What is Addiction?

What is Addiction?

The World Health Organization (WHO) defines Substance Use Addiction as:

  • Repeated use of a psychoactive substance or substances, to the extent the user (referred to as the addict):
  • Is periodically or chronically intoxicated;
  • Shows a compulsion to take the preferred substance(s);
  • Has great difficulty in voluntarily ceasing or modifying substance use; or
  • Exhibits determination to obtain the psychoactive substance by almost any means.

The Centre for Addictions and Mental Health (CAMH – Toronto, Canada) defines Substance Use Addiction as a primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors that influence its development and manifestations.  It is characterized by behaviors that include one or more of the following:

  • Loss of control over use of the substance;
  • Continued use despite harm; or
  • Compulsive use and craving.

Consequences of Addiction

Addiction produces a range of negative neurobiological consequences, including:

  • Tolerance: diminished effects due to repeated use and actual physiological changes to compensate for heavy use of a substance;
  • Withdrawal: the signs and symptoms that occur when the body has built up a tolerance and the then the substance use stops or is significantly reduced;
  • Physical dependence: the presence of physical effects such as tolerance and withdrawal.  Often accompanies psychological dependence, but not always;
  • Dependence liability: the ability of a drug to produce reinforcing states such as pleasure or euphoria;
  • Mood altering: impaired mood and functioning resulting from psychoactive and physical effects of the substance; and
  • Overdose: when intoxication threatens the vita functions of the nervous system such as breathing and heart rate.

(Addictions Foundation of Manitoba – AFM)

Substance Use and Mental Illness

  • People with a mental illness are twice as likely to have a substance use problem compared to the general population. At least 20% of people with a mental illness have a co-occurring substance use problem.  For people with schizophrenia, the number may be as high as 50%.
  • People with substance use problems are up to 3 times more likely to have a mental illness. More than 15% of people with a substance use problem have a co-occurring mental illness
  • People with mental illness and addictions are more likely to die prematurely than the general population. Mental illness can cut 10 to 20 years from a person’s life expectancy.
  • The disease burden of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together and more than 7 times that of all infectious diseases. This includes years lived with less than full function and years lost to early death.
  • Tobacco, the most widely used addictive substance, is the leading cause of premature mortality in Canada. Smoking is responsible for nearly 17% of all deaths.
  • Among Ontarians aged 25 to 34, 1 of every 8 deaths is related to opioid use.

 The Centre for Addiction and Mental Health | CAMH

Trauma and Recovery

  • Dr. Covington: ”It used to be believed that addiction had to be treated before one could deal with trauma – the rule of thumb was that you had to be sober for a year before you could work on your trauma. But we now know that trauma work can begin in early treatment and recovery.”
  • “Many women who are labeled “treatment failures” are actually trauma victims who return to drugs and alcohol because their trauma was not addressed. By integrating trauma and addiction treatment, the risk of trauma-based relapse can be lowered.”

Stephanie Covington: Pioneering a Woman’s Way to Recovery – Drug Rehab Options (rehabs.com)

Intersectionality

Many groups of people including LGBTTIQ?, Indigenous, Newcomers, Refugees, People of Color, People with Disabilities and/or Mobility challenges, various Religions and/or spiritual practices, Elderly People, People with problematic substance/drinking use, Women, Mothers, Survivors of IPV, People with mental illness, criminalization, etc. are subjected to stigma, stereotyping, judgement, exclusion, racism, discrimination, sexism, victimization, patriarchy, genocide, etc. across multiple SDOH factors and are therefore at higher risk of unhealthy life outcomes.

Intersectionality recognizes diversity by considering an individual’s combination of factors and characteristics in relation to their experiences of inequality due to power imbalances.

Intersectionality acknowledges that the factors and characteristics of an individual can create different challenges and varying experiences even among similarly situated people.

United Nations: Universal Themes in the Lives of Addicted Women

  • Treatment issues.
  • Systemic issues.
  • Shame and stigma.
  • Physical and sexual abuse.
  • Relationship issues.
  • Fear of losing children.
  • Fear of losing a partner.
  • Lack of services for women.
  • Lack of understanding of women’s treatment.
  • Long waiting lists.
  • Lack of childcare services.
  • Lack of financial resources.
  •  Lack of clean and sober housing.
  • Poorly coordinated services
  • Needing a partner’s permission to obtain treatment.

Intimate Partner Violence

Substance use and mental health problems frequently co-occur among people who are survivors of violence, trauma, and abuse, often in complex, indirect, mutually reinforcing ways.

Many women identify substance use as a way to cope with gender-based abuse and trauma. Nancy Poole writes in Gender does matter: Coalescing on women and substance use that alcohol problems have been found to be up to 15 times higher among women survivors of partner violence than in the general population.

Yet service providers and policy makers have not always acted on these connections; services with a primary mandate for domestic violence and sexual assault have often not served women with substance use problems, adding to women’s vulnerability.

(Published on Canadian Women’s Health Network (https://www.cwhn.ca))