Unfortunately, the illness is often portrayed as a choice — a misunderstanding that can further stigmatize people who struggle with substance use and addiction.
“Addiction is not a choice,” says Kim Hellemans, chair of the neuroscience department at Carleton University in Ottawa. “Sure, we’ll make the decision to use , but nobody decides to live that lifestyle.”
Many Canadians still don’t really know the science behind how addiction affects one’s brain and body. By talking more about what addiction is, how it feels and how it can be treated, Hellemans hopes the stigma might lessen.
What is addiction?
The Centre for Addiction and Mental Health (CAMH) defines addiction as the presence of four things: cravings, loss of control of amount or frequency of use, compulsion to use and use despite the consequences.
The exact science remains unclear, but doctors believe there are a region and a circuit in the human brain “listening for when we engage in highly rewarding events,” said Hellemans.
“When we eat tasty food or have sex, there’s a natural reward circuit because when we engage in these rewarding events, they tend to increase our survival.”
Most addictive substances target this system.
“Whether you shoot heroin or drink alcohol, smoke nicotine or cannabis, they all start to activate that pathway,” Hellemans said. “It translates to us feeling good.”
In people who develop addiction, doctors believe their “baseline reward pathway activation” is low.
“When they engage in heroin or alcohol use, it elevates the activity of that pathway so they feel like … that’s just normal,” she continued.
She noted if someone has depression or anxiety, and uses a substance to relieve symptoms, the brain notes this particular substance makes them feel good.
The pathway triggered by those substances, traditionally intended to signal survival, is triggered by something that is actually bad for you — but your brain doesn’t know this.
“Your brain starts telling you that engaging in these behaviours is going to mean you’re more likely to live,” she said. “ people who are trying to quit those substances may feel like they’re dying. That circuit isn’t being activated.”
Who becomes addicted?
Not everyone who uses an addictive substance, such as alcohol, cannabis or cocaine, will necessarily become addicted. Some people are considered more vulnerable than others.
Doctors are still trying to determine a complete list of risk factors, but at present, the following are known to contribute to addiction:
- Genetic factors: This is particularly true for alcohol addiction.
- Trauma: People may turn to substance use as a way of “coping” with difficult emotions or situations, according to CAMH.
- Inter-generational trauma: “If your grandparents have experienced trauma, that could put you at risk,” says Hellemans.
- Personality: “Some aspects of personality can make people more likely to use substances and engage in risky behaviours,” she adds.
How quickly a person becomes addicted to a substance will depend on the person and the drug, Hellemans says.
“Heroin and nicotine are highly addictive, less likely to develop addiction to cannabis. You can still develop an addiction, but it’s less,” she says.
The signs of addiction will also be different for everyone, but one common factor is continued use in spite of the adverse consequences.
“They use and they have a hangover, so they don’t go to work,” says Hellemans. “You’re not meeting your parental obligations. You’re not meeting your work obligations.”
Addiction is an illness
There’s a common misconception that continuing to use a substance after developing an addiction is a choice.
“The people who love that person are often really torn apart because they can’t understand why this person would still be choosing to do this when it’s ruining their life,” said Meredith Henry, Canadian Counselling and Psychotherapy Association (CCPA)‘s anglophone director for New Brunswick.
This can lead those struggling with addiction to lose their support systems.
The stigma around addiction can also prevent people from coming forward to ask for help.
“A lot of times, people do feel that they are being judged … this is seen as something they’ve done to themselves, instead of understanding a lot of factors that went into the person ending up where they are,” Henry said.
This judgment can be passed by friends, family and even health-care workers.
“If the first face that you see is somebody who’s judging you from a professional standpoint, then that’s not going to make you likely to want to continue down that road,” she explained.
Hellemans has seen this happen first-hand.
“When people actually go seek treatment, they are treated very differently than individuals who have another chronic disorder,” she said.
“Let’s say somebody has diabetes, and they don’t take their insulin. Do they get shamed? No. If somebody has an addiction and they relapse, do they get shamed? Yes.”
This can contribute to the further marginalization of groups already on the periphery of society.
“Take any chronic disease and replace the word addiction with whatever that word is, and you will see how stigmatized our society is in terms of treating these individuals,” Hellemans said.
“They’re often populations of people who have had a horrific life experience … people who have come back from war, people who have lived in poverty, people from oppressed societies and Indigenous Peoples.
“Stigma is a huge piece of addiction treatment. It’s not allowing us to be well.”
“We want to try and eliminate some of that stigma, ignite a discussion around mental health care and get people aware of … the service providers … they can turn to and how can those types of professionals help,” she says.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.
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