[5 minute read]
TL;DR: Addiction can be an overwhelming subject for many people. There are various definitions that can be used to explain how addiction comes to be. The most important aspect to note is that addiction is a form of coping, a response to emotional, physical, or psychological pain. Therefore, helping people with addiction concerns requires first understanding what underlies the compulsion to engage in the behavior. Resources in the community include detox, rehab, and outpatient treatment options, as well as counselling services such as Shalem.
Jump to: Treatment Options: Where to go for help | Resources
Addiction has been a much-discussed topic in our society.
From substance use, to alcohol, to gambling, sex-addiction, and gaming; most of us have heard of the term.
Most of us will also be affected by this disorder at some point in our life, whether directly or indirectly.
Despite how common addictions may be, it is one of the most perplexing conditions in mental health treatment.
With addiction being discussed so often, and various (often opposing) opinions and advice floating around, clients and families often tell us they feel confused and overwhelmed. This article is meant to provide a brief and accessible explanation of addiction and its treatment, including treatment options in Hamilton and beyond.
Addiction: An Illness or a Failure?
As a society, we tend to explain addiction in different, often contradictory ways. Some may say that addiction is an illness (physical or emotional), while others may use moral explanations (e.g. “it’s a choice, it’s their fault, they are bad people”). We may also use punitive measures to try and curb addictions (i.e. laws prohibiting and punishing the use/activity), on the one hand, while on the other, provide supports to help people stay alive and receive treatment (e.g. harm-reduction and safe injection facilities, detox, rehab).
First and foremost, addiction, and the people who struggle with it, are almost always framed in a negative light. We tend to blame the disorder (if not the individual), and we encourage “getting rid of” the behavior. A colleague of mine used to say that “addiction is the only disorder in which we tend to blame the person for their symptoms.”
Addiction can cause negative consequences and ripples that harm both the person and those around them. While this is true, and as I will explain below, viewing addiction and the individual through this ‘problem’ lens may not always be an accurate or helpful representation.
Defining Addiction: A Reflection of our Understanding
Perhaps most strikingly, even the definition of addiction is difficult to clarify. The DSM-5 defines addiction as: “a behavioral or psychological syndrome or pattern that occurs in an individual; the consequences of which are clinically significant distress or disability; not merely an expectable response to common stressors and losses; reflects an underlying psychobiological dysfunction; is not solely a result of social deviance or conflicts with society; has diagnostic validity using one or more sets of diagnostic validators; and has clinical utility.”(1)
Although this is an important definition in clinical settings, a much more useful (and concise) definition comes from Dr. Sumrok (2), who termed addiction as “ritualized compulsive comfort-seeking behavior”. This definition encapsulates the various facets of addiction in a non-pathologizing manner. In other words, addiction is a behavior with a goal, a structure, and tends to be beyond the individual’s control.
The most important part, in my view, is to understand that addiction is a comfort-seeking behavior. Dr. Gabor Maté spoke of this as well, often sharing that addiction is not the problem (despite having detrimental consequences). Addiction is a solution to a problem (see, for instance, (3)). As a comfort-seeking behavior, one that the individual is compelled to take part in, the intention of addiction isn’t to cause harm to oneself or others. Addiction serves a very important, albeit ‘maladaptive’ function: relieve the pain.
The connection between addiction and other mental health concerns, especially trauma, has been well-documented. According to the Canadian Mental Health Association, “Depending on the setting, prevalence rates for concurrent disorders [addiction and mental health] have been found to range from 20 to 80 percent” (4). The frequency of concurrent disorders shows that, more likely than not, having both addictions and mental health concerns is not the exception, but the rule.
Addiction, therefore, is often a coping mechanism, and, unfortunately, a very good one. Good in the sense that it does its job quite well: it relieves the emotional, psychological, or physical struggles that the person encounters. Often times, the relief that addiction provides the individual is so significant, in the moment, that the consequences of the behavior may pale in comparison.
If this is the case, then in order to understand how we can help someone with an addiction (be it a client, a loved one, or a community member), we must first understand what underlies the addiction.
Treatment Options: Where to go for help
At Shalem, we often hear from clients, parents, families, and community partners about their concerns regarding supporting themselves and others as they go through addiction struggles. For some, addiction-specific treatment can be helpful, particularly when they need support with managing the withdrawals. In such cases, the most common sources of support include the Withdrawal Management Centers (also known as detox).
The two Withdrawal Management Centers in Hamilton are the Men’s Addiction Services of Hamilton (MASH) (5), as well as Womankind Addiction Service (6). Both are run through St. Joseph’s Healthcare Hamilton, and provide a safe and supportive environment to transition people from active consumption to sobriety. Their main purpose is to support individuals as they biologically and psychologically adjust to not having the substance (i.e. undergoing withdrawals).
Detox is often followed by Inpatient Addiction Treatment, also known as rehab. There are numerous facilities in Ontario that are funded by the government, and can provide longer-term support to people recovering from addiction. These facilities, as well as details regarding the programs, can be found on Connex Ontario (7).
Another treatment option involves outpatient support. In Hamilton, these include Suntrac (8), Alcohol, Drug & Gambling Services (ADGS) (9), and the Rapid Access Addiction Medicine (RAAM) Clinic (10). Of note, ADGS can provide support for both individuals and their families, including counselling and information.
Finally, peer-led supports have been a consistent form of support for individuals in community. Cities across Canada have several 12-step groups that provide addiction support to participants, such as: Alcoholics Anonymous (11), Cocaine Anonymous (12), Narcotics Anonymous (13). Sex Addicts Anonymous, Gamblers Anonymous.
While Shalem doesn’t offer specialized treatments (such as detox or rehab), we do offer general psychotherapy. For some, that might be a place to start exploring whether or not an addiction exists, or a way to access recommendations for more specific treatment in their area. Shalem also supports partners and family members in therapy as they reflect on how best to support their loved one who is dealing with an addiction. In some cases, Shalem may offer couple therapy to help partners deal with the effects of addiction on their relationship.
Final Considerations
It is important to note that, as with any other mental health concern, change is only possible when the person sees this as a goal. We cannot force a loved one to want to change, and this requires a balancing act that can be highly taxing, stressful, and painful for families. As families support their loved ones, they may find themselves oscillating between their love for the person, and the need to maintain a stable living environment. It may also be a struggle between supporting their loved one’s mental health, as well as supporting our own. At times, these two needs can be contradictory.
As with many other areas in mental health, there are no “wrong” choices. Each person, family, and community, may have different needs. That’s why addiction treatment (and counselling for loved ones) must be individualized. If possible, it’s important to find a way to view the addiction treatment plan as a collaborative endeavor, rather than a battle of opposing demands. At times, prioritizing our wellbeing may mean setting boundaries and making difficult decisions. Feelings of guilt, shame, and anger, can often become predominant, and support is very important.
If you or anyone you know may be experiencing crisis relating to mental health or addictions, please contact a crisis line, such as Hamilton’s Barrett Center’s 24-Hour Crisis Line: 905.529.7878 (14) or the national crisis line at 9-8-8, or 911.
Maor Bernshtein, MSW, RSW, is a Substance Use Social Worker with Shalem Mental Health Network.
Resources
- Expanding the Definition of Addiction: DSM-5 vs. ICD-11: https://pmc.ncbi.nlm.nih.gov/articles/PMC5328289/
- Addiction doc says: It’s not the drugs. It’s the ACEs…adverse childhood experiences. https://acestoohigh.com/2017/05/02/addiction-doc-says-stop-chasing-the-drug-focus-on-aces-people-can-recover/
- Dr. Gabor Mate: Understanding the Nature of Addiction, Spotify Podcast: https://open.spotify.com/episode/3K7lyNQBJbkqJNBkRlz6ln
- Canadian Mental Health Association: Concurrent Disorders: https://ontario.cmha.ca/documents/concurrent-disorders/
- St. Joe’s Men’s Addiction Service Hamilton: https://www.stjoes.ca/hospital-services/mental-health-addiction-services/addiction-services/men%27s-addiction-service-hamilton-mash
- St. Joe’s Women’s Addiction Service: https://www.stjoes.ca/hospital-services/mental-health-addiction-services/addiction-services/womankind-addiction-service
- Connex Ontario: https://connexontario.ca/
- Suntrac Program: https://mission-services.com/programs-and-services/addiction-services/suntrac/
- ADGS: https://www.hamilton.ca/people-programs/public-health/alcohol-drugs-gambling/alcohol-drug-gambling-services
- RAAM clinic: https://www.stjoes.ca/hospital-services/mental-health-addiction-services/rapid-access-addiction-medicine-raam-clinic
- Find Alcoholics Anonymous: https://www.aa.org/find-aa
- Find Cocaine Anonymous: https://ca-on.org/meetings/
- Find a Narcotics Anonymous: https://www.orscna.org/meetings
- Hamilton’s Barrett Centre’s 24-Hour Crisis: https://goodshepherdcenetres.ca/services/barrett-centre-for-crisis-support/