Substance abuse is an ugly secret that no one likes to talk about. But it’s very real and it’s also extremely full of shame. When mentioning substance abuse most people think of illegal drugs, but the reality is the majority of substances abused are prescriptions.
Substance Abuse and Addiction
Addiction is very complicated and multi-factorial. And, yes, it is a disorder. It is as much of a disorder as any other mental health condition or physiological condition. Substance use changes the brain–it effects the reward center of the brain and with time it becomes a need. Factors that contribute to risk of addiction includes genetics, type of substance, length/frequency of use, coping skills, etc.
Addiction can happen simply from pain medication use after a serious injury or surgery. There is a difficult balance between pain control and dependence and unfortunately addiction seems unavoidable. If a person is experiencing severe pain and requires an opiate to control it, if used long enough, it will create an addiction. This leads us down the rabbit hole of opiate abuse.
I’m sure you’ve heard the term “drug seeker”. I hate it. Working in healthcare I hear it all too often and it’s generally a label slapped inappropriately to someone with legitimate pain. Remember, you’re not the one in pain. There is absolutely no way for you to know if it’s “legitimate” or not. If pain medications end up being prescribed to someone who already has a genetic and/or social predisposition to addiction we find ourselves in a conundrum. Some doctors will give in and allow the person to maintain their dependence, some try to cut them off cold turkey. My stance on this is: even if the person is using their medication inappropriately we cannot suddenly end it. Addiction is evil and controls the wants/needs of your brain creating a horrible physical reaction to going cold turkey–aka withdrawal. Not only does addiction occur physically, but often psychologically as well. Substances can become a crutch for the person and are used as a a way to cope. Pulling that completely away leaves the person without proper coping skills, no support, and dealing with withdrawal symptoms. They need support. They need us to recognize their agony (emotionally and physically) they need us to help them understand their addiction. They need us to help them through weaning off the medication and provide resources for them.
Any of you can become addicted. You may just not have found yourself in that situation. And of course not everyone who abuses substances will become addicted. Have you ever gotten drunk? That’s substance abuse. Do you smoke? Addiction. Caffeine? Yup. It doesn’t matter the substance, it affects our brain the same. The same reward centers are used and the same responses occur. Cravings, dependence, withdrawal. It’s all there, but alcohol, nicotine, and caffeine are more socially acceptable. The difference between that and heroine, is the drug is a lot more deleterious and side effects are deadly. Not to mention legality. So how could someone get addicted to drugs? Ask yourself when you’re sipping that latte. You haven’t found yourself in the same position as the person who became addicted.
Desperation. A person who abuses substances is trying to escape, whether it be physical pain, emotional pain, anxiety, suicidality, fatigue…what is missing is healthy coping skills. The ability to manage the pain outside of substances. People who find themselves addicted to meth most likely haven’t developed appropriate coping mechanisms and most likely do not have support to help them through those difficult…devastating…moments. Imagine yourself feeling like your burning from the inside. Severe emotional pain and trauma. Vivid flashbacks of a rape, you keep reliving the moment over and over and over. You want out. You find something that can dull the memories, the pain. There is no one you can turn to, no one knows or would understand. Those you have reached out to tell you to get over it, it was 2 years ago. They tell you that everyone has experiences like that, it’s no big deal. The idea of opening up to a stranger, a therapist, is terrifying. Also expensive. Someone offers you a medication (legal or illegal it doesn’t matter). At this point you’ll do anything to rid of the internal torment. You find this medication dulls your memories, dulls the pain. Makes it more tolerable to be alive. Would you not want that?
Or maybe you had invasive surgery and find yourself in a lot of pain. You’ve been given pain killers, they work. They make it so you can halfway function, so you’re not writhing. Time goes on and you begin to heal, but every time you try to wean yourself of the pain meds the pain returns worse than ever. And because of tolerance you find yourself needing more to make it so you can work, you’ve used up your disability.
It’s easy. Given the right situation, anyone can become addicted.
If you find yourself or someone you love facing substance abuse and addiction, please seek help. You are worth it.
This is an amazing video. A neuroscientist explains addiction in a TED talk: