Y’all, I am…stoked…to welcome our next guest, Paula Stokes, to the blog to talk about an aspect of mental illness that I don’t think gets nearly the amount of attention, compassion and conversation that it deserves: addiction and substance abuse. I am so happy to welcome Paula back to Shattering Stigmas. Her book, Girl Against the Universe, was a gateway and a game changer for my own consideration of my mental illness and she is such a wonderful, compassionate gem of a person. I’m going to let Paula get to it because we have a lot to cover, but you can find Paula on Twitter and on her website. You should sign up for her newsletter and read all of her books, which include Girl Against the Universe, Hidden Pieces and This is How It Happened. Take it away, Paula!
Hi. I’m really psyched that I was invited back to Shattering Stigmas, one of the most thoughtful (and helpful!) blog series I’ve ever encountered. This year I’m going to share some myths about addiction. I’m passionate about this topic because I’ve been working with Substance Use Disorder patients for the last year and a half as an inpatient nurse and I know a lot about the stigmas they face—both inside the hospital and out. I would like to continue working with this population in the future as a counselor, so I’ve begun the coursework and supervised hours needed to become a Certified Alcohol and Drug Counselor in the state of Oregon. Although I’ve never been addicted to drugs or alcohol, I overcame a severe addiction to internet gaming back in college (the kind where my GPA went from 4.0 to 1.5 and I nearly lost my scholarship), so I can speak a little about the topic from my personal experiences too. Okay, let’s get started!
MYTH: Addiction is a choice.
Addiction is a brain disease. Sure, it’s technically true that unless someone is given something against their will (e.g. the way sex traffickers will try to get their victims addicted to drugs as a way to keep them controllable) that the person does make a choice to first try gambling, or alcohol, or cigarettes, or drugs, etc. But that choice is often legal, and one that many people make without ending up addicted. Sometimes the choice is even recommended by a physician. (Plenty of people got hooked on opioids after being prescribed them for post-surgical or post-injury pain.) Other times it’s simply a bad decision made without much thought when someone is feeling alone or in pain. We’ve all made bad decisions. The thing about addiction is that some of us are at a much higher risk of getting addicted after bad decisions than others.
Have you ever asked yourself why some people can go to a casino or have a few drinks and be fine while others get caught up in the spiral of addiction? I don’t want to bore everyone with a lot of biology, but you should know there are not only genetic components and environmental factors, there’s also an increased risk for people who endured multiple childhood traumas. There are even things that can happen when a baby is still in the mother’s womb that make them more likely to struggle with addiction later in life. I’m talking actual changes in brain development where the parts of our brains devoted to impulse control and decision-making suffer long-term impairment. So if you’ve ever compared yourself to an addict and assumed you were smarter, more disciplined, more moral, etc., the reality is you just might just have been blessed with different genes or a more stable childhood. For more on how adverse childhood experiences predispose people to addiction and other issues, read this short report from the Substance Abuse and Mental Health Services Administration.
MYTH: If addicts wanted to stop using drugs or alcohol, they would.
Once you become addicted to something, it’s really, really hard to quit. Again, there are multiple factors in play, but one reason has to do with the body’s natural tendency to work toward homeostasis. All of us are born with a certain amount of neurochemical receptors. When we experience pleasure, the brain releases neurochemicals like dopamine that make us feel good. When a person drinks alcohol (or uses other substances/engages in addictive behaviors), the amount of dopamine released is a lot more than when that same person experiences a natural high, like watching a sunset or getting a smile from someone we like.
This means the brain’s dopamine receptors get flooded and the body’s response is to try to return to a baseline level of dopamine by turning off some of the dopamine receptors. And that means after the first few times someone drinks, it’s going to take more alcohol to get that same euphoric feeling. And the more they drink, the more the body responds by shutting down additional receptors. Until eventually, the person is drinking because if they don’t, those natural highs aren’t nearly enough to make them feel good. Forget feeling euphoric. Now this person has to drink more and more alcohol just to keep from feeling terrible—sick, lethargic, depressed, etc. For more info on how addictions combine with our biology to trap people in a vicious cycle, check out this blog post from Harvard Medical School.
It is especially hard to quit if your life is full of other stressors. Whether it’s the stress of homelessness, the stress of mental illness, or the stress of being forced to work eighty hours a week as a brand new lawyer, it’s hard to fight an addiction if you’re already rundown from dealing with other difficult things. Just think about the last time you tried to make a healthy change in your life. Would you have been successful if you had to start from a place of balancing multiple struggles and feeling awful?
MYTH: Addicts are mostly criminals/homeless/impoverished/insert your generalization of choice here.
This is a thing people say because addiction is devastating to witness and no one wants to admit “Hey, that could be me someday.” Reality check: That could be you someday. Some addicts are criminals. Some are poor or homeless. And then some are wealthy country club members and some are CEOs. I personally have worked with corporate executives, doctors, nurses, cops, military officers, college athletes, models, upper-middle class new moms, and seventy-five-year-old grandmas, all of whom were addicted to alcohol or opiates. Addiction is a huge problem that affects all segments of society. If you have noticed the prevalence of addiction in certain groups over others, that’s probably because people of privilege have better access to treatment, and can also more easily hide their problems from the public.
MYTH: Rehab doesn’t really work.
Not all types of rehab work for all people. Luckily there are lots of different types of programs, from inpatient medical detox to residential treatment to partial hospitalization to outpatient therapy. Not sure which path to take? Speak to your primary care provider or call around to find a treatment facility that does free assessments. No insurance? Google free or low-cost therapy for your town, or search via the SAMHSA website. Even no-cost support groups vary widely, from traditional twelve-step programs, to the cognitive behavioral therapy-focused SMART Recovery, to the Buddhism-inspired Refuge Recovery. Most support groups also offer online sessions for those who are housebound or lack access to transportation. There are options for everyone. People just need to find the right program that will work for them and their particular addiction.
Also, not all rehab is going to work the first time. Have you ever tried to lose weight or start a new exercise program or learn a new language? Were you immediately successful with no setbacks or relapses into your old habits? Probably not, an overcoming an addiction is even harder than doing any of those things. So if someone you love is on their third try to quit drinking or their fifth try to quit smoking, instead of being upset about how long it’s taking them, consider just being glad they haven’t given up, that they’re still committed to becoming a healthier person.
MYTH: People aren’t addicts if they can hold down jobs while using.
There are plenty of functional addicts. You are an addict if you meet even two of the eleven criteria as set forth in the DSM-V for Substance Use Disorders. If I use these criteria and extrapolate out to addictive behaviors, I am addicted to writing, Twitter, caffeine, chocolate, and exercise, among other things). And maybe you think, “Ah, but those aren’t bad addictions. Some of them might even be healthy!” I would disagree because…
MYTH: Some addictions are healthy.
Okay, this one is my opinion since what constitutes “healthy” is highly subjective. Sure, some addictions are less likely than others to kill you or make you wish you were dead. But if we’re using the official criteria for addiction, being addicted to anything represents a fundamental lack of balance. It says, “I prioritize this substance or activity so highly that I’m doing harm to other important areas of my life.” Nothing should be that important, should it? You tell me.
If you’re interested in learning more about addiction, I highly recommend the book IN THE REALM OF HUNGRY GHOSTS, by Gabor Maté. He’s a Canadian physician who works with some of the country’s most severely addicted people. I read this for a class and it’s written in interesting, accessible prose that intertwines the author’s personal feelings with the medical, social, and political realities of addiction. CW: Maté is unflinchingly honest when describing the traumatic histories of the people he works with and the difficult realities they currently face. There are mentions of gross neglect, physical abuse, and sexual abuse, as well as graphic descriptions of drug use.
One thing I learned from the book was this “equation” for addiction:
ADDICTIVE SUBSTANCE/ACTIVITY + RECEPTIVE ORGANISM + STRESS -> ADDICTION
I want to end with this because I think it’s a really good summary of addiction. We can’t do much about how receptive we are as organisms to addiction—a lot of that is coded into our biology and genetics. And some of us can’t necessarily avoid addictive substances/activities. After all, cigarettes and alcohol are available at most grocery stores and Facebook is available via almost every phone.
But what we can do is reduce stress—both our own and the stress of other people. Individually, we can start by practicing self-care. And I know that term has been distorted to mean a lot of silly things, but what I mean is simple stuff anyone can work toward—taking five minutes a day to meditate or relax, getting more sleep, taking breaks from being online, eating healthy at least occasionally.
Self-care also means asking for help. My internet gaming addiction was a direct result of a reality I couldn’t handle—I ended an emotionally abusive long-term relationship with my first serious boyfriend at the same time my parents were going through a bitter and contested divorce, which left me feeling completely alone to handle the aftermath of both events. I wasn’t really alone, though. I just opted to try to handle everything by myself instead of reaching out to a friend, a sibling, a counselor, or even my college advisor.
And yes, I know that in some cases (clinical depression for example) that it’s almost impossible for a person to reach out for help, but that’s not what I’m talking about here. I could have sought assistance in dealing with my own breakup and my parents’ divorce. I didn’t because I thought needing help would mean I was weak. Wrong, wrong wrong! If you take one thing away from this post, please let it be this: ASKING FOR HELP IS BRAVE.
With respect to others, reducing stress means being supportive when it comes to your friends and family and practicing compassion when it comes to strangers. Addiction is a huge, huge problem worldwide and it’s true that we can’t help people who aren’t yet ready to help themselves. But we can behave in ways where we don’t make the problem even worse.
Do you need help? Start here. Or call the Drug and Alcohol Helpline at 1-800-923-4357.
Thank you SO much Paula! I learned a lot from this post and I hope if you’re reading this, you did too!
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