“We see addiction itself as the problem, rather than the use of a specific drug” (Narcotics Anonymous World Services, 2014, p. 7).
It can be hard to tell if a friend or loved one has a problem with addiction, and even harder to recognize addiction in ourselves. The stigma around drug and alcohol abuse and addiction means that inaccurate stereotypes (like the “alcoholic living under the bridge” or the “addict sleeping on the street”) persist. This usually does not reflect the true face of addiction. Most people in active addiction — about 70% — maintain their employment. Even among highly marginalized populations like those in Vancouver’s Downtown Eastside, less than 10% of overdose deaths were accounted for by people with no fixed address. Job loss and the experience of homelessness are extreme consequences usually suffered only by those far along in the progression of their disease.
Is Addiction About a Specific Drug?
The markers of addiction are often subtle and hidden, especially in the early stages of the disease when it can be most receptive to treatment. When we are trying to assess our own substance use or that of a loved one, we tend to look at patterns of use around a particular substance. For example, we might focus on how much and how often our loved one is using cocaine or drinking alcohol. However, the Canadian Medical Association defines addiction itself as a disease — a chronic, relapsing disease that is not associated with any one particular substance.
In fact, the disease of addiction is rarely about a specific drug. A scientific review of research on addiction showed that only 11% percent of people in addiction treatment report a single addictive issue. Generally, people experience cross addiction, where addictive patterns of behaviour occur across different substances or processes.
What Is Cross Addiction?
Cross addiction manifests in different ways. People can experience polydrug addiction, where they experience physical and psychological dependence on more than one substance. Some people may find that their addictions are fused, where one addiction triggers the other (think of the person who only smokes when they drink.)
Other people combine drugs in order to achieve a particular kind of high, different than the effect of each drug alone. The practice of combining heroin and cocaine is an example. People may also combine drugs to extend a high (e.g., using cocaine in order to be able to keep consuming alcohol over a longer period of time), or to manage it (for example, using benzodiazepines to come down from a stimulant high). Some people may also use one substance addiction to enhance the experience of another; for example, an individual with a sex addiction may use alcohol, ecstasy, or ketamine to increase the pleasurable experience of the sexual encounter.
Sometimes people also engage in substitute addictions when they are trying to cut down on substance use. For example, a person may begin to use more and more cannabis in order to stop drinking alcohol, or drink more alcohol to stop smoking weed. In this way, a secondary addiction that was relatively harmless at first may become increasingly destructive when the harmful primary addiction is stopped.
People who are cross-addicted may use one addiction to mask another. For example, a person with a sex and love addiction may engage in the more socially acceptable behaviour of drinking in order to be able to participate in the less socially acceptable behaviour of sex addiction. The use of alcohol may also have a disinhibitory effect; the person can control the sex and love addiction unless they are under the influence of alcohol. Alternately, someone may use drugs or alcohol to manage feelings of guilt and shame arising from a primary addiction to behaviours like gambling, sex or love.
What Does Addiction Really Look Like?
Surveys of drug use typically focus on single substance use and miss the full picture of what drug and alcohol addiction actually looks like in real life. For example:
- Benzodiazepines are detected in 20% of opioid poisoning deaths, while stimulants (meth, cocaine, or both) are detected in 52% of fatal overdoses;
- 30% of problem gamblers also experience alcoholism;
- Over 60% of people with sex addiction also struggle with a substance addiction;
- 30% of people with alcohol use disorder use cocaine, and 40% use benzodiazepines — a particularly dangerous combination that can result in lethal overdose;
- Up to 60% of alcoholics use cannabis and two-thirds of cannabis users drink alcohol.
Furthermore, poly-drug use tends to accelerate the progression of addiction; alcohol users who use cannabis drink significantly more than those who do not, and cannabis users who drink alcohol consume more cannabis than those who do not drink.
Addiction Can Affect Anyone
During the COVID-19 pandemic, many of us have turned to alcohol and other drugs as a way to soothe anxiety and manage stress. Sales of cannabis and alcohol have increased dramatically throughout the pandemic. In the first two months of the lockdown, cannabis sales increased by a remarkable 600%; alcohol sales showed a significant jump as well. The concurrent use of multiple substances is both a risk factor for addiction and an accelerant of the progression of the disease. Furthermore, the pattern of use of each one of the substances in isolation might not be a concern, but the actual pattern of consumption for both is a serious red flag. Someone might say “I only drink four nights a week”; however, they are only able to go a night without alcohol if they consume cannabis instead. In other words, their actual addictive pattern is one of daily use. In addiction treatment, many people tell us that they first began to face serious consequences in their addiction when they became polydrug users.
When we look at addiction as a distinct phenomenon rather than a problem associated with a specific substance, our understanding of it changes. Addiction is not rare but actually quite common. A scientific study examined addiction across a matrix of different people, substances, and behavioural processes. Their data showed a larger, generally non-addicted group (approximately 70% of the people in the study) and a smaller, generally addicted group (30% of the people in the study), which the researchers called the Work Hard/Play Hard group. A follow up study showed that the distinctions between these two groups remained stable over time even if the primary addictions of the people in the Work Hard/Play Hard group shifted over time.
Renascent Can Help
In deciding whether you or a loved one need help for a drug or alcohol addiction, it is important to look at patterns of use across substances and addictive behaviours, rather than examining each substance of concern in isolation. Our approach is holistic and individualized to each person. We know that recovery is possible, when treatment addresses the problem of addiction itself. We understand that addiction treatment is not about separating a person from a drug but about confronting the underlying disease of addiction. We appreciate that our clients are vulnerable to the disease of addiction itself, not to the action of one particular drug. We believe that recovery involves empowering each person to understand their own addictive patterns, and to overcome them.
If you think that you, your friend, family member, colleague, or employee might need help, call us today. We can help you identify patterns of problem use across substances, and help you understand the available treatment options. Like all mental health issues, substance use disorders occur along a spectrum that ranges from mild to severe. Untreated substance use and addictive disorders tend to progress in severity over time, becoming increasingly resistant to treatment. The best time to seek help is now.
A portion of this article is adapted from an excerpt from the upcoming book Hope Against Hope, authored by Renascent’s Clinical Director Michael Lochran and consulting Psychotherapist Laura Cavanagh. Hope Against Hope’s anticipated release is in 2022.
