Cultivating a habit

Addiction extends to more than just drug misuse, and anyone regardless of their position in life can fall prey to the condition. Priya Kulasagaran looks at what defines an addiction, and if there are new emerging addictions arising from the way we live now.

Many people may not have any qualms tossing out the word “addiction” to describe their love for something, be it food, a hobby, or even love itself as in Robert Palmer’s signature song “Addicted To Love”. For those struggling with a dependency on either a substance or a habit, addiction can be a dark and lonely path to walk.

There is no standard definition of what addiction is, a basic explanation is that it is a condition where a person is so dependant on a particular substance or activity that it interferes with their ability to live their lives. The Harvard Medical School lists three main characteristics people with an addiction tend to show: “craving for the object of the addiction, which can be mild to intense”; “loss of control over use of the object of addiction”; “continued engagement with the object of addiction in spite of harmful consequences”.

It is safe to say that no one intentionally sets out to develop an addiction. Something that starts out as a pleasurable experience (say a drink or two with friends) can eventually turn into a compulsive habit that is no longer a source of pleasure. Studies have shown for example, that substance abusers hooked on drugs, often report that they still feel compelled to use the drug in question even though they no longer enjoy having to do it.

In worst case scenarios, this desire for the object of their addiction starts to eclipse everything else in their lives; family, passions, and even their own well-being. The physical and psychological rewards offered by the substance or behaviour become more valuable than everything else.

Seductive substances

Addictions generally fall under two categories of either substance dependency and behavioural addictions. Substance dependency, be it drugs, alcohol or nicotine, usually has a physical addiction attached — this is where the body adapts to the presence of a drug so that the drug no longer has the same effect. This tolerance could then cause someone to ingest more of the drug over time, as the body become dependant on it.

Chances are that when you think of addiction in Malaysia, drugs are the first thing to come to mind. Despite having some of the harshest drug laws in the world, the country has been battling misuse of drugs since the late 1970s. According to a report by the National Anti-Drug Agency (AADK) in 2016, there are more than 130,000 drug addicts that have been registered from January 2010 and February 2016. In 2015, 41% of 4,838 addicts who were in treatment returned to their old habits.

However, there is also the problem of “legal” addictions, namely alcohol and nicotine. The statistics of alcohol of misuse are hard to come by, and tend to be contentious. In 2011, the World Health Organisation (WHO) ranked Malaysia as the 10th largest consumer of alcohol in the world. Meanwhile, the National Health and Morbidity Survey 2015 found that over half of Malaysians who consume alcohol had indulged in binge drinking. While this does not necessarily indicate addiction, there is a significant danger that those who overindulge may be come too dependant on their drinks.

Smoking is being increasingly viewed as a public health issue, with numerous campaigns and programmes available to help smokers quit, it is still a mostly tolerated addiction. As of 2015, about five million or 22.8% of the Malaysian population aged 15 and above were smokers. More worryingly, statistics also show that smoking-related death accounts for about a fifth of all deaths annually and more than 15% of total hospitalisations were from smoking-related illnesses.

While nicotine is what causes the addiction to smoking, this substance is not the one responsible for the health issues associated with the habit. Heart attacks, lung cancer and respiratory conditions can be blamed on other cigarette additives like tar.

Unhealthy habits

Behavioural addictions such as gambling, overeating and compulsive shopping are where the person is addicted to the behaviour or the feeling associated with carrying out that behaviour. These sort of addictions do not have the physical symptoms of substance addiction — or so it may seem.

Increasingly, neuroscientists have uncovered signs that the underlying development of behavioural addictions may be remarkably similar to substance addictions. Behavioural addictions, by indirectly affecting the neurotransmitter systems of the brain, can serve as reinforcers that comparable to pharmacological substances that directly affect these systems. Patients have reported the same levels of withdrawals, depression and anxiety as those dependant on substances.

With gambling for instance, the addiction comes from experiencing the promise of scoring a big win. With time, compulsive gamblers become obsessed with the thoughts of gambling and the anticipation of winning. The addiction itself is hidden, as there are no noticeable physical signs of the problem. In most cases, the loved ones of gambling addicts do not realise the problem exists until it is very far advanced and the addict is in serious financial trouble.

Some addictions meanwhile, are symptoms of an underlying mental health condition. Those who are addicted to cosmetic surgery for instance, marked by repeated procedures despite health or financial risks, are commonly diagnosed as having body dysmorphic disorder (BDD). BDD is an illness that is characterised by obsessively thinking about physical appearance, flaws in one’s  physical appearance and numerous attempts to fix the flaws (no matter whether they’re real or imagined). Believed to be caused by a combination of genetics, chemical imbalances in the brain, as well as environmental factors such as social pressure and low self-esteem, BDD can have a devastating impact on sufferers.

In fact, otherwise harmless habits can tip into the realm of addiction if the individual becomes too obsessed with the activity, even something as recommended as exercising.

Compulsive exercisers make exercise their focus, to the detriment of their relationships, work and ironically, even their own health. Compulsive exercise comes from a need for control and many who are addicted obsess over caloric intake or pounds lost. They may work out alone, work out with the same routine, work out for more than two hours every day, skip work to exercise, and even exercise to the point of injury – or continuing to workout despite their injuries.

Causes

While we know what addiction looks like, experts continue to debate the causes of it. Some scientists see addiction as potential a disease of its own; the American Society of Addiction Medicine for instance, classifies addiction as a “chronic disease of brain reward, motivation, memory and related circuitry”.

There is some evidence of a genetic predisposition to develop an addiction. For example, due to genetic vulnerability, children of alcoholics are at higher risk for future alcohol problems, and many show high levels of impulsivity. However, at the same time, researchers have yet to find an “addiction” gene to conclusively determine that this is the case.

Psychologically, a leading theory of addiction suggests that individuals with deficits in emotion-regulation skills — the skills relevant for modifying emotional reactions and tolerating negative emotions — may use drugs in an attempt to manage negative or distressing affective states. For instance, individuals with histories of exposure to adverse childhood environments (such as physical and sexual abuse) tend to have a diminished capacity to regulate negative emotions and cope effectively with stress.

A great deal with the stigma attached to addiction is the element of moral judgement that comes with the label. One of the biggest misconception of addiction is that it only afflicts those who are merely hedonists, or are too weak-willed. In reality however, anyone can risk developing an addiction, be it substances or activities, and one’s strength of character often have little to do this.

Treating addictions

When it comes to substance dependency, a detoxification is usually a necessary component of a wider treatment programme. A detox is a professionally monitored period of cessation from drug use until the chemical substances are no longer in the user’s body. It can be important for this to occur within a professionally monitored environment, because some types of drug withdrawal cause painful symptoms. In extreme cases, drug withdrawal can have life-threatening physiological consequences.

One common kind of outpatient treatment, used frequently for heroin or opioid addiction, is medication-assisted treatment through clinics using methadone or buprenorphine. These programmes typically administer a medication that controls cravings and blocks the effects of opioids on a regular basis, often requiring the client to pass drug tests as well.

Counselling or therapy is a crucial aspect of addiction treatment, be it for behavioural addictions or substance dependancy.  Working through previous trauma, hidden anger, depression, or other factors of a substance use problem can help sufferers understand some of the reasons for their compulsive behaviours and understand how to change them. Family therapy can be helpful for repairing the damage to treasured relationships that addiction often causes.

Connecting with other people who are battling a substance use or addiction problem can also help keep one accountable for their recovery. It also helps people struggling with addiction to openly talk to those who have been through a similar experience.

Residential treatment programmes, such as our Pusat Serenti here, can be useful in giving people the space to fully focus on recovery. Residential programs are often recommended because they allow someone to radically change their day-to-day lifestyle, which up to the point of starting treatment has been trapped in a cycle of compulsive drug seeking. They allow clients to re-evaluate the direction of their life and stake out a point of change. Plus, they can more effectively educate clients about the science of addiction and physical dependency as well as strategies for changing one’s behaviour. The caveat here is that such residential programmes require a holistic approach for them to be effective.

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