Introduction
Many individuals describe themselves as having an “addictive personality”; they are seemingly incapable of saying “no” or are more likely than others to overindulge. While there are several factors that can increase one’s risk (continue reading!), anyone can be susceptible to developing an addiction.
Addiction can come in many forms. For instance, you can be addicted to certain behaviours, such as exercise, gambling, video games, or eating. Of note, the most common form of addiction pertains to the use and abuse of substances (including alcohol, cannabis, illicit drugs, and prescription medication).
Definition
Addiction can be defined differently depending on the activity but at its core, it reflects a change in brain chemistry and subsequent engagement in problematic behaviours that leads to an inability to control such behaviours and significant consequences. A helpful way of understanding addiction is the 4 C’s approach. This includes:
- Craving
- Loss of Control of amount or frequency of use
- Compulsion to use
- Continued use despite consequences
Types of Commonly Abused Substances
These are the various types of abused substances; some are currently legal in Canada, while others are not:
- Alcohol
- Cannabis
- Stimulants, such as cocaine and methamphetamine
- Hallucinogens, such as ecstasy
- Sedatives, such as benzodiazepines
- Opioids, such as oxycodone, fentanyl, and heroin
- Nicotine
- Synthetics, such as GHB or bath salts
Prevalence
Rates of addiction depend on several factors, such as the type of substance, age, sex, and geographic location. Generally speaking, alcohol is the most commonly abused substance in Canada, with the prevalence of problematic alcohol use around 15% of the general population according to a 2019 national survey. However, alcohol use in general has a prevalence rate of nearly 80% of the general population, according to the same survey.
When considering illicit substances, according to the 2019 survey, rates of cocaine, ecstasy, and hallucinogens have increased over the last several years in Canada (with prevalence rates ranging from 1-2% of the general population).
In Ontario, about 10% of individuals engage in problematic substance use behaviours. Indeed, Ontario rates of problematic cannabis and opioid use have significantly increased over the last several years, while rates of alcohol abuse have remained high yet somewhat stable.
Risk Factors
It is a common misconception that someone will be instantly addicted after consuming a substance; while some substances are more addictive than others, there are physical (i.e., genes and brain composition), behavioural, and environmental influences that interact with each other to increase one’s risk of developing addiction. Indeed, there are a number of risk factors related to substance abuse and addiction, including but not limited to one’s genes (i.e., if addiction runs in the family), early age of onset of substance use, the way a person’s brain functions, past trauma, cultural influences, and/or social issues (e.g., poverty).
Protective Factors
Conversely, there are many protective factors that decrease one’s chances of developing addiction; some of these factors include having positive role models in one’s life, personal goals, community support, and healthy hobbies/activities.
Motives for Substance Use
People use substances for different reasons; often it is used for stress or pain management and/or to minimize co-occurring mental health symptoms like depression or anxiety. Some may also use due to peer pressure. Others may seek out substances to feel more creative or to feel a desired “high”.
Spectrum of Substance Use
While some individuals consume substances with little consequence, others’ use can create significant harms. Substance use can be seen on a spectrum ranging from beneficial use to chronic dependence.
At the most severe end of the spectrum, substance use disorders can develop when an individual develops dependence to a substance and they experience impairment in their daily life as a result of their use. They often develop tolerance and have to take more to feel the same effects. They also often experience difficulty reducing their use, or experience withdrawal symptoms.
Reference: https://ontario.cmha.ca/wp-content/uploads/2023/06/Spectrum-of-Substance-Use-2023.jpg
Consequences
Depending on the substance, short term consequences associated with its use can include injuries, accidents, violence, impaired driving, suicide, and overdosing. In the long term, substance use is associated with financial issues, relationship strains, neglecting responsibilities in work/personal life, poor mental health, and increased health risks such as cancer, heart disease, and liver disease.
Treatment
Barriers to treatment include having limited access to, or availability of, mental health resources and discrimination/stigma against those with addiction from society. However, there are numerous evidence-based treatment options that can effectively help to treat addiction.
At the community level, we can assist in educating society regarding harm reduction practices and other ways of decreasing possible consequences associated with substance use. By talking openly about addiction, including treatment options within communities, we can help to reduce discrimination and stigma.
Harm reduction
At the individual level, one can engage in harm reduction strategies if they choose to engage in substance use; these are strategies that help minimize social/health harms associated with use without reducing or stopping one’s use. Harm reduction strategies are evidence-based and can be tailored to the individual’s amount and frequency of use, substance(s) of choice, and overall lifestyle. They help to meet people where they are at; indeed, not everyone is currently able to reduce or stop their use. Examples of harm reduction strategies include the following:
- Using a nicotine patch instead of smoking
- Drinking water while drinking alcohol
- Using substances in a safe environment (e.g., safe injection site)
- Telling someone you trust your plan for use and where you will be that day
- Setting a limit of use in advance and sticking to it
- Engaging in a methadone maintenance program
Other Considerations
It is important to focus on healthy practices to promote positive physical and mental health; for instance, this can include having healthy ways of managing stress (e.g., spending time in nature, meditation, exercise), having good sleep hygiene, having social supports, and engaging in meaningful activities (e.g., hobbies, cultural practices, etc.). This may also mean finding ways of reducing negative influences that maintain substance use; for instance, one can learn new coping strategies for managing cravings or mental health symptoms, and staying away from people, places, or activities that encourage substance use.
Participating in psychotherapy and/or community-based groups (e.g., Alcoholics Anonymous) can also be very helpful for overcoming addiction by providing support, structure, and education. Working with a health practitioner such as a physician or psychiatrist can also be helpful for medication management, which can address underlying mental health issues that are commonly seen in individuals who engage in substance abuse. Medication can also be used with certain types of addiction to reduce one’s use gradually or to minimize harms associated with use (e.g., methadone).
Psychotherapy
Psychotherapy for substance abuse and addiction can be done on an outpatient or inpatient basis. For an outpatient setting, you would meet with a therapist typically on a weekly or biweekly basis. On the other hand, attending an inpatient treatment program typically involves staying at a hospital or medical facility for several weeks or months consecutively where you can attend various programming, including psychotherapy. Some residential treatment programs also involve withdrawal management (to safety “detox”). Typically, cognitive behavioural therapy (CBT) is used in psychotherapy for addiction; this is an evidence-based treatment strategy that can help an individual become aware of negative behaviours/thought patterns and triggers for their use. You also learn healthy coping strategies and problem-solving skills in order to change such patterns.
Conclusion
In conclusion, substance use does not automatically lead to negative harms and addiction. However, it is important to educate yourself on the risk factors and possible consequences associated with substance use; it is also important to be familiar with harm reduction strategies in order to be as safe as possible.
Have you ever engaged in a behaviour that you considered “addictive”? If so, have you ever monitored yourself in order to determine if such behaviour was leading to negative consequences in your life? What would be your “warning signs” that this behaviour was becoming problematic?