I continue my series of blog posts focused on drug, set (the person) and setting (the social context) [Part 1 is here]. Drug, set and setting is not only of relevance to addiction, but also to overcoming addiction.
The path into and out of addiction
The ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward.
One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.
On the other hand, people are in general more likely to develop substance use problems if they have complicated personal problems (e.g. suffering from childhood trauma, co-occurring mental health issues), few personal resources, and live in a deprived social environment offering few alternative rewards. Serious substance use problems often occur as part of a larger cluster of psychological, medical, family and social problems.
One common feature of many of the Stories in this book is that the person felt uncomfortable about themselves and how they interacted in their environment, and as a result often experienced anxiety or other difficulties. Drugs and/or alcohol were an antidote to these negative feelings. They helped the person escape or ameliorate the feelings and/or got them out of themselves. These people did not experience mental health problems as such—they just had difficulties with being who they were or with part of their psychological make-up.
A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one.
Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems. Most people, however, experience multiple attempts either to stop using or to bring their use under better control before they eventually resolve their substance use problems.
The ease with which people overcome substance use problems, and achieve recovery from addiction, is largely dependent on two factors, namely problem severity and recovery capital.
Recovery capital is the quantity and quality of internal (‘person’ factors such as self-esteem, resilience, mental health) and external (‘social context’ factors such as family support, peer support, prejudice) resources that one can bring to bear on the initiation and maintenance of recovery.
The interaction of problem severity and recovery capital shapes both the prospects of recovery and the intensity and duration of resources (e.g. formal treatment) required to initiate and sustain recovery.
In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. Moreover, substance use problems are easier to overcome if a person has good internal and external resources.
Heroin use can result in a person losing a substantial amount of recovery capital—they may become homeless and penniless, lose the support of family and friends, have psychological and physical problems, and be involved in the criminal justice system. Under these circumstances, it is very difficult for a person to have the psychological strength to be able to deal with their addiction as well as everything else that is going on in their life. Remember, cigarette smokers who fail to give up do so under much more favourable conditions.
Another way that the ‘environment’ can influence the impact of heroin and the recovery from addiction is the view of society towards the drug and heroin users. The heroin-using lifestyle that develops for many users arises in part because use is illegal and users are prejudiced against and stigmatised by society.
As a result, heroin-users become isolated from ‘normal’ society, and their drug use becomes reinforced and ‘normal’ amongst the drug-using society to which they now belong. This prejudice—which also exists towards ex-users—also makes it more difficult for users to recover from addiction, because an important element of the recovery process is being accepted by non-users as a‘normal’ member of society.
The photograph used in this blog post was by Jon Tyson and has come from Unsplash, a great resource of free high resolution photographs.
