There is no doubt that substance use is stigmatized. Research has shown that the general public holds unfavorable views about words such as ‘alcoholic’ and ‘addict’, so it follows logically that this transposes into how they treat them in real life. The weight of stigma has the ability to negatively affect a person’s sense of self-worth, personal relationships, and even someone’s recovery journey.

Untreated drug and alcohol misuse contributes to tens of thousands of deaths each year, in the US alone. The fallout of this is not limited to the individual – it also affects the lives of family, friends, and colleagues. Stigma places people who are affected by alcohol and drug dependency at a considerable disadvantage when it comes to seeking help and much-needed treatment.

So, what is stigma and how can we prevent it?

Stigma is characterized as an assortment of negative beliefs and attitudes that an individual, group or society holds surrounding a certain topic, ways of behavior, or a specific group of people that are not perceived as ‘normal’. The toxicity of stigma comes from the simple fact that this disapproval isn’t person-specific nor the actions of an individual, but rather the perceived assumption of “somebody like that”.

Stereotypes also serve to dehumanize people, as the individual’s identity and personality are no longer their most prominent or defining feature. This generally leads to bias and prejudice in almost all societies regarding drug users. This can cause anger, shame, and guilt within the family, between spouses and also friends.

Stereotyping can also alter the way in which people perceive themselves, which can be very hard to change. This is known as ‘self-stigma’. This is when people start to believe negative stereotypes about themselves and causes low self-worth and motivation to change. This can lead to a snowball effect, where the shame and perceived isolation leads the person to increase their use, which in turn furthers the stigma.

How can stigma contribute to continual addiction?

Not only does stigma affect people who suffer from substance use disorder, but it also negatively affects the people immediately around them. People can be worried that y associating with a substance user it could damage their reputation, and they may even be worried that they might come to physical harm.

Stigma can be a vicious cycle. It can lead to job loss, homelessness, and antagonism from those close to the individual and society as a whole. It is often said that the opposite of addiction is connection; it is less likely that a person is going to reach out for help if they feel that society is against them.

This can lead to further stigmatization when the individual reintegrates back into society. Low self-esteem can be a barrier to recovery. Landlords may be hesitant to give them tenancies, employers may not hire them due to their history, and family and friends may be hesitant to be involved with them. The public stigma associated with drug and alcohol dependency places blame on the people suffering from addiction and creates a society where these people are to be feared, rather than viewed as people who need help.

Many individuals who are in recovery have also found that they are discriminated against.

This can have a detrimental effect on the individual, as they feel that they are defined by their past – this can increase the risk of relapse.

How can we prevent stigma affecting addicts and the recovery process?

Fear and misunderstanding are usually the cause of stigma. Many people hold a deterministic false view that “once an addict, always an addict”. The fact is that substance or alcohol abuse disorder is a medically recognized condition. Many people who discriminate against the people who suffer from them wouldn’t dream of doing so to any other illness.

In changing people’s mindsets, education is the key. It will foster a non-judgmental environment, which will in turn encourage people to seek recovery.

While it has always been necessary for society to have norms for behaviors and a perfectly reasonable expectation for individuals to take responsibility for their own actions, judging substance use as a moral failing rather than an illness that needs compassion only serves to further it.

It is essential that the public understand the many causes of drug and alcohol dependency and the process of drug treatment and recovery. If people were informed about the neurological changes which take place in the brain during addiction, and how childhood trauma can predispose someone to substance use later in life, they would be less inclined to judge those who are suffering from it.

How can I reduce stigma?

As individuals, there are many ways we can prevent stigma and influence others to prevent it. We can be wary of using labels such as ‘addict’ or ‘alcoholic, and especially avoid terms such as ‘junkie’. If we use terms such as ‘substance abuse disorder’ it frames these medical conditions positively, may foster a more open-minded response from others. Be wise with your words – they have the power to ignite emotions that can start a change.

Medical science, and our understanding of habitual drug and alcohol use, has progressed a great deal in the past 50 years. Unfortunately, many of the old values and judgments surrounding it are still prevalent in society. Through educating yourself, and gently sharing it with others, you can serve to reduce stigma. Although it might seem small, it really is a matter of life or death, and your contribution could help to save someone’s life.

In conclusion, alcohol and drug-dependent people are almost always expected by society, as a whole, to change their behavior and exhibit better responsibility for themselves and their actions. However, in return, society has to begin to challenge the negative attitudes and barriers that keep those with addictions and drug dependency problems trapped in dysfunctional habits, behaviors, and overall lifestyles. Change is possible, but it has to be a collaborative effort.

Earnshaw, Valerie et al. “Drug Addiction Stigma In The Context Of Methadone Maintenance Therapy: An Investigation Into Understudied Sources Of Stigma”. International Journal Of Mental Health And Addiction, vol 11, no. 1, 2012, pp. 110-122. Springer Science And Business Media LLC, doi:10.1007/s11469-012-9402-5. Accessed 10 Oct 2020.

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HARBIN, HENRY T., and HOWARD M. MAZIAR. “The Families Of Drug Abusers: A Literature Review”. Family Process, vol 14, no. 3, 1975, pp. 411-431. Wiley, doi:10.1111/j.1545-5300.1975.00411.x. Accessed 10 Oct 2020.

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What is Addiction?

When we hear the term ‘addiction’ it is common to immediately think of alcohol or drugs. However, addiction is simply when a person cannot seem to stop doing something, even though it is causing them harm. This can include alcohol or drugs but can also include behaviors, which are also known as process addictions.

Addiction is thought to be caused by a variety of factors including genetics and trauma. Traumatic events include childhood abuse or neglect, sexual abuse, war, natural disasters, motor accidents, although from a therapeutic point of view any prolonged stress can be traumatic.

An addicted person will experience urges and compulsions to use or behave in a certain way in order to satisfy their addiction. This can be disruptive to daily life as the person will tend to prioritize their addiction over the rest of their life, and may experience overwhelming anxiety, frustration, or agitation if they cannot satisfy their addiction.

In this blog, we will explore substance addiction and its signs. As addiction is a progressive disease, the earlier a person receives intervention the more likely it is they have a successful recovery. We are going to outline and discuss the signs of substance addiction, so that you the reader can be better prepared to notice an addiction in its early stages, either in yourself, a friend, or a loved one.

Understanding Substance Addiction

Many of us use substances on a daily or weekly basis (caffeine, alcohol, nicotine). Simply using substances is not usually problematic – caffeine and alcohol in moderation do not cause lasting harmful health consequences. However, any substance can be habit forming and some can be physically addictive. This can pose significant health risks.

Drugs that are not physically addictive but can be habit forming are:

• Cocaine and crack
• Methamphetamine and amphetamine
• Marijuana

Drugs that can cause physical dependency include:

• Alcohol
• Opiates and opioids such as heroin, morphine, fentanyl, oxycodone, oxymorphone, and codeine
• GHB and GBL
• Benzodiazepines such as Xanax, Ativan, and Valium
• Ambien

Substance Withdrawal Symptoms

Substances that are physically addictive change the make-up of the brain. This means that the brain and body become dependent on this substance to function normally. If the substance is stopped abruptly, withdrawal symptoms can range from extremely uncomfortable to fatal. This leads the addict to pursue the substance to stave off these symptoms. Eventually, the addict will build up a higher and higher tolerance and will need more of the substance to prevent withdrawal.

Withdrawal symptoms tend to vary depending on the substance of addiction, but according to SAMHSA they typically include:

• Anxiety
• Difficulty falling or staying asleep
• Short-term memory problems
• Fatigue
• Poor focus, concentration and decision making
• Cravings for a substance
• Poor executive function
• Anhedonia
• Depression
• Dysphoria
• High Irritability
• Physical aches and pains
• Reduced sex drive
• Diarrhea
• Shaking and sweating
• Those addicted to substances may seek to hide their problem from their friends and loved ones. When approached or confronted, they may persistently deny their condition or avoid others altogether in order to prevent confrontation.

Due to this denial, often withdrawal symptoms are the first thing that friends and family will notice in someone who is addicted. This is why it is important to be aware of how the symptoms may present in people. It is especially helpful to look for these occurring in conjunction with the behavioral and physical signs of addiction, which are listed later in the blog.

The sooner an addiction is noticed the sooner you can provide your friend or loved one with the help that they need. Being aware of these signs puts you in the best position to notice addiction in its earliest stages and prevent the condition from worsening.

The Signs of Addiction

Substance use takes its toll on the body. The following are some physical signs of substance to look out for, according to the U.S. Department of Justice.

 

• Headaches
• Insomnia
• Broken facial capillaries
• Shaking and trembling
• Sudden, drastic weight loss or gain
• Unfocused eyes
• Flushed skin
• Track marks (due to injection)

Beyond the physical symptoms of addiction, there are certain behavioral changes that are characteristic of substance abuse. Look out for:
Frequent blackout

instances of memory loss

Argumentative disposition

Depression

Frequent mood swings

Regularly using drugs to relax or help with sleep

Using substances alone, or in secret

Promising to not use – then using anyway

Social withdrawal or avoidance

Neglecting previously enjoyed hobbies and interests

High-risk behavior (unprotected sex, driving under the influence)

Lying to loved ones

Neglecting personal hygiene

Stealing money, borrowing without repaying, with no explanation

Possession of drug paraphernalia* (Pipes, cigarette papers, bongs, miniature spoons)

*Possession of paraphernalia is a clear sign that a person is using drugs. However, this does not necessarily mean that they are addicted. A person may own cigarette papers for rolling tobacco, which they can use to roll joints. Perhaps there are empty bottles in their bedroom or left lying around the house. The type of paraphernalia found should be noted. While cigarette papers or bottles are not always a cause for worry, possession of needles and burnt spoons, or small plastic bags with residual white powder certainly indicate that the person is using harmful substances and intervention is necessary. Again, confronting your loved one alone is not advised. If paraphernalia is found, consult with an addiction professional as the first step.

Changes to Daily Life Following Addiction

Excessive use of substances can lead to significant changes in relationships. Those addicted to substances may begin to spend more time with others who use the same substance and neglect previous relationships. Family and friends may observe that their loved one is less socially engaged than before and is secretive or avoidant about discussions on how they have been spending their time.

Academic and professional performance can be hindered by excessive substance use. Students with a previous record of good grades may begin to decline in academic performance, due to less time spent studying and the actual effects of the drugs.

Important attributes for professionals may diminish, such as punctuality, motivation, and work ethic. Problems may arise in relationships with managers, supervisors, and other co-workers.

Spotting the Signs of Addiction in Adolescents

The signs of addiction outlined above can be considered if you believe your loved one is abusing substances. Teenagers, given their life stage, are prone to mood swings and secretive or rebellious behavior. Behaviors that seem like addiction may just be a normal part of their stage of development and vice versa.

In order to notice the signs of addiction in a teenager, it is important to stay informed about multiple signs. Furthermore, younger generations often find innovative ways of using substances. For example, you may find plastic bottles with burn holes in them (used for smoking, like a bong). It is important for parents to stay informed about different types of paraphernalia that their teenagers may be using.

Spotting a Process Addiction

Process addictions can be harder to spot than substance addictions, as they do not tend to take as hard a toll physically on the body. They are also not intoxicating, so you will not see people acting as out of character as you may with alcohol or drugs. However, there are signs you can look out for. They include, but are not limited to:

1. Unaccountable money going missing (gambling, shopping)
2. Forgoing other life activities (all)
3. Frequently lying about whereabouts or activities (all)
4. Disrupted living habits (all)
5. Sudden weight loss or gain (eating disorder)
6. A sudden change in character (all)

In Conclusion

The consequences of addiction permeate through all aspects of an affected individual’s life, from their physical and psychological health to emotional and behavioral well-being to relationships with themselves with others. Addiction, untreated can impact not only the life of the individual but also the lives of his or her family and friends. In this blog, we have outlined the signs of addiction so that you can be vigilant around your loved one’s suspected addiction and take the right course of action if you believe they are abusing substances. If you are reading this, your loved one is fortunate, because they have someone in their life who wants the best for them.

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Being in a relationship with an addict can be extremely tough emotionally. Addiction typically takes priority over everything in the lives of those who suffer from it. If you love someone suffering from substance use disorder, it is important that you try not to take their actions personally; you must remember that their condition is not your fault.

Addiction is a disease that affects not only the individual living with it, but also immediate family and friends. Addiction is not a choice, nor something that the individual can control. Drug or alcohol dependency is a compulsion, and in order to stop it, those suffering need professional help. On top of that, addiction is unfortunately so often characterized by relapse that, as a bystander, it can seem impossible to withstand it all. One thing you have to remember is that addiction is a disease, and their condition is not a reflection on you.

The Importance of Boundaries

When dealing with a loved one who is addicted to something, it is important that you establish clear boundaries. This could include not lending money, asking them to follow specific guidelines, such as having times they should come and go from the house, or asking them not to socialize with certain people. Take some time to consider your limits and make that clear to yourself and to your addicted loved one. Setting these boundaries will protect you from unwanted hurt. For example, if your loved one has been using, you have the right to refuse to allow them inside your home. It can be hard to set (and stick to!) boundaries that your loved one may feel is unfair, therefore have a support network around you that helps you feel safe and supported when setting these boundaries.

These boundaries are in place to protect both you and your loved one, and if possible, it should be explained that they aren’t being put in place as a punishment for the addiction, rather as a way to protect both of you from more pain.

Remember that being supportive of their recovery does not mean making excuses for their addiction and consequent behaviors. Encourage them to seek the help they need. Help them to find the best treatment and let them know that you are there for them.

Relapses

Unfortunately, relapse is often part of the recovery journey. Remember that it is not a sign of failure, but a common part of the recovery process. In the event of a relapse, take some time to analyze what might have triggered the lapse, and then make an action plan on how they could avoid that specific trigger again. Although relapse can feel like a huge disappointment, not only for the substance user but to all those supporting them, However just because they’ve relapsed, doesn’t mean it’s the end of their recovery. Help them pick themselves up and continue onwards. Do not allow the perceived shame of using again to affect your loved one’s perspective on the hard work they’ve put into their recovery thus far. Use the experience as a reminder that recovery comes day by day, and each moment is a miracle.

Look After Yourself

You need to make sure you’re emotionally and mentally prepared for the journey you may need to take with your loved one; recovery can often be a bumpy road. Make time to focus on your mental and physical health during this process. Speaking with a therapist could be extremely helpful to the family members of an addicted person. Therapy can offer a safe space for you to express your true feelings and a nonjudgemental environment where you can work through any emotions that may need processing. Therapy can also help you develop resiliency, become aware of, and prevent your enabling behaviors, and also can assist in making and setting healthy boundaries with your loved one.

What if I can’t handle it anymore?

First and foremost, you have to remember that it is not your job to save your loved one. You can only do as much as you’re able to do. Sometimes, despite how much you try, helping someone can become too painful. Seeing your loved one’s physical, mental and emotional deterioration and detachment will be one of the hardest parts of living with addiction. Watching the person that you love in pain is hard and can take a toll on one’s mental health. As we mentioned before, your own self-care is one of the most crucial components of looking after someone suffering from addiction. If you’re unable to continue living in this situation, remember you are allowed to leave. This may be the last resort and something you’ve never thought could occur, but living with addiction can be too much. It is not shameful to prioritize yourself and the rest of your family and other loved ones. However painful, it can sometimes be necessary.

Practicing self-compassion can be an integral part of healing. Forgive yourself for the mistakes you may have made during this process. Forgiveness is a process that takes time and there is no right or wrong way to navigate through it and move on from the past. No one is perfect and everyone reacts to situations differently. You may feel guilt over the way you handled things and events that occurred; Allow yourself to acknowledge the depth of the predicament you were facing and the difficulty of your position within that – allow yourself to forgive the mistakes.

Living and loving an addict can be one of the most difficult experiences anyone has to go through. Ultimately all you can do is let them know that everything you are doing is because you love them. Let them know they have your support, even if it’s not in the way they think they want it. Making sure you tell them you love them is just as important for you as it is for them.

  ALEXANDER, BRUCE K., and GARY S. DIBB. “Interpersonal Perception In Addict Families”. Family Process, vol 16, no. 1, 1977, pp. 17-28. Wiley, doi:10.1111/j.1545-5300.1977.00017.x. Accessed 10 Oct 2020.

Camí, Jordi, and Magí Farré. “Drug Addiction”. New England Journal Of Medicine, vol 349, no. 10, 2003, pp. 975-986. Massachusetts Medical Society, doi:10.1056/nejmra023160. Accessed 10 Oct 2020.

 Volkow, Nora D. et al. “Neurobiologic Advances From The Brain Disease Model Of Addiction”. New England Journal Of Medicine, vol 374, no. 4, 2016, pp. 363-371. Massachusetts Medical Society, doi:10.1056/nejmra1511480. Accessed 10 Oct 2020.

Orford, Jim et al. “Family Members Affected By A Close Relative’s Addiction: The Stress-Strain-Coping-Support Model”. Drugs: Education, Prevention And Policy, vol 17, no. sup1, 2010, pp. 36-43. Informa UK Limited, doi:10.3109/09687637.2010.514801. Accessed 10 Oct 2020.

SEE, RONALD E. et al. “Drug Addiction, Relapse, And The Amygdala”. Annals Of The New York Academy Of Sciences, vol 985, no. 1, 2006, pp. 294-307. Wiley, doi:10.1111/j.1749-6632.2003.tb07089.x. Accessed 10 Oct 2020.

Davidson, Larry et al. “Enabling Or Engaging? The Role Of Recovery Support Services In Addiction Recovery”. Alcoholism Treatment Quarterly, vol 28, no. 4, 2010, pp. 391-416. Informa UK Limited, doi:10.1080/07347324.2010.511057. Accessed 10 Oct 2020.

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Healthy Eating in Recovery

Nutrition is a key component of any successful recovery journey. When recovering from addiction to substances, simply ceasing use is not always enough to ensure recovery success. Substances, such as alcohol, tobacco, cocaine, cannabis, opiates, and even sugar, shift the brain out of homeostasis, or balance. This is why, when trying to quit, we don’t quite feel like ourselves.

Drugs and alcohol affect the brain’s natural homeostasis by frequent over-stimulation. The brain wants to adjust and orient towards balance, so when substances are used in excess, it believes that it has over-produced certain chemicals, leading it to aim for balance by becoming less responsive.

Homeostasis is not the only aspect of healthy brain functioning affected by addiction. Over-stimulation as a result of substance misuse also damages neurotransmitter production. Neurotransmitters are chemical messengers within the brain that contribute to normal functioning. When substances are taken in excess, neural pathways can become “fried”, diminishing the brain’s ability to effectively communicate with itself and with the rest of the body.

Nutrition for a Healthier Brain

For a successful recovery, brain health must be restored. One effective way of restoring brain health and function is through proper nutrition. Recovery becomes easier when the brain and body are in good health. Nutrients absorbed from healthy, whole foods contribute to the synthesis of neurotransmitters in the brain, promoting recovery.

Addiction and Malnourishment

Those struggling with addiction are subject to malnourishment, even if they are unaware. Substances can affect our appetite and can even trick our bodies into thinking that our nutritional demands have been met. Alcohol, for example, makes a person feel full even though they are not. Substances like tobacco and cocaine provide us with a surge of dopamine that can give us a temporary boost in energy and reduce the perceived need to eat healthy food.

Furthermore, the power of addiction is such that intake of substances becomes a priority over eating right, as well as other important personal and social factors in daily life.

Nutrition for Healthier Behavior

Lack of proper nutrition is known to lead to stronger experiences of urges and cravings related to drug use, as well as more negative emotional states. These urges and difficult emotional states can be strong obstacles to a successful recovery.

With the right nutrition, these urges may be less intense. Both brain and body are in a stronger position to experience cravings and urges without giving in to them.

What is Healthy Eating?

According to the U.S. Dietary Guidelines for Americans, a healthy eating plan involves:

• Fruits, vegetable, whole grains, and low-dairy products
• Lean meats, poultry, beans, nuts, eggs, and fish
• Low intake of saturated and trans fats, cholesterol, salt, and added sugar
• Meeting calorie needs

The above are the recommended guidelines for the general population. For those addicted to substances, a higher intake of certain nutrients may be required to counter any deficiencies caused by substance abuse.

The Impact of Addiction and Poor Diet on Health

Addiction often goes hand in hand with poor eating habits. This destructive combination diminishes the healthy functioning of both brain and body, leading to malnutrition. This can manifest as:

• Depression
• Cognitive impairment
• Weakened immune system
• Vitamin and mineral deficiencies
• Low body temperature
• Electrolyte imbalances
• Low body temperature
• Deterioration of muscle tissue

Further consequences of malnutrition relate to specific substances.

Alcohol Abuse and Nutrition

Alcohol abuse damages the body by disrupting its ability to absorb nutrients, due to the damage alcohol causes to the stomach lining. Pancreas damage is another consequence of alcohol abuse. This is particularly detrimental to health as the pancreas is responsible for the digestion of lipids, carbohydrates, proteins, and hormones related to blood sugar. When the pancreas can’t function properly (due to alcohol abuse), addicted individuals are at risk of developing pancreatitis, which can be fatal.

Opioid Abuse and Nutrition

Opioid abuse is known to cause chronic constipation. In order to find relief, many sufferers take laxatives. However, overuse of laxatives can cause further health issues, such as electrolyte imbalance, heartburn, and vomiting. Instead of relying on laxatives for relief, patients in recovery from opioid abuse can support digestion by adding whole grains and fiber to their diet.

Stimulant Abuse and Nutrition 

Cocaine and amphetamines, which are known as stimulant drugs, suppress a user’s appetite. Suppression of appetite can lead to dehydration and vitamin deficiencies and is a major contributing factor to malnutrition. Prolonged periods of malnutrition can result in:

• Dental issues, such as tooth decay and gum disease
• Hair thinning and hair loss
• Irregular menstrual cycles
• Slower wound healing time
• Death

While stimulant abuse suppresses appetite, the comedown following use can create a spike in appetite, which can cause a user to binge eat.

 

Benefits of Proper Nutrition in Addiction Recovery

Getting the right nutrients offers a range of benefits for those in recovery, such as:

• Improved Mood and Increased Confidence
  

Healthy eating – getting the right nutrients in the right volume – helps those in recovery maintain a stable mood and positive outlook, unlike the mood swings, anxiety, and depression associated with nutrient deficiency according to research.

• Greater Focus
  

Healthy eating improves overall brain function. With healthy functioning, those in recovery can experience greater focus and awareness of their thoughts and emotions, key to successfully maintaining recovery. Deficiencies increase the likelihood of distraction, which in turn can lead to relapse. For example, a magnesium deficiency can lead to feelings of confusion and insomnia which are dangerous for those in early recovery.

• Increased Motivation and Energy
  

With proper nutrition, clients give themselves the best chances at staying motivated and maintaining energy levels through the recovery journey. With motivation and energy, it is easier to stay consistent with other important healing tools, like meditation and regular exercise.

Nutrient deficiencies, like those caused by substance abuse, cause those in recovery to experience more unstable and inconsistent energy levels. Deficiency in iron is known to cause apathy and feelings of fatigue, which can jeopardize recovery success.

• Resilience
  

Eating healthy can improve a person’s ability to deal with cravings by reducing their intensity. Cravings are amplified by nutrient deficiency. One study by Biery et al. observed that patients addicted to alcohol reported less intense cravings when receiving talk therapy in combination with nutritional therapy, compared with patients who had not received nutritional therapy.

Nutrition, Exercise, and Meditation for Addiction Recovery

Nutrition is one of a multi-pronged approach to supporting the recovery process. Proper nutrient intake, regular exercise and daily meditation can all contribute to the whole person healing necessary for recovery to be successful in the long term.

In Conclusion

Proper nutrition has a profound effect on the recovery process. Healthy food intake leads to significant improvements in our overall well-being and promotes a positive outlook. This improved mood and well-being reduces the likelihood of relapse in those in recovery.

Recovery is a long road, but small steps can be taken every day to ensure success. When it comes to healthy eating, it is best for those in recovery to receive consistent support from a nutritional counsellor or therapist to help them first understand the importance of nutrition and then figure out a realistic plan to ensure that the right nutrients are consumed on a daily basis.