CN: drug use, anxiety, depression,
BPD, OCD, eating disorders,
PTSD, withdrawal, suicide
Many people believe those who experience addiction are simply lacking in moral judgement and willpower, making the wrong decisions and flushing their lives down the drain. But they have no idea what would drive someone to take drugs in the first place––addiction isn’t a flawed character trait––it’s a complex and chronic disease, one that is often linked to mental illness.
Addiction typically starts how you think it does—without the intention of becoming addicted. It could be because drugs are a recreational pastime for some, and could also be due to peer pressure. But it’s often much more complex than that, and is never as black and white as you think.
Through Twitter, someone gave an honest account of how their heroin addiction didn’t start with the drug. Taylor, who wrote the thread, struggled with anxiety and depression, in addition to an eating disorder, at a very young age. By age 16, she was prescribed a range of medications: benzos, amphetamines, antidepressants, sleeping pills. She became dependent and didn’t know how to function without them.
“I felt happy, finally right? Something makes me feel normal,” Taylor said. But she continued to put more and more into her body, which she says now she feels further disrupted her brain chemistry. She was abusing drugs and eventually she ran out, so she began to crave them from outside sources––whatever she could find; opiates, prescription painkillers, etc., but she would run out again. “I can’t find any but I’m already hooked. Someone says ‘well I can get you heroin’ and that’s where it took me.”
Taylor takes responsibility for her actions, but makes it clear that she wasn’t in a good place. “It was a choice to try it. I said yes, I put it in my arm. But my point is, I was in no place mentally to make sound decisions and it led me to hell.”
Parts of this example sound all too familiar to Madeline, a student and recovering addict, who has struggled with alcohol abuse since she was 14. She never thought her drinking would turn into dependency, especially within the context of Britain’s normalised binge drinking culture. “It began as a socially acceptable coping mechanism, which soon led me to drink more and more to achieve the same numbing effect,” she said. “It eventually became the only way I could manage my untreated mental health issues.”
“Someone says ‘well I can get you heroin’ and that’s where it took me”
She began to steal alcohol from her parents to get through days of unbearable anxiety. “As soon as I reached the age I could buy it myself, I went off the deep end – from 18 to 21, the longest I spent sober was a few weeks at a time.” Madeline says it made social gatherings more enjoyable for her.
Student and recovered addict Olivia, who was addicted to various prescription pills during high school, says her main motivation for taking them was curiosity and boredom, but she also touches upon mental health: “I was depressed and very rarely had the energy to see my friends, so I just needed something interesting to do.” Olivia adds that her mum’s health issues meant there was always a huge supply of pills in the house, so she had constant easy access. She only realised she had a problem when she started going through other people’s medicine cabinets in search of more pills.
Why do people become addicted to substances?
Most drugs work by affecting the neurotransmitter known as dopamine. It plays a crucial part in our day to day functioning, especially when it comes to the ‘reward circuit’. Dopamine provides feelings of pleasure and reinforcement when we do something we enjoy (such as having sex or eating chocolate cake), which motivates us to want to do this activity again.
When taking a drug, such as cocaine, the brain is flooded with dopamine, causing what can be an intense and pleasurable “high”. This is one of the factors that might lead people to want to repeat the behaviour.
Eventually, the brain will adapt to the excessive production of dopamine by making less of it. This reduces the high that is felt when taking the drug again, which is what we know as building up a tolerance. This is why, next time, someone may take more of the drug in order to experience the same level high they felt initially. They may also get less pleasure from doing what used to interest them, because the dopamine produced from those activities is still nowhere near the euphoria they now know is possible.
What about alcohol dependence?
Dopamine is linked to alcohol consumption too. Though ‘dependence’ is a contested and highly subjective term, broadly, alcohol dependence is characterised by a strong, uncontrollable desire to drink. This might impact work, family and social commitments. People who abuse or are dependent on alcohol may also experience encounters with the law or emergency services.
Alcohol dependence can also cause severe withdrawal symptoms, like many forms of dependence. These can be physical symptoms, such as sweating, shaking and nausea, but can also be psychological – like depression and anxiety. It also makes people who are dependent more likely to give up on relationships, work and social activities. Sometimes people who are dependent will go to extreme measures to get access to alcohol, for example theft, which both Madeline and Olivia did in order to cope.
People who are dependent on alcohol often find it hard to stop drinking because of the cravings and withdrawal effects, just like with drugs. They will continue to drink in order to satisfy their craving and avoid experiencing any unpleasant withdrawal symptoms. A good way to begin to understand what dependency may be like is through a hangover. After a night of drinking, the sedative effects of alcohol wear off which often causes a hangover. This is your body going through withdrawal symptoms, which are similar to what people who are dependent on alcohol experience – only they experience it to a much greater extent.
Madeline says it’s difficult to curb cravings. “I have found in the past that if I usually began to start drinking at a certain time, but was forced to wait longer, I would be irritable, twitchy, often shaky and prone to snapping at people.” She also talks about the first time she tried to quit drinking and become sober: “After only 24 hours sober, I was shaking, nauseated, even more of an insomniac than usual, while absolutely exhausted, with the light burning my eyes and the need for drink raging through me like a fire.” Madeline says this experience alone has helped her to try and manage her dependency better, as she doesn’t want to experience detoxification ever again.
How else does mental illness come into this?
People who struggle with drug and alcohol abuse are often seeking a way to cope with other things in life, for example mental illness, stress or bereavement. However, drinking and taking drugs can end up making mental illness worse in the long run, as they further interfere with the chemical balance in our brains.
Carrie Fisher, who had bipolar disorder, talked a lot about her problems with mental illness and addiction. The mania side of bipolar causes a person to feel super energetic, which in practice is often incredibly distressing and can drive people to make decisions they regret (such as spending lots of money or taking drugs). In an interview with Diane Sawyer, Fisher said: “The world of manic depression is a world of bad judgement calls […] because it all seems like a good idea at the time.”
At one point, Fisher said she was taking 30 pills a day to try and mellow out her manic state. She just wanted to feel normal, instead of manic and destructive. She said: “I used to think I was a drug addict, pure and simple – just someone who could not stop taking drugs wilfully. And I was that. But it turns out that I am severely manic depressive.”
People can also develop a dependency on drugs and/or alcohol in order to cope with chronic pain. Betty Ford, former First Lady of the United States, confronted her alcoholism and addiction to pills in the late 70s. She began taking pills to treat a pinched nerve and relied on them to ease the excruciating pain of arthritis. She also felt that they eased the stress of life. Ford said: “I like alcohol. It made me feel warm. And I loved pills. They took away my tension and pain.” After her recovery in the early 80s, Ford opened the Betty Ford Center to treat people, including children, with drug and alcohol addiction. Ford also discussed how she didn’t fit the stereotypical profile of an addict: “My makeup wasn’t smeared, I wasn’t dishevelled, I behaved politely, and I never finished off a bottle, so how could I be an alcoholic?”
“Addiction can also come in the form of needing to drink every afternoon and evening – it doesn’t have to include tequila for breakfast”
Madeline also challenges the stereotype of an alcoholic. “It does not mean being wasted all the time, or even necessarily drinking all day. Addiction can also come in the form of needing to drink every afternoon and evening, and being unable to stop once you have begun – it doesn’t have to include tequila for breakfast.” She says alcohol eased symptoms of mental illness, and she went on to be diagnosed with a number of mental health problems: “I am currently diagnosed with an anxiety disorder, chronic depression, emotionally unstable personality disorder (also known as BPD), obsessive compulsive disorder, an eating disorder and complex post-traumatic stress disorder.”
Madeline understands that alcohol is a depressant and exacerbates her mental health problems, but she finds the short-term relief of drowning out “anxiety, flashbacks, insomnia and obsessive thoughts” helpful. Madeline also recognises that she may have been more prone to substance abuse as a result of her personality disorder: “EUPD/BPD is based in instability of self and relationships, which includes impulsive destructive behaviour.”
It’s hard for Olivia to not touch upon the stereotype of an addict, too. She explains that almost nobody knew that she was abusing pills, mainly because she’s always been high-functioning and relatively high-achieving, despite her mental health issues. “Of course there are lots of addicts who are in desperate situations, but many addicts also manage to take care of all their responsibilities (work, school, family, etc) and keep their problem a secret for years or even decades.”
Olivia says she grew up with an emotionally and physically abusive parent. “Being on pills made what should’ve been everyday things a bit easier for me”, including socialising with others, which she had a fear of. She says she knew the risks of abusing pills, but it didn’t stop her. “I pretty much hated myself and couldn’t have cared less if I died, although at the same time the pills made me feel less suicidal.” In fact, Olivia attributes the end of her incessant pill abuse to the overall improvement of her mental health.
What’s the outlook?
It’s possible to recover from addiction and dependency. They are relatively common problems and there is help available for those who are struggling. You can go straight to your GP, or refer yourself to a service such as Alcoholics Anonymous. There are also numerous websites, namely Talk to Frank, who can provide free, confidential and non-judgemental advice and treatment. However, Madeline found it took time and dedication to recover. She says the biggest misconception she has encountered is that “getting over addiction is as simple as going to AA,” because people don’t realise that addiction is often far more complex and far less linear when it comes to the process of recovery.
Treatment includes psychological therapies, medication and relapse prevention through long-term follow-ups. Recovering means overcoming both the craving and the urge that their body demands, which is why it’s not just about having the willpower to say “no” and walk away. Even those who have recovered may continue to experience varied cravings due to this, which is why it’s easy for people to relapse even though they might be aware of the consequences. However, recovery is still possible no matter how many times someone relapses, as recovery is a continuous journey.
How can you support someone dealing with addiction?
It can be incredibly difficult to watch a loved one suffer through addiction, but Olivia says that they need “love, support and understanding, just like any other person suffering from an illness.” Recognise that people will do anything to feed their addiction and prevent horrendous withdrawal symptoms, including behaviours that are impulsive, reckless and unfamiliar to the person you once knew. Olivia recalls overdosing, driving under the influence and stealing pills. “Those are the things that, looking back, make me realise that I was pretty much a totally different person during my years of addiction, since I generally consider myself a responsible and trustworthy person.”
“Getting over addiction is as simple as going to AA”
Olivia thinks the main problem is the stigma regarding mental health problems. “Asking for help before things get out of control can be unbearably difficult and I assume that’s one of the many reasons why addicts end up in desperate situations in the first place.” She says if the stigma surrounding mental illness was reduced and people had access to proper treatment, then they might less frequently resort to drugs or alcohol abuse so easily as a way of coping. “We’re human and it’s only natural to want to feel better and, because of lack of resources or fear of being judged, for some people drugs or alcohol feel like the only option.”
It’s devastating that many people are made to feel so alone in their suffering. It’s imperative that we break the stigma surrounding addiction, and lobby for increased service funding, so people can safely get the appropriate help and support they need.