360 degrees of opinion: Philip Seymour Hoffman and heroin addiction.

These are important, uncomfortable conversations to have.

The question of drug addiction is one that many families will grapple with in their lifetime. We reached out to drug and alcohol councellor Nicola Cowling from ANEX for some more information to help us understand how to frame this complex conversation.

Q: Is addiction really a disease?

A: Unfortunately the jury is still out on this definition.  I think it is fair to say that addiction is, in many ways, like a disease.  It is a chronic, relapsing condition.  Advances in brain imaging suggest long term, heavy drug use causes significant changes in how the brain works. And without some sort of intervention, drug addiction can worsen with potentially devastating results.

Certainly addiction is recognised by the World Health Organisation (as dependence syndrome). And the disease definition has allowed addiction to be regarded as a health issue rather than a moral or criminal one, and rightly so.  Improving access to treatment and support services is far more beneficial, and more cost effective, then incarceration and other punitive measures.

Q. By calling it a disease, does it absolve addicts of personal responsibility?

A: I think if we can understand addiction as a health issue, recognising there are changes in how the brain is working, it’s easier to understand an individual’s continued use isn’t due to a lack of will power.  In addiction, continued drug use becomes less about seeking euphoria and more about just trying to feel normal.  It’s about keeping withdrawal symptoms, such as depression and anxiety, at bay.

It can also be about self-medicating physical or psychological pain. In addiction, the individual continues to use despite any negative physical, psychological and social effects.  This is because the effects of being without the drug are more difficult to face. Methamphetamine use, for example, greatly increases the availability of feel good or “reward” chemicals like dopamine.  But it doesn’t give the individual more of these chemicals, rather it makes them use more than their normal share in a short period of time.

This results in extreme confidence, energy and euphoria.  When they stop using, they go from having an excess of these feel good chemicals to a deficiency.  They go from feeling on top of the world to significant depression, apathy and amotivation.

With regular, high dose use, the brain can alter, adjusting to these excess levels of feel good chemicals.  This means the more they use, the greater the deficiency of feel good chemicals and the worse the individual
feels.  Because these symptoms can last for weeks or months, it is very common for individuals addicted to methamphetamine to relapse during efforts to stop using.

This can explain, to some extent, the sense of powerlessness experienced in addiction. The individual develops a tolerance to the more desirable effects of be drug.  They must use increasingly more, therefore, in an effort to achieve these effects.  As their physical and psychological dependence grows, the negative effects begin to outweigh the positive. The drug use simply allows the individual to function.  Without it they face debilitating symptoms of withdrawal.

Though drug addiction effects a broad spectrum of individuals, it is much harder to address when there are other contributing factors.  Individuals with a history of mental illness, trauma or significant social disadvantage are particularly vulnerable to the effects of addiction.

How have you reacted to the news of Philip Seymour Hoffman’s death? Does the way he died change the way you feel about it?