Notes on addiction

For hundreds of years, drugs have been abused and societies across the world have suffered the adverse effects of addiction and the heavy consequences that it carries.

Unsplash - @thomasstephan

Unsplash - @thomasstephan

What is addiction? In the case of drugs, it’s the inability to stop using a substance despite facing negative consequences. Most medical associations define addiction, clinically known as substance use disorder, as a complex, chronic brain disease.

The Maldives has seen the drug abuse epidemic and related criminal offences rise steeply since the 80s — with a significant jump in the last decade or so. Where it was previously mostly hash oil, alcohol and brown sugar, more recently we have seen the likes of cocaine, crystal meth and other party drugs making their rounds, with the age of drug users also dropping at an alarming rate.

We opened our first rehabilitation centre back in 1997, and have had little or no success over the years. With the program remaining stagnant, there have been very few changes at the policy level — implementation itself has failed miserably.

A week ago, the minister of health declared that they have no idea how to solve the drug problem. Which isn't surprising, considering the current state of things. But it is a great first step, as only by admitting we don't know will we be able to learn and grow.

So, what really is happening here? Why are so many succumbing to drugs and addiction?

Many still believe it is a moral failure; a lack of willpower — once an addict, always an addict. This kind of high-horse thinking is part of the problem, because research has consistently shown that that just isn't the case. And addicts do recover. Many have quit and found new ways to live. 

Contrary to popular belief, drugs aren't the problem, the problem lies within the individual. As we have known and seen, not everyone who uses drugs gets addicted to them. Not everyone who ‘uses’ watches in horror as it destroys their lives, nor can they realise they are just unable to stop. 

There are many things which lead people to abuse drugs in the first place. Like childhood trauma, chronic pain, mental illnesses. While the environment a person grows up in, along with a person's behaviour, influences whether they become addicted to drugs, genetics plays a key role as well. Scientists estimate that genetic factors account for 40 to 60 percent of a person's vulnerability to addiction.  Modern treatments address these issues and treatment is also tailored to fit the specific individual. It just isn't a ‘one size fits all’ scenario — another key insight that most fail to recognise.

While it is understandable that not every recovering addict would want to share their most vulnerable moments with the world; it is those moments that provide key insights into how one might become a user.

We sat down with a recovering addict and their story, like so many others, is distressing. Though they (s/he) grew up in a loving home, yet they also encountered traumatising episodes. With the parents getting divorced when they were just a few months old, growing up without a father was confusing. Sexually abused at the age of seven and not being able to talk about it, they carried this into adolescence. This was a time when people just didn’t talk about “those things.” Having very low self-esteem, this was the foundation for the young adult they would become.

"I had a hard time forming meaningful relationships, which was a reflection of how I saw myself. I was weak emotionally; feelings were something I suppressed all the time because I didn’t know how to deal with them. I was angry and confused. I had no goals or dreams and to be honest, I had a lot of questions about everything and there was no one with answers.

“The first time I used drugs, I was 15 years old. I still remember that day clearly. The euphoria; for the first time in my life I felt complete. And from that day, I was hooked. 
What followed were years of unmanageability and desperation. The first time I went to a rehab, I was just 20 years old.

“I had no idea what was happening. All I knew was I couldn’t stop using. It was the government rehab in Himmafushi. There wasn’t much of a program those days. A few classes during the day. I spent close to eight months there and was then sent back home. There was no aftercare program either and I lasted exactly one week — I was sent back to rehab. I was fortunate to have a family who never gave up on me. They found a way to take me abroad to another rehab.

“But I didn’t learn. I kept relapsing. It was like having a huge void inside me and the only way I knew how to fill it was by doing drugs. That was my life for years, in and out of rehab, countless detoxes. It was a vicious cycle.

“I lost everything, opportunities to make something out of myself, money, friends, couldn’t hold a job, failed marriages. The thing was, I could stop, but staying that way was a different story. It wasn’t until my last stint in a rehab in India about seven years ago when things changed.

“What I realised was that I was doing the same things over and over again expecting different results. That is the definition of insanity. I learned to ask for help, I needed help to restore myself to sanity. I needed support to stay in recovery.

“But frankly there isn’t much support available here. As the Health Minister recently put it, they don’t know how to solve the issue. Addicts remain addicts because they don’t know anything else. Most people relapse right after their stay in rehab because there is no program to meet their individual needs. What worked and is working for me is narcotics anonymous (NA) meetings

“[NA] is a world wide fellowship of recovering addicts who meet regularly to help each other stay clean. It is the only option we have here and to be honest, the sad truth is it might not be what works for everyone. People are helpless and hopeless and help seems to be a dot far, far on the horizon.

“I was lucky. I will always be a recovering addict because the disease I have is a chronic one. Learning to deal with my emotions, being a responsible, productive member of my society was something I never even dreamt of. But it has become my reality now.”

The story is similar to many, with slight variations that make them unique to every single one, and it gives us a little insight into what may lead people to choose destruction. People do not choose how their brain and body responds to substances. Even though the initial decision to use a substance is based on a person’s free will, once addiction takes over, that choice or willpower can become diminished to varying degrees. Everyone’s path to addiction is different, but the end is, sadly, mostly the same.

It could happen to anyone. Rich or poor, functional or dysfunctional; it does not discriminate. We, as a people, are only just beginning to understand it.

Addiction is a disease.

It is neither less nor more of a disease than the likes of diabetes, cancer or other diseases — addiction is caused by a combination of psychological, behavioural, environmental and biological factors. And the good news is, dire as its effects can be, it is treatable.

Hopefully, the authorities can come up with a better, a more viable plan than throwing up their hands in the air and admitting near defeat.

But is it just the authorities who can do something? What about individuals and society?

Society at large needs a slight change in perspective; to be more empathetic and see the humanity in the fellow travellers that are part of our collective journey — 'ordinary' individuals may not have fancy titles or powers that allow them to enact policy, but they can still be a force for good just by being a little bit better as people.

And one can perhaps hope that this will set an example to policy makers and get them to roll up their sleeves, see, and explore, the problem and then come up with more viable, long term, policy solutions.

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