Understanding addiction and its causes

The use of drugs and other addictive behaviour is a form of self-medication to help cope with unpleasant feelings

In her early twenties and a fresh graduate from one of Karachi’s top universities, Sana* first started using drugs for recreational purposes with her boyfriend during college, just to fit in. She felt like she desperately needed for him to love her, while also getting some sort of attention from him that she craved while growing up in a house where her parents were constantly fighting with each other. Her mother was also emotionally unavailable most the time as she was suffering from depression and other mental health issues.

“Throughout my childhood I was on my own. I used hash to escape the feelings of loneliness, rejection, and worthlessness that I usually experienced after a conflict with my parents. Now even when there is no argument I deliberately go and trigger my parents so that I have an excuse to smoke hash.”

Addiction is a complex condition characterised by a dependence on a particular substance or activity. Gradually a person builds tolerance for the substance and a higher dose or an increase in the particular activity is needed to feel the desired effect. When someone tries to stop using the substance or break out of a habit, negative feelings that come up during the withdrawal motivates the user to continue using addictive substance or activity.

Drug abuse is not the only form of addiction. Many different activities such as shopping, work, exercise and gambling can be addictive too. Consider the case of Mehreen, 37, single and employed at a bank as well as owning a business that deals with properties.

“Five years ago I was in a very bad place in my life. My relationship struggles were making me anxious and distressed. I started distracting myself by shopping. It started with me spending on online shopping in the thousands, which increased to lakhs and finally to millions. I realised this was a problem but I had no control over my binge shopping at that time. I initially started therapy to cope with relationship issues with my mother. In the safe, accepting space, I was able to uncover the supressed hurt and anger at my mother's rejection of me.”

Mehreen realised that no matter what she did was never good enough for her mother, which made her turn to shop in the first place, which made her feel better.

“I would buy three of the same kind of product and remember thinking that even if one of them turns out damaged or is damaged, at least the other two will be there for me and I would not feel abandoned.”

It was once that she became aware of the issues that were stemming from her feeling abandoned that she was able to find some peace.

"Once I understood, what I was doing and why, I did not feel the need to buy stuff to fill a void or even to distract myself. I am no longer controlled by my shopping.”

Addictions can manifest from biological, psychological and even social causes. Some people may just be genetically predisposed to having an addiction, while others may have personality traits that may make them more likely to be addicted. Some people may just be impulse seeking while others may have a low tolerance for peer pressure or even frustration. Then there are more sinister reasons for addictions like abuse and neglect. However, it is mostly shame that is at the core of addictive behaviour.

Toxic shame is a deep-rooted belief of being flawed, which leads to self-loathing. In dysfunctional families where constant belittling, neglect, perfectionism and criticism are the norm, it is not unusual for kids to internalise the shame and consider themselves as unworthy, inferior, unloved and inadequate. Feeling superior to others, boasting, and having contempt for others are also manifestations of internalised toxic shame. These deep-rooted feelings of being unloved and unworthy are linked to depression and anxiety. The use of drugs and developing other addictive behaviour is a form of self-medication that helps to cope with these unpleasant feelings.

Sehr, who recently returned after graduating from a Canadian university, is one such person who uses drugs to escape from unresolved emotional issues.

"I turn to drugs at night so that I can sleep and my mind stops overthinking. I lost my father early on in my childhood and I had to move in with my uncle. We were also financially dependent on him. I remember feeling like a responsibility or a burden for as long as I can remember. No one noticed that I was being sexually abused as a small child by one of our servants neither did I ever feel understood by my family. I now know whatever mess I am in I cannot share with my family as they will only blame me and not understand as usual. I am lonely and angry and drugs brings me temporary relief."

However, the relief is just that, temporary and is very short-lived. This feeling of relief soon starts being replaced by feelings of shame and guilt for consuming the said drugs or being addicted to a habit. These feelings only increase the anxiety a person feels; more drugs are used to protect the self from experiencing negative feelings and a dangerous self-harming spiral of shame and addiction continues.

The cycle can be broken by an intervention from a therapist experienced in working with addiction or a psychiatrist. Medicines may be needed to cope with the symptoms of withdrawal and sometimes admission into a rehab facility may be the best option depending on the person’s condition. The first step, however, is to come out of denial and acknowledge that there is a problem.

The families whose loved ones are addicted to a substance are also in pain and are usually experiencing anxiety, fear, remorse, guilt, and anger. The prospect of addressing addiction and the stigma attached to it is so large and daunting that families also sometimes continue to stay in denial. But the path of healing and recovery requires facing the problem head on.

Although it may seem like there are no options for those who are addicted to drugs and even though it may seem scary but there is hope in therapy. At the end of the day each one of us is worthy of being helped and loved and we deserve good things to happen to us, even if a part of us is not ready to believe it yet.

*All characters are fictitious amalgams used to exemplify many simlilar cases.