ADDICTION: an insidious, sneaky bastard

One of the things I work with regularly is addiction. Addiction can come in a range of shapes and sizes but there are some principles that remain the same, regardless of the poison in question.

We all have the tendency to form habits, but if there is a genetic predisposition, emotional trauma or mental health issues then we can be susceptible to developing an addiction.  We all struggle at times and we all try to silence painful emotions at one time or another but when we use substances to escape and anaesthetise our emotions, we succeed in feeling nothing, we lose the only way we can know what is hurting us and to understand why and without that our problems that can become overwhelming.

The human brain is the most fascinating and complicated organ: this tiny convoluted mass of grey is at the core of our existence.  We use it to breathe, to create, to work, to love, in fact in every human activity.  This grey matter is the control room for every basic body function and helps us to understand our experiences and make choices all day long. A healthy brain is multifaceted but works as a finely tuned instrument to shape our thoughts our emotions and our choices in a healthy way.   When we put alcohol and drugs into our brains compulsively over time this changes the chemistry of our brain: it changes the way our brain functions.  This is done by activating the brains’ reward system by releasing tons of dopamine.  Dopamine makes us feel pleasure and overstimulating this neurotransmitter with alcohol or drugs creates a chemical euphoria which reinforces the behaviour of drug or alcohol use and then we learn to do it again and again…. resulting in an addiction.

You can think of addiction as a little devil on your shoulder (this is a METAPHOR – you’re not actually engaging with anything demonic here). This little bugger grows or shrinks depending on how much you feed him. If you let him, he will become a slavering demon that will eat your life. But he generally starts small. The more he eats, the hungrier he gets. And he never, ever goes away.

Let me say that again: he doesn’t go away completely EVER. Rehab can’t kill him. But it can shrink him, and when he’s smaller he’s easier to manage. Managing addiction means having a tiny part of you that insists that if you use X, you will feel good, and having to recognise that as the little bastard, and say NO to him again and again and again. Which can be utterly exhausting, and incredibly difficult, especially when you are in a bad space. That’s why healthy self-care habits are absolutely vital, and why best practice for treatment of addiction includes ongoing support (groups, therapy, psychiatric intervention) and mood management: addiction almost always overlies other mood issues.

The little monster gets very scared when you threaten to starve him. When an addict contemplates giving up his poison, he feels terrified, and his immediate wish is to use as much poison as possible in response to this anxiety.

The addiction monster is an insidious, sneaky bastard. He will lie to you again and again: just this once; you’ve had such a hard day; no one will know; you can stop again tomorrow; everyone else is doing it; you’ve been clean for so long you deserve some fun. It can be very hard to recognise his voice, and to remember that he is striving to be fed, not to help you. He will also happily change poisons: if you give up drugs, for example, it’s very easy to start drinking alcohol. And the process begins again.

The thing is, dealing with this little bastard means fighting with your own brain chemistry. If you have become addicted, your brain has learned to associate dopamine (a reward neurotransmitter) with your substance. It feels good and the devil on your shoulder wants more. And over time there’s a domino effect: the more you make your brain create extra dopamine by using, the more it tries to save itself by removing dopamine receptors, so the more poison you have to use to feel good. That’s called building a tolerance. Continue down that road and eventually you are using just to feel normal, not to feel good any more, because when you don’t use your chemistry is out of whack and you withdraw.

That’s another reason why ongoing support is important: when you stop using your poison it takes your brain a while to catch up and to start using dopamine normally again. In that time it can be very difficult to manage your mood as you’re likely to be low and sluggish. The little bastard will tell you that you can’t have fun without the poison. I always call bullshit on that one: when you were a child you knew how to have fun with mud and sticks. You didn’t need any substance at all. Your brain will remember how.

Withdrawal can also be dangerous. Some drugs cause terrible pain and anxiety, even hallucinations. Alcohol is in fact one of the most dangerous substances to withdraw from: if you are dependent on alcohol you should withdraw with medical assistance or you may risk seizures as your brain desperately tries to regulate itself. Alcohol is a central nervous system depressant. If you drink enough for long enough, you will become depressed. You can think of it like a hand pressing downwards on your brain, squashing the energy levels downwards. Your brain needs to push upwards hard to compensate and try to keep the energy where it needs to be. If you suddenly stop pushing down, there will be too much energy shooting upwards – and that’s the risk of seizures.

Having said all that, addiction is by no means unmanageable. The risk in seeing addiction as an illness is that it almost gives permission to use: the demon tells you you can’t help it because you’re sick. I think of it like diabetes: it’s an illness that will never go away, but must be managed responsibly. If you are diabetic, you shouldn’t live on chocolate cake because your body doesn’t deal well with that. If you are an addict you need to manage your lifestyle choices as carefully as possible to avoid relapse, because your brain doesn’t deal well with certain chemicals. You need to make success as easy as possible, and relapse as hard as possible.

Always allow yourself the help you need. Often family members and friends aren’t enough. Look for professionals. Also, addiction can ruin relationships, so relationship recovery and good healthy boundary work is an important part of your own wellbeing.

The little monster can kill trust, for example. If you’ve promised to stop but haven’t been able to (also a sure sign of addiction) family and friends may no longer want to help you. You can’t expect anyone else to take this journey: it’s all yours. You need to take ownership of your life. Trust can be incredibly difficult to grow back. For a person whose partner drinks and lies about it, for example, the impact is as if they are having an affair with alcohol. It is powerful and hugely destructive.

If the devil on your shoulder is driving your life, get some help. The sooner the better. Not because you are a terrible human being (although you may feel that way, you’re not – you’re just someone wrestling with an awful demon, who has made some shitty choices, which can change going forward), but because there’s a lot of good out there for you if you’re willing to reach for it. You need to find your way back to you!

©Psych in a Box

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