Addiction and the ‘addict’ are heavy laden concepts rooted in a highly contested brain disease model. A model that demands total abstinence from all illicit substances as the only ‘cure’, and one that celebrates the identity of being ‘clean’ – and by inference creates the spoilt identity of ‘using again’ – becoming ‘dirty’. Clearly, some people do develop issues with drugs and we need to make sense of this, so how can we move beyond these reductionist and binary frameworks of addiction and the ‘addict’?
From the outset, let’s be clear, the use of drugs is normal. Most people use drugs, and using psychoactive drugs is for many, a regular pattern of behaviour. For example many people insist on starting their day with a shot of coffee (a psychoactive stimulant), some regularly enjoy a beer after work or in the evening (a psychoactive depressant), others enjoy a cigarette breaks (a psychoactive stimulant). Psychoactive drug use is very much part of everyday life. We all use drugs, and the vast majority of people do so without any significant issues.
Drug use while often habitual, is not the same as what people call drug ‘addiction’, but at what point do we say someone is having difficulties using psychoactive drugs, and how should we best define, describe and understand such difficulties?
Habitual patterns of behaviour (which by the way don’t necessarily need to involve drug use) often become difficult to change, that’s because once established they become engrained and can happen automatically with limited thought or control, triggered by the physical and social environment and by their mood.
Habits are neither good nor bad. We may have habits of always brushing our teeth at a certain place, certain time and in ritualistic manner. Some people may develop habits of jogging and may get quite irritable, even angry, if they can’t get out for a run every day. Drug taking similarly often becomes habitual. There is nothing inherently wrong with that, as we have already illustrated in relation to caffeine & alcohol habits. In this way these habitual patterns of behaviour (including drug use) can lead to a degree of social & psychological dependence. There is nothing inherently wrong with this.
If a person’s pattern of drug use is creating social, psychological, physiological and/or financial harm to themselves I would suggest their pattern of drug use has become problematic. However, people have agency to determine what they consider to be problematic. It’s their body, their life & their choice – so ultimately they should determine whether they consider their drug use is problematic.
Provided the person is not hurting others in any significant way, it’s their choice and up to them to self define. However, when a person’s habit or pattern of behaviour is clearly infringing, harming or hurting other people, I would describe this as ‘problematic drug use’.
While all drugs can lead to a degree of social & psychological dependence, some drugs also have a physiological dependence, for example opioids, ethanol & benzodiazepines. With these psychoactive drugs regular heavy use will lead to physical dependence and the person may suffer unpleasant withdrawal symptoms if the drug supply is not maintained. Interesting too is that physical withdrawal symptoms (‘turkeying’) can also be triggered psychologically. So regular drug use can lead to psychological, social & physical dependence, but despite this most people who lose control of the pattern of drug use regain control without professional help, as illustrated by thousands of cigarette smokers who have quit or reduced their intake.
Only a small minority of people seriously struggle to regain control of their drug habit, and this challenge is made considerably more difficult by prohibition which fuels stigma; forces them into an underground market where quality control is dubious, leaving them uncertain about the precise content or purity of what they are taking. If they seek help they risk stigma, rejection and criminal conviction.
Repeatedly it seems those who most struggle to regain control of a problematic drug habit are those who lack support networks, have limited personal resources, have severe long standing unmet needs such as domestic abuse, sexual abuse, special needs, unemployment, poverty, mental illness, homelessness, exclusion & isolation. Too often these folk, trapped in patterns of enduring problematic drug use, are misleadingly presented as examples of what happens if you take illegal drugs, as if it’s an inevitable trajectory – that’s utter nonsense! Interestingly, people having a coffee, a cigar or a beer aren’t told they are most likely to end up trapped in a cycle of problematic drug use.
Interestingly, the folks whose lives are ravaged by enduring problematic drug use (legal or illegal), are most often using drugs not for pleasure, not to enhance their experience, – but as a way of surviving, a way of self medicating, a way of blotting out unbearable and seemingly unresolvable harsh realities. Drugs for this group are not usually the cause of their problem, but drugs have become a way of surviving or escaping issues they can’t fix. Their real problems are often severe, deep seated, underlying, unmet & often unheard. Life can be messy, complicated and difficult, blaming drugs is an easy distraction from the challenge of addressing long standing unmet complex needs. To label these folk as ‘addicts’ suffering from a brain disease called addiction that can be cured by lifelong abstinence from all banned substances is not only misleading and incorrect, it minimises and misunderstands their plight. It locates the problem with the individual when such issues are often structural, systemic and societal problem.
People in dire situations, struggling with unmet complex needs for most of their lives, overlayed with patterns of enduring problematic drug use, should not be misleadingly labelled as if they are struggling with some pathological personal deficit. They are people first and foremost. It is time we moved away from the reductionist, pathologizing and inaccurate paradigms of the ‘addict’ and addiction – we all use drugs, we all have habits, and probably we all lose control of habits to some degree, sometimes problematic.
Julian Buchanan
8th August 2023
Thanks to Reza Mehrad on Unsplash for the free use of the photo
Drugs, Human Rights & Harm Reduction 