Why do some people become addicted and others don’t? Every year, many people are killed by their addictions, while others with the same or more severe addictions turn things around. Why? What makes the difference between life and death?
In over 35 years of providing psychotherapy, I have yet to meet a person who is drug or alcohol addicted and who is not engaged in self-medication.
Indeed, most forms of addiction, in my experience, have a large element of self-medication if “medication” is used to mean a method to cope with or ameliorate some kind of physical, social, spiritual or emotional pain.
Most addictions that start off as self-medication, whether that is chemical escapism or behavioural reassurance, soon become self-harming.
Social scientists around the world are aware of the cocktail of social factors that determine health outcomes. They are known as the social determinants of health, SDoH. That is, factors such as poverty, homelessness, poor education, and stigma, (of all kinds), make addictions more likely to be lethal.
At the other end of the scale, affluent, well-educated, well-supported professionals, are more likely to obtain the support necessary to either contain, or overcome, their addiction.
Many people claim that addiction is a “brain disease.” If that were the case, we would be able to point to the pathogen that causes the “disease.” Of course, no such pathogen exists. Most addictions start off, as self-medication for a problem, and end up being a problem of self-medication.
The journey to addiction is well-documented and seems to follow the same stepped pattern, regardless of the nature of the addiction:
- A trigger, introduction to, or initiation into the addictive substance or behaviour.
- Exploration of the addictive substance or behaviour and experimentation with it (as self-medication).
- Increasing frequency of usage until self-medication becomes regular and habitual.
- What started out as a short-term and helpful amelioration of emotional pain reaches the tipping point of risky usage.
- Once passed the tipping point, dependency sets in, in all senses of the word. The person no longer controls that habit; the habit controls the person.
- After a period in that state, full-blown addiction is consolidated and becomes part of the person’s identity. In this phase, the person is gripped by the four Cs: compulsion, craving, (loss of) control, and adverse consequences.
That is not a pleasant place to be.
How does an economic squeeze, in the current case, called a “cost of living crisis”, impact people with addictions?
If they are affluent and addicted to something like cocaine (with the huge list of harms that cocaine causes), the street price of their preferred narcotic can decrease (because of reduced demand).
If the addict lives in relative poverty, the price is likely to reduce in an economic crisis, meaning that they can continue to use their chosen form of self-medication.
However, some addicts will experience a worsening of their own financial circumstances, and may feel that crime is the only way to feed their addiction.
By its nature, it is nearly impossible to determine how much acquisitive crime is committed to for the purposes of obtaining money for drugs. Reliable estimates from crime specialists indicate that around 50% of all acquisitive crime, (burglary, fraud…) is committed in connection with or further addictions.
People with any form of addiction can interpret the cost-of-living crisis as a reason for more despair or, an opportunity to regain control of their lives.
Anyone who is addicted or has worked with people who are addicted knows that overcoming addiction is difficult.
One of the many compounding factors that make overcoming addiction so hard is that for a long time, the addict has sought comfort from whatever it is they are addicted to. The prospect of even getting through a day without that comfort is inconceivable. Obtaining comfort from another source is essential if recovery is going to happen.
For many successfully recovered addicts, the new comfort is sought out and adopted after a tipping point, when an absolute low is reached. In that moment of despair, some can see where their addiction is leading and be motivated to make the choice to go in the opposite direction.
They draw new comfort from knowing that life can and will be much better without the source of their addiction. They choose to change. They choose to turn their lives around. Many ex-addicts go on to great achievements, while others inspire and help many people to the same recovery.
For some current addicts, the cost-of-living crisis will be that tipping point. If so, what can addicts do to regain control of their lives?
Create and reinforce a big why
People who overcome adversity almost always have a compelling reason to do so. There is something they want, and that something, in the case of addicts, is hugely more important than whatever they were addicted to.
One person I helped, the parent of a nine-year-old child, held three pictures in their mind as their way to develop healthy, smoke-free lungs: their child’s university graduation day, wedding day, and the birth of the first grandchild. None of those momentous events the person would live to see if they continued their heavy smoking.
Link overcoming the addiction to the big why
Kicking any self-destructive behaviour is achieved one day, one decision at a time. The successful ex-addict links their big why to every decision they take. If they are tempted, they remind themselves of their big goal.
Identify addictive behaviour triggers
People who overcome addictions learn what externally triggers their addictive behaviours and ensure that those triggers are no longer part of their lives.
They know that some of their triggers are internal and plan how to deal with them. Some successful ex-addicts go as far as reassigning the triggers to increase their resolve. For instance, one person I helped with a food addiction that led to obesity turned hunger pains into a reinforcing trigger of their determination: “If my stomach is rumbling between meals, that means I am achieving my goal.”
Build commitment to recovery
Some ex-addicts have an incident that is their instant tipping point. Others set themselves a date to change their lives, gradually build commitment, and work towards that day. A new life date is the best option if there is no natural tipping point.
Set up a support network
Many addicts choose to create a new group of friends and mutual supporters after deciding on recovery. Those new friends quickly become positive triggers, reinforcers of the new lifestyle. New friends and supporters also mean not having anything to do with people or places that were triggers of the addiction.
Remove all temptation
Many people who may be tempted to drink alcohol at home decide not to have any in their living space. Those who may be tempted to call their drug dealer delete their details. People who know they will binge on biscuits won’t have them at home.
Ex-addicts behave that way towards the former object of their addiction; they remove all temptation. In a cost-of-living crisis, removing the temptation to spend money on the addiction can make a huge difference in making financial ends meet.
Stopping harmful behaviour that previously occupied much time can leave a huge vacuum in a person’s life. Successful ex-addicts fill that time hole with constructive, healthy activities.
Acquire or develop empowering tactics to deal with temptation
Not all temptations and triggers can be removed. Successful recovery involves adopting and mastering coping strategies to deal with temptation.
For many addicts, the cost-of-living crisis could be the event they have been waiting for to turn their lives around. “Necessity is the mother of invention” became a cliché for good reasons; it contains much truth.
If you or anyone you know has an addiction, will the cost-of-living crisis be, to use another piece of folk wisdom, the cloud that has a silver lining?
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.