with a prescription from the doctor for pain medication. Addiction is a chronic illness that has no cure that requires lifelong management and treatment.
We, as a society, have to be careful about the language we use when talking about people who have addiction problems. Calling someone a “drunk,” “wino,” or “pothead” are not acceptable terms. These are harmful labels that create negative stereotypes. The shame and stigma labeling invoke can prevent people from seeking help. Instead, we are encouraged to use “people-first language,” such as “a person who uses alcohol” or a “person who has a substance use disorder.” We also want to remember to use terms like “a substance a person is using” vs. a “substance of choice.” A person, who is not using substances or is reducing use, is a person “in recovery.”
Why Do People Become Addicted?
There are several theories, and I don’t think there is one clear answer. I understand there are common internal (within us) and external (outside of us) risk factors that are often referenced or referred to by the experts and those who have an addiction. They are:
- Genetics (e.g., a “vulnerable brain” inherited from parents, “Addictive personality,” “Disease of choice,” poor self-esteem or self-image)
- Social Conditioning – Family and Lifestyle (e.g., what you grew up with, how your family handled stress and other life situations, peers, workplace activities and norms, habits, loneliness, boredom)
- Past Trauma (e.g., PTSD, adverse childhood experiences, abuse, loss)
- Underlying Mental Health Illness (e.g., depression, anxiety)
A person does not have to possess all risk factors to develop an addiction. The addiction may be related to only one of the above-listed factors yet still be enough to ignite the disease process. Conversely, not all people who have any of these risk factors will develop a chronic addiction. One in five of us will develop an addiction. It could all start with a very innocent habit or hobby. Having a glass of wine with dinner every night can lead to two – and so on. I would say the process of addiction festers and brews for a while before it becomes a full-on substance use disorder (or problem behaviour). I think it is safe to say it is a combination of things that may cause one to develop an addiction – much like that “perfect storm” situation.
Interestingly, although a mental health problem may be made better with substance use in the beginning, in the long run, the mental health problems can get worse (especially depression and anxiety.) The other important thing to note is that addiction problems can increase the risk of mental health problems such as psychosis or depression.
Some experts like Craig Beck, The Stop Drinking Expert, don’t believe addiction is genetic. He believes alcohol is a poison. A person becomes a problem drinker when the “nice to have” becomes a “need to have.” He explains how there is an “evil clown” inside us that causes us to drink more than we should. Lack of willpower is also a big factor.
Any substance-use problem is not only a physical and mental health addiction, but it is also a behavioural problem. One would say, if you have a drinking problem, just stop drinking; but, it’s much more complicated than that. Unless the root cause of the problem is understood and acknowledged, and the desire to get the behaviour under control, there will be no recovery.
I believe addiction is an illness. It’s a chronic (lifelong) illness, just like any other disease. For example, let’s compare a person with alcohol addiction to a person with type 2 diabetes. If the person diagnosed with diabetes wants to get better, they have to change their lifestyle (diet and exercise) and perhaps take medicine such as insulin. In many cases, this is done and it is a positive outcome. Comparatively, if the person living with years of addiction is told they have to change their lifestyle, behaviour and take medicine, their brain’s ability to recognize and understand that there is a problem may have become damaged. Therefore, there is an aspect of not knowing – not even being able to know there is a problem – combined with denial and unwillingness to make changes. Dr. Kevin McCauley states, “Addiction is a disease of choice. It’s a disorder of the brain that affects our ability to make proper choices.”
Some people don’t want to change anything, as they feel “better” when using or acting in a harmful way. Harm reduction is one way that a person with an addiction can be helped. If the person is not able to completely abstain from the substance or behaviour, putting limits on it may be better than continuing as they are. Limiting access to the substance or behaviour is a significant first step in harm reduction and recovery.
Treatment for Addiction
Some people can recover from their addiction without the help of a doctor. They may find sharing their emotional issues with others helps them find healthier ways of coping. For others, there are medications that can help. There are even implants that can be effective for up to six months. These medications help control these cravings. Think back to the person with type 2 diabetes who needs to take medicine. A person with addiction may need to take medicine. Sometimes an antidepressant can help the person manage by helping stabilize their moods, therefore, making the person feel better without self-medicating with additional substances. Co-occurring mental health disorders have to be treated at the same time. For example, an addiction to opioids has to be treated at the same time the bipolar disorder is.
Groups and supportive communities are key factors in recovery. Connecting with others and being kind to oneself aid in a successful outcome. Groups and programs like Alcoholics Anonymous, Narcotics Anonymous, and Smart Recovery are popular and helpful for many. Individualized counseling programs can help one deal with past traumas and family issues.
Addiction treatment and recovery do not respond well to a “treat and release” approach. It takes a lot of effort, time, and ongoing management to ensure relapses don’t occur. And, if a relapse does occur, it’s important to keep in mind that recovery and moving forward is still possible. Being mindful of any system gaps is key to ensure a positive outcome. Detoxification, rehabilitation, and residential programs often have waitlists.
As we age, we must keep in mind that our bodies are changing. It takes a lot less of a substance to get the same “buzz” or “high” than when we were younger. The aging process affects our metabolism, which, in effect, changes the way our body reacts to drugs and alcohol. We may be on medications for other health conditions, which will also interact with our use of harmful substances.
Help is Available
If you or someone you know has an addiction, no matter how big or small, please get help. It is possible to get those sails under control. There are effective programs and treatments that can help you get better, and reduce the risks for unfortunate endings. Addiction is a chronic illness, just like type 2 diabetes and heart disease. There is nothing to be ashamed of.
Addiction recovery is ongoing; it’s a lifelong process. There is help. Talk to someone.
Angela G. Gentile, MSW, RSW