Scrolling through my newsfeed recently I saw an article about a young man who died under the influence of drugs. The article was by his sister, writer Elspeth Muir, who wrote Wasted: A Story of Alcohol, Grief and a Death in Brisbane. Muir discusses how her brother’s death was a result of being under the influence of drugs but also explored our “drinking culture”, and why we tend to excuse behaviour that is clearly problematic.
Muir’s story will sound familiar to many people and is consistent with an alarming trend I have noticed in my therapy room: a growing number of people “self medicating” to regulate negative feelings and emotions. Alongside this is a pervasive normalising of excessive drinking with justifications such as “you are only young once” or “I deserve to blow off some steam”. Why do we, as educated adults, do this? Why as a society do we normalise dysfunctional behaviours despite alcohol causing four times more deaths than road accidents? Our brains continue to develop right into our 20s, yet we think it is a rite of passage for our young people to drink excessively every weekend.
Although addictions extend to many other substances, physical addictions to alcohol and drugs are the most common for which people seek treatment. What turns a habit into an addiction? It can be best summed up as an interplay between genetics, neurophysiology and environment. Alcohol addiction changes the brain, modifying the way it processes pleasure/rewards through alternating some of the brain’s nerve cells (neurons).
Psychological drivers
Treatment focuses on detoxing physically and addressing the psychological drivers that maintain the addiction. Drug and alcohol co-ordinator David Hunt from Smart Recovery says, “When we treat addictive behaviours, we often focus on what is driving the addiction rather than the type. While there is a strong neurobiological basis to addiction, we tend to focus on what addiction means to that person and what is driving them to use a substance.”
Hunt believes that people find solace in addictive behaviours, sometimes because of mental health issues, poverty or even boredom.
The desire to inform the community has meant a number of educational programmes but the thing that many alcohol and drug workers like Hunt would like to see is for people to understand that once the substance has left the body, they are not free from addiction. “When a person leaves detox, they may be free of that particular substance, but are still psychologically dependant,” he says.
The past decade has uncovered a plethora of new addictions, from not being able to stop using social media to orthorexia, an addiction to healthy eating. Although the face of addiction is changing, so too is the way we understand it.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the terms “addiction” and “dependence” are no longer used when classifying substance use disorders (SUDs). Instead, the DSM divides SUDs into “mild”, “moderate”, or “severe” categories of disorder. All substances are lumped together with the key distinction being whether the use is dysfunctional.
Interestingly, alcohol remains the number one issue of addiction, with eight out of 10 Australians over the age of 14 drinking alcohol, with one in five of these individuals at risk of alcohol-related harm over their lifetime. These findings suggest that at an individual and societal level we need to make some changes.
The role of culture
People who refuse alcohol are often regarded with suspicion or are judged in social situations. Opting for water over wine when at an event regularly leads others to jump to conclusions: the person is pregnant, or perhaps a recovering alcoholic. Even driving is no longer seen as an excuse for not drinking. Group treatment drug and alcohol workers like Hunt often report that addicts struggle to reintegrate into their social worlds sober because they feel the pressure from friends and family to pick up a drink.
Hunt says that many feel stigmatised, as our culture seems to pride itself of excessive drinking. The emphasis on binge drinking and the “we all do it while we are young” ideology feeds into the denial of problematic behaviour and further increases the addict’s avoidance of treatment. People who struggle with alcohol often justify their behaviour by saying that it is not interfering with their life. We call these people “functional addicts”. This group of individuals can often be overlooked because they do not fit the Trainspotting stereotype of an off-the-rails addict.
But addiction does not discriminate. High-functioning addicts can be in any type of employment and tend to be characterised by denial, justification and projection: “I’m not an alcoholic because I never miss a day of work,” or,“I am prescribed these painkillers by my doctor, I’m not scoring drugs on a street corner.” There is a darker side to our culture, which denies addiction if it does not fit the stereotype.
Finding a solution
The Journal of Studies on Alcohol and Drugs found that, by the age of 12, a child will have seen in excess of 1300 alcohol ads on television. Australia has one of the highest rates of drug use per capita despite also having reportedly some of the most expensive prices.
Our war on drugs is clearly not working. Many argue to legalise drugs, raise the drinking age or bring in earlier lock-out laws.
However, one small change we can make right now is to be honest with ourselves and others about problematic behaviours, whether they be related to drinking, food, sex or even watching too much television. Change can occur through a collective agreement that certain behaviours are “not okay”. It worked with cigarettes – in the 1980s we all wanted to be Sandy, chain-smoking at the carnival with Danny in Grease. Now, you are practically a leper if you light up in public – it’s cool to not smoke. We did this through laws, television commercials and changing attitudes.
In my clinic as you walk in the door there is a quote on the wall: “Change
our thinking and you will change the world.” It’s time to stop normalising behaviour that is hurting the people we love – and ourselves.
Am I addicted?
There are many signs of addiction, but symptoms may include:
• Neglecting work or school responsibilities.
• Using drugs under dangerous conditions, or taking risks like driving while high, using dirty needles or unprotected sex.
• Legal problems related to drug use such as stealing to support the addiction.
• Fighting with partners, friends or family.
• You need more of the drug (or use it more often) to achieve the same effects.
• Using drugs to avoid or ease any withdrawal symptoms.
• You experience withdrawal symptoms such as nausea, anxiety, insomnia, tremors, sweating, depression or body aches if you are unable to take the drug.
• You find you take the drug more often than planned.
• Life revolves around your drug use, and you spend most of your time thinking about the drug, or how to obtain more.
• Despite problems caused by the drug use, you continue to use.
Where to get help
You are not alone. Find support at:
• Visit smartrecoveryaustralia.com.au or druginfo.adf.org.au to find out more.
• Contact Alcoholics Anonymous on aa.org.au or call 1300 222 222.
• Al Anon 1300 ALANON al-anon.org/australia offers help to the families and friends of people with alcohol problems.
• If you feel unsafe, call 000.
Am I enabling?
Many times family and friends try to “help” their loved one with their addiction only to find they are making it worse – this is called enabling. Dr Karen Khaleghi, co-author of The Anatomy of Addiction, lists several clear signs that you may be enabling an addict: • Do you often ignore problematic behaviour?
• Do you find yourself resenting how much you have to take on?
• Do you consistently put your own needs last in order to help someone else?
• Do you ever feel afraid of causing an argument that might make the person leave you, or result in violence?
• Do you ever lie to cover for someone else’s mistakes?
• Do you consistently assign blame for problems to others rather than the person who is actually responsible?
• Do you continue to offer help when it is never appreciated?
Enabling is a serious problem but it is completely possible to break the cycle by:
• Establishing clear boundaries for yourself and your relationship with others who are prone to substance abuse. Let the person know that you still care for them, but will be saying “No” to all requests for help.
• Never conceding to a threat. Instead, stand firm on your decisions, taking action as necessary.
• Encouraging those whom you care for to seek treatment.
• Expecting unreliability and making plans to cope with it in advance.
