What is addiction?
The word “addiction” is often used to refer to any behaviour that is out of control in some way. People often describe themselves as being addicted to, for example, a TV show or shopping. The word is also used to explain the experience of withdrawal when a substance or behaviour is stopped (e.g., “I must be addicted to coffee: I get a headache when I don’t have my cup in the morning”).
However, experiencing enjoyment or going through withdrawal do not in themselves mean a person has an addiction.
Because the term “addiction” is commonly used in such a vague way, there have been many attempts to define it more clearly. One simple way of describing addiction is the presence of the 4 Cs:
- loss of control of amount or frequency of use
- compulsion to use
- use despite consequences.
Why do people keep using substances?
Substance use can be hard to change. One thing that makes change so difficult is that the immediate effects of substance use tend to be positive. The person may feel good, have more confidence and forget about his or her problems. The problems caused by substance use might not be obvious for some time.
The person may come to rely on substances to bring short-term relief from difficult or painful feelings. The effects of substances can make problems seem less important, or make it easier to interact with others. The person may come to believe that he or she cannot function or make it through the day without drugs. When the person uses substances to escape or change how he or she feels, using can become a habit, which can be hard to break.
Continued substance use, especially heavy use, can cause changes in the body and brain. A person who develops physical dependence and then stops using may experience distressing symptoms of withdrawal. Changes to the brain may be lasting. These changes may explain why people continue to crave the substance long after they have stopped using, and why they may slip back into using.
What are the signs & symptoms of addiction?
There are two important signs that a person’s substance use is risky, or is already a problem: harmful consequences and loss of control.
The harms of substance use can range from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). While each time a person uses a substance may seem to have little impact, the harmful consequences can build up over time. If a person continues to use substances despite the harmful consequences, he or she may have a substance use problem.
The harms of substance use can affect every aspect of a person’s life. They include:
- injuries while under the influence
- feelings of anxiety, irritability or depression
- trouble thinking clearly
- problems with relationships
- spending money on substances rather than on food, rent or other essentials
- legal problems related to substance use
- loss of hope, feelings of emptiness.
Loss of control
Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended, or in situations where they didn’t want to use. Some people may not see that their substance use is out of control and is causing problems. This is often referred to as being in denial. This so-called denial, however, may simply be a lack of awareness or insight into the situation. Whether people realize it or not, lack of control is another sign that substance use is a problem.
What is the treatment for addiction?
There is no “one-size-fits-all” approach to addiction treatment. Choosing the appropriate treatment depends on the severity and type of addiction; the support available from family, friends and others; and the person’s motivation to change.
Some people with substance use problems are able to make changes on their own using self-help materials (e.g., self-help books and websites).
Self-help groups, also called mutual aid groups, support people who are working to change their substance use. Many people participate in a self-help group at the same time that they are in formal treatment. The oldest and largest self-help organization is Alcoholics Anonymous (AA). Today, there are many self-help groups with various philosophies and approaches for people with substance use problems.
To reach out to people who may not be ready, willing or able to give up substances, some treatment programs have adopted a harm reduction approach.
Examples of harm reduction strategies include:
- helping people learn safer ways to use substance
- helping people learn how to recognize the signs of an overdose
- providing clean needles and other injection equipment (“works”) for injection drug use (to reduce transmission of infections such as HIV/AIDS and hepatitis C through needle sharing)
- helping to ensure that people’s basic needs, such as for food, shelter and medical care, are met
- substituting a safer drug for the one a person is using (e.g., substituting methadone for heroin)
Counselling comes in a variety of forms, including individual, group, couples and family therapy. Counselling generally aims to:
- increase people’s awareness of how substance use affects their lives, what puts them at risk of substance use and how to reduce substance use
- help people examine their thoughts and emotions and learn how these inner experiences affect how they behave, how they interact with others and how others see them
- promote physical, emotional and spiritual wellness, e.g., by helping people learn to:
- manage cravings and temptations to use substances
- meet their needs through assertive communication
- develop a healthy lifestyle
- find ways to meet people and form relationships that aren’t focused on substance use
- reduce stress.
Alcohol and other drug education
Learning about the effects of alcohol and other drugs can help prepare people to make informed choices. Some treatment programs also offer alcohol and other drug education to family members.
Medications used to help treat addictions include:
- nicotine patch, gum or an inhaler, or taking the medication buproprion (Zyban) (for smoking cessation)
- methadone or buprenorphine (for people who are dependent on heroin or other opioids, (pain medications such as codeine, Percodan, OxyContin).
Medications to treat other types of addiction are limited. One is naltrexone (Revia), which can reduce cravings to drink in people who are alcohol dependent. Naltrexone can also be used to block the effects of opioids. Another medication used to treat alcohol dependence is disulfiram (Antabuse), which causes people to feel sick and nauseous if they drink alcohol.
People sometimes need short-term help dealing with substance use withdrawal. Withdrawal management helps them manage symptoms that happen when they stop using the substance. It helps prepare clients for long-term treatment. Clients also learn about substance use and treatment options.
A holistic approach to treatment
Many treatment programs offer a variety of other supports and services, including information and counselling about:
- stress or anger management
- grief and trauma
- finding a job or going back to school
- healthy eating
- accessing safe, affordable housing
- getting social assistance or disability benefits
- managing money and budgeting
- developing parenting skills.