Spotlight on Mental Health – Substance Related and Addictive Disorders

“It’s never a bad time to be a good person” 

Katie is a 25 years old caucasian female. She loves binge watching The Good Wife on Netflix, eating all the candy, and anything purple. She paid her way through a Master’s degree serving at various restaurants, which she can tell you about in both English and French. She has watched Legally Blonde and The Rocky Horror Picture Show way too many times to count.

Katie is most proud of her “big, open heart”. And, having known her for many, many years, I can say that it is really big and really open. Her mantra? “It’s never a bad time to be a good person”. She has that kind of charm that makes everyone like her. She’s beautiful, open minded, well spoken, and totally hilarious. An afternoon with her [and some earl grey tea] is the only ab workout you need!

She once broke her ankle jumping off a curb.
[it was a really good jump though]

I asked her my favourite question of all time: If you could have any super power, what would it be? Her answer: “The ability to travel to different spaciotemporal dimensions, because Rick and Morty make it look so FUN!” So, yea. She’s a Rick and Morty fan!

To sum it up: Katie is awesome. Everyone loves her. You wouldn’t even know she struggles with addiction.


What comes to mind when you hear the word “addiction”?

Maybe you think of alcoholics, drug addicts, celebrity DUIs. Maybe you think of poor impulse control and bad life decisions. Maybe you think of the word in its slang use (“I am so addicted to Fuller House right now!”)

Or maybe you think of a friend’s urges or desires, a parent’s stints in rehab, or your own lack of success with support groups. Maybe you feel ashamed or embarrassed.

An issue that we see with most disorders, mental or physical, has to do with semantics. The words we use to describe various disorders, conditions, and emotions are just that: words. The words addict, addiction, and addicted are used in every day life, and in many cases have taken on an informal meaning. This is perfectly normal in the evolution of a language.This means that it falls on us to know the difference between a word and its meaning – to know the difference between the word ‘addiction’ and the meaning being clinical addiction.

We also need to know that every mental disorder occurs on a spectrum. How each person experiences and copes with mental illness is unique and deserves to be respected. The best way to understand how someone experiences mental illness is to talk to them about it. I had the privilege of talking to Katie about her own experiences with substance addiction.


The Facts

Substance-related disorders are made up of 10 distinct classes of drugs: (1) alcohol; (2) caffeine; (3) cannabis; (4) hallucinogens; (5) inhalants; (6) opioids; (7) sedatives, hypnotics, and anxiolytics; (8) stimulants; (9) tobacco and; (10) other/unknown substances. Gambling disorder is another type of addiction. At this time, other repetitive behaviours such that present like addictions (e.g., sex addiction, shopping addiction, exercise addiction) are not defined as addictions because the jury is still out on the research.

As with many other mental disorders, substance-use disorders can sneak up on us. Katie says that although she has struggled on and off with addiction for 10 years, she didn’t always acknowledge it. “I always told myself that as long as my drinking and drug use did not negatively impact my life (work, academics, relationships), then I did not have a problem.”

The Features

To be considered a disorder, substance use has to involve a problematic pattern of use that leads to significant impairment (social, occupational, financial, etc.) or distress over a 12-month period. The impairment or distress is measured based on a variety of cognitive, behavioural, and physical symptoms. It is common for those struggling with addiction to experience many symptoms. Katie says she experiences sadness, crying, worrying, and guilt. She also describes having a racing heartbeat while feeling irritable and irrationally angry – cue mood swings. She has racing, often obsessive and intrusive, thoughts and yet she can be slow to process them. This leads to a “foggy” brain and a loss of focus and concentration. She panics. She fidgets. And, of course, she has cravings.

In addition to these symptoms, individuals with substance-use disorders often build up a high tolerance and take larger amounts of the substance than they wanted for a longer period of time than they wanted. They frequently want to cut back or quit, but are unsuccessful. Some people spend a lot of time in activities needed to obtain the substances. This leads to a reduction in social, occupation, and recreational activities, as well as a failure to fulfill major role obligations, such as working, taking care of family, or going to school. Finally, individuals with substance addictions continue to use despite having (and being knowledgeable about) persistent physical, psychological, or social impairments.

Most importantly, what addiction looks like for one person is completely different than for someone else. Some people have only a few of the above symptoms and behaviours, whereas others have all of them. There is no one-size fits all for most mental disorders.

The severity of substance-use disorders depends on the number of symptoms someone experiences. Typically, an addiction is considered mild if there are 2-3 symptoms, moderate if there are 4-5 symptoms, and severe if there are 6 or more symptoms.

Very often addictions co-occur (jargon term: comorbidity) with other mental disorders. Bummer, I know! As a perfect example, in addition to addiction, Katie struggles with anxiety and depression. She feels that addiction, anxiety, and depression have joined forces in her life. In her own words, “they form a web of sorts, an organizational structure of my mental health landscape.”

How common a substance-use disorder is (jargon term: prevalence) depends on the substance. For example, only 0.37% of adults over age 18 have problematic opioid use, whereas 70% of the same age group have problematic drinking use.

Getting Help

Although many people struggle with substance-use disorders and addiction, lots do not get help. Why? First, many people do not know where to go. Katie says she does a lot of research on the internet and this lead her to speak with a counsellor and a private psychologist. She is also grateful for a support network including family members, friends, and her cat [go therapy pets!]. She noted that she is very fortunate to live in Toronto, where The Centre for Addictions and Mental Health (CAMH) is located. As she puts it, CAMH has been “an immeasurable resource”.

Despite having people to talk to and CAMH in her neighbourhood, Katie did have some challenges along her journey. “Financial hurdles were the biggest challenge at times. For a while I couldn’t afford private therapy, but I’m extremely lucky and grateful that my parents help me with the costs”.

Another reason people struggle without help is because of a fear of medication. Many people feel that they (or others) don’t need medication or that it’s the ‘easy way out’. Although this can sometimes be the case, other times medication is imperative. Katie says that medication is necessary for her to handle her depression and anxiety. “Without antidepressants I would not be a functioning adult. I’m also learning that excessive drinking and smoking can definitely have a negative effect on my mood and anxiety”

Finally, many people skip out on getting help because of the stigma that is mental illness. Like many others struggling with mental illness, Katie is no stranger to the stigma. She has sometimes has difficulty talking about her struggles, and has hidden them completely at other times. And, like many others, Katie doesn’t feel that she gets the same recognition of her struggles as she would if she had a physical disorder. “Sometimes people don’t understand how [mental disorders] work and that can be extremely frustrating to deal with”.


Katie’s Final Thoughts

Her biggest challenge

“Because I’ve struggled with addiction for so long, around 8 or 9 years, it’s kind of become this undercurrent in my life that sometimes threatens to overflow and sweep me away. But since I’ve gone through CAMH’s addictions services and met with an addictions counsellor, I’ve learned so much about how addiction functions in my life and that is an empowering feeling, to understand myself better.”

Her mental health challenge is…

“…kind of a bitch. That’s the first thing that popped into my head. But truly I feel more positive than that. Addiction is…something I can handle. It isn’t something I can’t beat, I’ve overcome this obstacle before.”

A myth surrounding her addiction is

“In my case, the idea that addiction is a disease. Because I am not physically addicted to any one substance, it’s not accurate to characterize addiction as a disease, it’s part of my mental health landscape.”

Her advice others who are struggling

“Everyone is different, and what constitutes a “problem” for one person may not for another. Hearing a healthcare professional tell me I had dependencies and dependencies were an exclusionary criteria for a cool research study I wanted to be a part of was a bit of a blow, but that made me want to change the parts of my life where my habits were negatively impacting me.”

 


The most interesting part of all this to me is that without knowing of her mental health difficulties, everyone loves Katie. However, once she shares with people what she goes through, their opinion of her often changes. Why is this? I know the answer has to do with stigma. But let’s think past that. Why should your opinion of someone change when you know their dark places? Is it because we like to be ignorant of difficulty? Is it because we want to believe we are all perfect? No one is perfect. But in my opinion, getting up every day and trying your best even when the deck is stacked against you brings you pretty damn close.

So today, as you finish reading this, I challenge you to ask yourself what it is about mental illness that is so scary. You might be surprised to find nothing at all!


Thank you so much for taking the time to learn about substance-use disorders and addictions. And, of course, a huge thank you to Katie for sharing her story! For more information on addictions and related disorders check out CAMH: Addiction. This is an amazing resource outlining everything you need to know about addictions and how to get help!

 

 

 

 

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