The Illness of Addiction
Chapter 7
According to the medical profession, addiction is a mental disorder all on its own. But it often occurs alongside other mental disorders and sometimes because of them.
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As with all mental illnesses, social and genetic factors can combine with physical and psychological ones to complicate issues of cause and effect. Chris Curry is of the view that people with mental health disorders or suffering from trauma frequently turn to drug or alcohol use as a form of self-medication. As a young man, he dropped out of journalism school in Ottawa to follow music. He became a drug addict and dealer. After rehabilitation, he counselled other addicts who had come into conflict with the law.
Dr. David Goldbloom is one of Canada's leading authorities on addiction and mental illness, with degrees from Harvard, where he studied government; Oxford, where he was a Rhodes Scholar; and McGill, where he trained in medicine and psychiatry. He is the senior medical advisor to the Centre for Addiction and Mental Health in Toronto, professor of psychiatry at the University of Toronto, author of numerous medical papers and editor of two medical text books. He is also a past chair of the board of directors of the Mental Health Commission of Canada. In this exchange, Mindset asked him to comment on a line from a 2014 newspaper story published in a mid-sized Canadian city.
Q: Recently, in an otherwise sympathetic newspaper story on sex workers being raped, a reporter wrote: "A street level sex worker is seen by many as just addicts, criminals, liars and women who know what they are getting into." Evidently putting "just" in front of "addicts" did not trouble the copy editor any more than the grammar did. And addiction was lumped in with three other situations in which there was at least arguably a considerable element of choice. How does that view - which is far from uncommon - fit with your broad experience of people who have addictions?
A: Clearly, there is an element of free will in substance use disorders. A glass is raised, a line is snorted. And where there is an element of free will, there will always be an element of judgment by others. People with psychosis don’t “choose” to be psychotic. However, we know that disorders such as alcoholism are highly heritable, that family histories may be dotted with people with a vulnerability to alcoholism, and that susceptibility varies across individuals. And the compulsion to use substances can be powerful and reinforcing, when withdrawal symptoms perpetuate the cycle.
Q: Doctors and neuroscientists say addiction is associated with physical changes in the brain. Can you explain in simple terms how that works and what it means for treatment and recovery?
A: The brain is the single most complex organ in our bodies. Someone once said: 'If the brain were so simple we could understand it, we would be so simple we couldn’t.' Drugs and alcohol act on receptors in the brain which then triggers changes in the brain’s production of the chemicals that act on those receptors. These receptors form the network of communication between the neurons of the brain – all one hundred billion of them. Some drugs – like methadone – can be life-changing for people who are addicted to opiates. Benzodiazepines can protect people as they withdraw from alcohol. While people carry genetic vulnerability to substance use disorders, it is important to remember that genetic vulnerability is not the same as destiny. There are things individuals can do on their own, with peer support, and with professional intervention that reduce the harm of substance use, sometimes all the way to zero. Recovery can be a reality for people with substance use disorder, even if at times they are the subjects of undue pessimism by others.
Q: Why do you think society generally has such a hard time accepting addiction as an illness?
A: Addiction has been for centuries the subject of religious and moral disapproval, and the neuroscience of addiction is still in its early days. Again, the free will component of addictive behaviour limits understanding of it as an illness, and the ability of some people to recover from it through free will and/or support also makes it difficult to understand as an illness. However, I would draw an analogy to high blood pressure. Some people control it through meditation or losing weight; others require medication or even surgery.
Q: The story we began with was written by a general-assignment reporter, not a health specialist. The stigmatization in it is collateral damage. What can you say to reporters that might help them avoid this kind of thing?
A: When it comes to mental illness or substance use disorders, we all know someone who has been affected. Take a moment to think about that person in particular and how this casual aside would sting or demoralize.
This exchange has been edited.