Contrary to popular belief, addiction does not develop “because of bad choices.” Many people make the choice to use drugs and/or drink alcohol and never develop an addiction.
Some of the complex reasons addiction can develop are as follows:
- To cope with unbearable trauma when specialized trauma resources are not accessible, available, or effective
- To cope with unbearable circumstances like extreme poverty, homelessness, etc.
- Genetic vulnerabilities
- Substance use was normalized in family and communities
- Social inclusion relied on substance use
- Complex biological mechanisms cultivate and perpetuate addictions
- To soothe chronic pain when doctors cannot find effective traditional treatments
- To cope with mental illness that is not effectively treated through therapy or medication (or due to inaccessible mental health supports)
- Inappropriate prescribing and promoting of addictive drugs ETC.
Unhelpful responses:
Lecturing:
- “You’re putting yourself at risk.”
Commanding:
- “You need to go to treatment.”
Judgement:
- “Is this really what you want to do with your life?
Labeling:
- “You are an addict.”
Conveying blame and judgment does not help someone to reduce or stop their substance use. In fact, blame and judgment can encourage substance use. Feelings of shame and low self-esteem tell the person with an addiction they are incapable of change or not worth change. We do not want to reinforce this story.
It is not helpful for us to tell people with addictions how they should act or why they should change. A person with an addiction needs to be motivated to change their substance use for their own reasons. Similarly, we cannot tell someone that they have a problem if they do not believe they have a problem. They need to realize it themselves.
Helpful responses:
Harm reduction:
Connect the person to resources on how to use drugs and alcohol safely.
The reality is that people will continue to use substances regardless of our personal
opinions on the matter. It is important that if people choose to use substances, that we connect them to information on how to use that substance more safely.
For example, there are ways to use heroin that reduce some of the risks associated with the drug. Search for local or national harm reduction and safe use resources and pass them on to the individual who is using.
Normalize relapse:
Relapse is not a failure; it is an essential part of any attempt to make significant
change.
Humans in general struggle to change their behaviours. Whether it’s trying to spend less time on social media or going to the gym more, there is almost always a relapse into old behaviours while we are trying to establish new behaviours. Stopping substance use is infinitely more difficult than committing to a new workout routine. This means there will inevitably be relapses throughout this process too. Relapse is normal and part of the change process – it does not mean someone has failed.
Point out changes you have noticed:
“I’ve noticed that you don’t play music much since you started using.”
“I’ve missed spending time with sober you. We used to have so much fun
together.”
A way that we can help someone identify the impact of their substance use is by non-judgmentally pointing out ways we’ve noticed they are acting differently. It’s important that these are statements not questions. Some examples include: “I’ve missed spending time with you,” “I’ve noticed you haven’t been in class lately,” “You don’t quite seem like yourself recently,” or “You’ve seemed more anxious than usual.”
Motivational Interviewing
Find the person’s own motivation for making a chance in their life. Explore their
reasons for wanting to change instead of simply stating your reasons for wanting
them to change.
Telling someone with an addiction the reasons why you think they should stop using is ineffective. It does not help people to change their patterns of substance use. What can be much more helpful is finding out someone’s own reasons why might want to change their substance use. The intent of using these questions is simply to be a sounding board to the individual of the reasons why they might want to change. We have to hold back our reflex to give advice or pass judgment and simply be curious about why they might or might not want to change.
- What concerns or worries you about your drug use?
- How has drinking caused problems for you?
- How would you like for things to be different in your life? Can you get there with this pattern of use?
- How would your life improve if you didn’t feel the need to use cocaine?
- What concerns you the most about using?
- What is the worst thing that could happen if you continued on as you are?
- What is the best thing that could happen if you stopped using?
- Do you remember a time where you didn’t use substances? What was different about that time?
- What did you envision for your life when you were younger? Has what’s going on now gotten in the way of this vision? How?
- If nothing changes, what do you see happening in 5 years? If you decide to change, what will it be like?
- If you were to go to treatment or see an addictions counsellor, what would be the reasons why?
- Do people you care about think this is an issue? What do you make of that? Are any of their concerns reasonable to you?
- How will you know when it is time to make a change?
- What is more important to you than alcohol?
- What’s something you’ve done in the past that was really hard? How were you able to do it?