Addiction, take cocaine for example….

Addiction is a complex issue and varies greatly amongst different cultures.  There are different types of addiction, different stages of addiction, different recovery models, different attitudes towards addiction and different outcomes from addiction.

The lifestyle of a person caught up in addiction, will depend on what that person is addicted to.  People can be addicted to relationships, sex, drugs, alcohol, polydrug use, gambling, work, sugar etc.

What exactly is addiction, what is the definition?

There will be many definitions of addiction if you google the term.  After 10 years of working in the field, for me addiction is simply a symptom, coping mechanism, self medication, compulsive habit, obsession, but most of all, an addiction is something which will take a priority in someone’s life.  It does not matter if it is a smart phone, or a class A drug, if you have an addiction, it could easily take priority over work, children, family, partners and so on.  Some addictions could be more socially acceptable than others, or even fashionable and culturally expected or accepted, where other addictions can be shunned and considered unfavourably.

Often it seems that a person seeks something for comfort, when feeling distressed. Although often the opposite can be true at times and someone may crave a reward or treat when feeling good, a kind of celebratory craving.

When working with substance misuse, there can different outcomes or goals, it may be complete abstinence, or controlled recreational use. For someone who uses multiple substances, they may decide that a certain substance needs to be stopped, whilst feeling other substances are not so problematic.  This is known as a harm reduction approach.

The success of achieving certain goals in addiction, depends very much on the substance (or substances) being used and the persons circumstances, lifestyle and readiness for change.  For example, if we look at cocaine and alcohol.  Attitudes towards these substances can be very liberal at times, there can be a sociable aspect towards this combination of drug use.  Especially in the initial early stages of use, or longer term maintained recreational use.  Often when someone seeks help for cocaine addiction, it is when their drug use has become isolated, with episodes of psychosis, health problems, financial difficulties and relationship breakdown or threats from dealers etc.  If someone seeks help before then, it can be due to a family member or loved one pressuring them to seek help, or some kind of police order.

Cocaine addiction is a psychological addiction.  The substance itself creates adrenalin and often this is what a person develops an addiction to, as well as the feel good chemical release of dopamine and serotonin.  It can lead to feelings of confidence and power.  Once the initial ‘high’ wears off, a person will experience the opposite, the ‘come down’.  Often people want to avoid the drug wearing off, so resort to further use  The initial high of the first intake, will not be achieved by any following use directly following, the ‘come down’ will simply be prolonged.  This can be a very costly habit, so often other substances will be used that may be cheaper, to self medicate the ‘come down’.  The low mood that follows can last a number of days and the urge to use again increases, to self medicate the come down, hence the cycle of addiction.

Paranoia is common when using stimulant substances, due to the release of adrenalin. Adrenalin is usually released in a natural fight or flight situation, so when it enters a person’s system artificially, the psychological response can often be that of perceived dangers.  The body has increased adrenalin, so the mind in reaction is alert looking for perceived threats, leading to paranoia as people often report.

I am using cocaine as an example as it can outline the complex nature of addiction, treatment and recovery.  First of all we need to consider what stage of addiction a person is at.  Prochaska and Diclemente explored stages that they labelled pre-contemplation/contemplation, preparation,  action, maintenance, relapse.

stagesOfChangePieChart

People may at times, although rarely, come into treatment at the very initial stage of addiction (pre-contemplation/contemplation) and usually that can be due to some kind of police order or pressure from loved ones.  Pre-contemplation is the stage where a person is using and happy to do so, with no concerns or feelings that their behaviour could be problematic in any way.  Therefore, why would they come and seek help and support for themselves?  They wouldn’t, unless under pressure to do so.  The approach that seems most successful at this stage, is to simply allow a person to talk openly about their use, and how they consider it not to be a problem, rolling with any resistance.  If they mention any indication that their substance use is causing a problem, whether that be relationships, health, social difficulties, it is best to ask them if they think the substance could be making the issues worse and accept whatever answer the client gives.  The minute you try to challenge anyone on their substance use, in early stages of addiction, you will simply provoke defences and resistance more often.

This is why, as a practitioner, you will try and discourage the appeals from loved ones to help someone in addiction.  The person needs to seek help themselves and be at a stage where they can identify at least some minor issues with their drug use.  Loved ones can sometimes enable people to continue using.  They may fear a person racking up debt, so help financially, they may give lots of concern and attention to a person using, this can act like positive reinforcement.  They may criticise, plead and the conflicts can lead to a person feeling more of a compulsion to use.  Loved ones may need as much support as the person in addiction, because they need to accept they can not force change, but by detaching with love (alanon term) and withholding any kind of enabling support, they can help to influence positive change.  There is less motivation for a person to face their addiction, if they have enablers around them.  Addiction is not easy, there is a lot of pressure to fund habits, and managing practicalities in life can feel much more difficult in addiction, so more pressure will not help.

So if someone is in pre-contemplation, it may be best to distance yourself from their substance misuse and allow them to see that often problems in addiction will escalate.  If that happens, then a person will begin to move into the next stage of contemplation.  This is where a person is in addiction, happy to be in addiction, but aware that it is causing some issues.  The same strategies for pre-contemplation apply, although a therapist will begin to add tools like a pro’s and con’s list regularly at this stage, to help a person identify if their issues around their addiction are beginning to increase.  The other stages will vary greatly with each individual.

To highlight further how complex addiction can be, take for example the poly drug use of cocaine and alcohol.  It is common for some to say that they would like to completely abstain from cocaine, but drink occasionally.  This could sound like a perfectly reasonable goal, if they aim to drink within safe limits.

It is actually not really that simple in reality.  When a person takes cocaine and alcohol together, the two substances combined, created a third drug.  If you mix red and white colours you get pink.  If you mix cocaine and alcohol you get .  Cocaethylene is highly addictive and the combination of a depressant substance (alcohol) combined with a stimulant substance (cocaine) can increase the risk of harm and organ failure.  There are other risks like the ability to drink more alcohol and the dangers associated with high levels of alcohol use.  So if a person decides ‘Ok, I will cut down my drinking and stop using cocaine’ that could be a rather unrealistic goal to set, because once a person has alcohol in their system, the cravings for cocaine will be intense, due to the strong compulsion to create the effect of cocaethylene, as it is much more addictive than alcohol or cocaine when used in isolation. The other factor to be aware of, is if alcohol dependency develops, the risk of withdrawal becomes very serious as alcohol withdrawal can lead to seizures that can kill a person.

This is a brief outline of some aspects of addiction.  Professional help is best for anyone who has concerns about their own or someone else’s addiction.  You may have heard some say ‘coming off drugs was the easy bit, staying of them was the challenge’  It would take a lot more time to be able to scratch the surface on maintenance and recovery.  Also, often, underlying addiction are past trauma’s or dysfunctional relationships that have led to poor coping skills and low self worth.

Many people overcome addiction and go on to lead successful lives but sadly some stay in addiction and even end up losing their lives.  It is a serious problem, the issues in addiction escalate.  People will often prioritize their addiction over anyone and anything, they may lie, steal, manipulate people and situations, then they will battle with feelings of self loathing, guilt, shame, helplessness and lose all faith in themselves and their ability to change.  Criticising someone will simply add to that.  There is lots of help out there, peer support meetings, Tier 3 services, Rehab, Counselling, Alanon……the list is long.

If you are caught in addiction, you can change when you are ready, with the right help and support.  My favourite kind of people are those that have danced with their darker side but decided to turn it around and focus more on their potential, choosing love towards themselves and others.  Those people more often are the most genuine.  I think it is safe to state that every person I have worked with in my 10 years of working in addiction, has been a very loving sensitive person deep down, needing substances to help them cope with feelings usually.  If you see arrogance, joking, uncaring sides to someone in addiction, I can almost guarantee, that is just a ‘front’.

 

Thoughts and opinions are my own, to offer a general sense of personal development topics.  

Angela Neild

http://www.counsellormanchester.uk/

For support in the Uk:

http://www.talktofrank.com/

http://www.mind.org.uk/

http://www.samaritans.org/

If you feel in crisis, please contact your local Accident and Emergency Service.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s