It's a disease and not a social issue, says president of the Canadian Society of Addiction Medicine

ThumbPills"I sought help in July of 2009 because I ended up homeless again and I was starting to think of robbing people. For some reason, I just reached a point of where that was unacceptable," says Ian Hipperson, 26, who struggled with addiction since he was 15-years-old. Now, six-years sober, Hipperson is one of many who have overcome a substance addiction.

It is easy to assume that anyone who misuses substances, whether drugs or alcohol, can easily stop drinking and using whenever they choose to. While most people have self-control and understand when enough is enough, there are still individuals who struggle with establishing the line between abuse and addiction.

Substance addiction is still a valid issue in Canada and is a disease that has no simple cure. There are many programs such as Alcoholics Anonymous and Fresh Start Recovery Centre to aid individuals with their recovery. However, it only helps those who seek help, and those with a substance addiction do not always understand what an addiction truly is.

Substance addiction, or substance dependence, is defined as the "gradual but progressive loss of ability to predict what will happen when you drink or consume drug. Consequences can be emotional, mental, physical, spiritual, home, relationship, legal or job," says Dr. Paul Sobey, addiction medicine physician and president of the Canadian Society of Addiction Medicine (CSAM).

A common misconception about substance addiction is that it is frequently mislabeled as substance abuse. Dr. Sobey says substance addiction is classified as a disease, whereas substance abuse is defined as a social issue. Substance abuse is "the use of mood-altering substances to a preconceived level of intoxication that is the same as a peer group's norm with little or no consequences, that the individual will grow out of over time," says Dr. Sobey.

A 2012 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) suggests that 78 per cent of Canadians consume alcohol, making it the most commonly used substance. This is most likely due to the legality of alcohol, however, illegal uses of opioids or pain relieve medication are becoming a large issue within Canada. According to the 2014 International Narcotics Control Board (INCB) report, "North American customs authorities reported the largest number of drug seizures of any region in the world, with 35,943 drug seizures reported to World Customs Organization, through its Customs Enforcement Network."

The INCB report also said that North America has the highest drug-related mortality rate of any other sub region in the world (142.1 per 1 million inhabitants ages 15-64 years old).

Dr. Sobey says that the quality of life in North America could account for its high usage rates. "The lifetime risk is the same everywhere in the world. It's what we call polygenic, so anywhere you go the risk is the same. But if you are born and raised in say an Islamic country where use of any mood-altering substance is highly frowned upon, your likelihood of exposure is less, so the tendency or lifetime prevalence is remarkably less. However, if you are born and raised in Vancouver, where the price of heroin is extremely cheap and alcohol is everywhere, your likelihood of exposure is greater and therefore the incidence of prevalence would rise."

A Health Officer's Council of British Columbia report says that substance addiction as a whole accounts for 47,000 deaths per year in Canada.

However, in 2014, the Government of Canada allocated nearly $45 million over a five-year period towards the ongoing National Anti-Drug Strategy in developing public awareness about safe drug use, according to the INCB report.


According to a 2014 Canadian Centre on Substance Abuse (CCSA) report, Childhood and Adolescent Pathways to Substance Use Disorders, genetic factors account for 40 to 60 per cent of vulnerability towards substance addiction.TequilaA 2014 study released by the Pan American Health Organization and World Health Organization says that 15 deaths on average occur from alcohol alone in Canada.

Photo courtesy of Flickr

Dr. Sobey agrees, saying that the brain's reward and inhibitory zones are the main contributors to an addiction. The inhibitory zone is controlled by the frontal lobes, which is an individual's knowledge and memory function. "But it also tells us what we learn is appropriate and inappropriate," says Dr. Sobey.

The reward zone is part of the brain that focuses on reinforcement. "That's clearly the pleasure centre in the brain. So in a normal functioning brain, people who seek out food, procreation, sex and childhood care, it causes dopamine in the nucleus accumbens. In addition, there are certain people who are genetically predisposed who develop too much dopamine production in the nucleus accumbens," says Dr. Sobey. "They drink alcohol, they experience extreme pleasure it turns off the frontal lobes so that they become disinhibited and then they engage in behaviors that are inappropriate. So people with this disease develop an abnormal production of dopamine within the pleasure centre."

Shutting down the frontal lobe leaves the brain functioning with the four 'F's' or the four basic drives of the brain: feeding, fleeing, fighting or fornicating.

In addition, Dr. Sobey suggests that individuals who suffer frontal lobe problems, such as schizophrenia or ADHD, are more likely to develop a substance addiction. "Those are diseases where there is frontal lobe disinhibition already," says Dr. Sobey.

Another factor that contributes to an individual's reaction towards substances are environmental influences.

"There is this whole area of what we call epigenetics, the study of what causes gene expression. Genes are not automatically turned on. They have to be turned on and sometimes stressors or other environmental influences cause them to be turned on. So this, to a certain extent, explains the genetic influences. In addition, if you are stressed extensively, you are more likely to develop this disease if you already have the underlying risk for it," says Dr. Sobey.

Additionally, an individual's maturity also plays a role in addiction. Teens who develop an addiction early on may not have the context to understand the influence of their decision compared to an adult who delves into a substance but has more knowledge about the disease.

Hipperson says that substance dependence was a common trend within his biological family. "I think I was set up to use long before [my addiction started]. My biological mother was a drug addict, and to my knowledge she still is to this day. We were all adopted separately except for my sister, but I had unstable environments, failed adoptions, failed foster homes and was on and off the streets since I was seven."

Hipperson says that while alcohol didn't really give him the edge he desired, he used drugs to cope with his feelings.

However, addiction can also surface in individuals who have had a stable family life.

Kate King, who struggled with an alcohol addiction for over 20 years, had a "fabulous" upbringing, however she says that her family's lifestyle revolved around alcohol. "My parents' lifestyle was one of parties and lots of entertaining. I never saw them drunk, that was just part of the lifestyle and so I grew up in that lifestyle thinking that alcohol was how you interacted with other people; that's how you had fun," says King.

Another contributing factor to King's addiction was her low self-esteem. "Everybody always said 'you had the world, you seem so happy' and that was the mask that I wore. I didn't really let people know how I felt. I didn't know how to value myself, I didn't know how to tell someone what I wanted or needed, and the opposite of that as well, what was unacceptable in my life because I didn't feel worthy," says King. "Every relationship that I had and some friends in my life that I didn't value enough, customers in my restaurant, I look back and I'm saddened by the loss of that relationship and that will never go away because that's not going to change in my life."

The CCSA report suggests that children who are raised with values and morals that teach concern for others, problem-solving and behavioural control contribute to healthy brain development of the frontal lobe.

"One of the hardest things to do is just walking in the front door or picking up the phone and calling for help because then they would have to break the denial and say 'I have a problem'."

-Jennifer Kent-Charpentier, program manager of Fresh Start Recovery Centre
Hence, this control allows individuals to understand the consequences of severe drinking and drug abuse.

The CCSA report also says that, "In most cases, mood and anxiety problems precede the onset of substance abuse, suggesting individuals self-medicate with alcohol or drugs to temporarily diminish their anxiety."

True to that statement, King, now 58-years-old, says that she saw alcohol as a way to cope with her anxiety of being isolated from others. "I realize that my life revolved around the fear of being alone, the fear of not being good enough, the fear of not being loved. And I look at it now and think those are the silly thoughts of a young girl, but I was 43 and those are still thoughts that I had."

The legal substance

A study released in 2014 by the Pan American Health Organization (PAHO) and World Health Organization (WHO), said there are on average 15 deaths per year from alcohol alone in Canada. 

Furthermore, alcohol-related deaths account for 80,000 mortalities annually in North and South America.

"There is no sign saying you can't have it, regardless of the research. When you're 18-years-old in Alberta, you're legally old enough to drink," says Fresh Start Recovery Centre program manager Jennifer Kent-Charpentier. "It's legal. It's within cultures and within our society. It's been so socially acceptable to use it, I don't know where you learn to drink appropriately."

King says she didn't really understand what alcoholism was until she began her recovery process. "I thought I was going to learn how to drink like a lady, I didn't understand what the disease of alcoholism was. There were many times in my life that in those fleeting moments I wasn't honest with myself. I knew that I was in trouble, but I didn't know how to deal with it."

Understanding the components of the disorder is a crucial part of working towards sobriety, says Kent-Charpentier. "Part of our programming is getting the alcoholic or the addict to understand that this disease is actually affecting them physically, mentally, emotionally and spiritually."

Finding hope

"It's a disease. When you admit that it's a disease, it means it has certain signs and symptoms, so then it becomes about 'what do I need to do'?" says Kent-Charpentier. "Treatment is about giving you the time in a supported, secure environment that says 'okay, here's what you need to work on'."

There are two types of treatment methods for individuals who suffer from substance dependence. "To prevent the pleasure centre working too well, we use medication like suboxone, methadone, naltrexone, acamprosate, excreta for treatment of opioid dependence and alcoholism. And the way you rehabilitate the frontal lobes is through psychosocial treatment like Alcoholics Anonymous' (AA) residential treatment, or one-on-one counseling," says Dr. Sobey.

There are several different types of common psychosocial treatments present. Long-term treatment, in which patients reside within the treatment centre, 12-step approaches, outpatient treatment, in which patients go into a treatment daily, but do not reside in the centre, and individual and group counseling are a few of the programs available.

Fresh Start Recovery Centre, for example, uses AA's 12-step approach that focuses on admitting and understanding the addiction while providing ways to cope. "The 12-step recovery has been around for 70-plus years. The people that come and take our program realize they thought they were in control when they were abusing, but they were actually powerless," says Kent-Charpentier. "If you've been living in a place of distrust, fear, anger and resentment then it's learning to turn that around and start to have some faith, have some trust, reach out, ask for help, learn how to forgive yourself."

Both Kent-Charpentier and Dr. Sobey agree that while programs like AA's 12-step approach have been around for decades, understanding that substance addiction is a disease and not a moral issue is still one of the largest misconceptions about the topic.

"A significant part of the medical community and a large part of the general community believe that addiction is not a disease, it's a moral problem, people can just make a choice. And yes, you can make a choice in addiction, but there's a lot of people who become disinhibited and that decision becomes really difficult," says Dr. Sobey. "People continue to use a moral model to explain the nature of the disease, but morality is contained in the frontal lobes, so the outcomes are very poor. If you apply a disease treatment model you get pretty good outcomes."

PillsThe difference between substance addiction and substance abuse is that substance addiction is classified as a disease, while substance abuse is more of a social issue, says Dr. Sobey.

Photo courtesy of Flickr
Now 15-years sober, King says that in sharing her story, she hopes to help those who are currently struggling with an addiction. "Your world can change and it only gets better. It's not always roses, but I know that when I was in recovery I couldn't imagine my life would be this fabulous. I couldn't imagine that so many of my dreams would come true. In the 12 steps of Alcoholics Anonymous there are the promises and if somebody wanted to see what life could look like, they could read the promises and say 'okay I want that in my life'," says King.

Finding new kinds of happiness and freedom, becoming less self-seeking and allowing your past to become a part of you are just a few of the promises of AA, according to their website

"One of the hardest things to do is just walking in the front door or picking up the phone and calling for help because then they would have to break the denial and say 'I have a problem'," says Kent-Charpentier. "Everyone deserves help, everyone deserves to have peace and joy. It doesn't mean that you have to be living under a bridge somewhere before you have a problem. The problem can happen at any time and the problem does have solutions."

Hipperson, who once was homeless and had thought a criminal act might be his only way to freedom, is now the outreach coordinator at Fresh Start Recovery Centre. He says that he has no regrets on his past because it has gotten him to where he is today. "Today it doesn't control me. I don't use it against myself. I don't use it to dampen any other decisions. I'm 26-years-old and I am behind a desk, I work at an amazing facility and I have an amazing life."

Photos courtesy of Rodrigo Gianesi/Flickr and Victor/Flickr, Creative Commons Licensed