Ending the stigma against addictions

Photo by Külli Kittus on Unsplash

Addictions shouldn’t define anyone and they should be treated as the health concern that they are. This is a big step in destigmatizing those who experience addiction in society.

Rethinking or reframing addictions is only one piece of a very complex puzzle that society faces today. There are many factors linked to addictions that need to be addressed before we see a societal shift in perception, but it all begins with education.

On top of societal factors, there are individual factors people often dismiss. Everyone’s body reacts differently, meaning two people could experience the same event but each have different brain reactions.

This is why some people are more predisposed to addictions. Different activities result in different chemical rewards, for example, someone who goes on a hike might receive enough dopamine to satisfy their needs, while another person might need to go on a rollercoaster to receive the same levels. Those that need more thrilling experiences to receive that reward are more predisposed to addictions.

While individual brain function plays a big role on whether a person is more likely to become addicted or not, another important factor is the reason why the drug is consumed. If someone consumes drugs to enhance already positive feelings, they are less likely to become addicted, but if someone is using drugs as a coping mechanism to relieve anxious feelings, they are more likely to become dependent on the drug effects.

This is where societal factors come in. Drugs alone are not enough to cause a person to develop an addiction. Conditions independent of any biological predisposition where basic needs are not met, such as lack of food, shelter, and clothing increase the chance of people developing dependence on drugs to cope. This is why homelessness, mental health and addictions are linked so strongly.

Addiction is not a choice, and the solution is not as simple as telling someone to stop using. After an addiction has been developed the brain’s pathways have been rerouted expecting the same levels of dopamine every time, so when it doesn’t receive it, withdrawal symptoms arise which can be severely negative. Once this dependence is built, the user’s control begins to slip and it’s much harder to overcome the addiction.

To get more insight on the topic, especially within the Niagara community, Talia Storm, director of StreetWork Services at Positive Living Niagara, answered some questions. 

Positive Living Niagara is an AIDS service organization that focuses on harm reduction. Their StreetWork program provides harm reduction supplies and supervised consumption sites, also known as Consumption and Treatment Services (CTS). There are also advocates for support outside of harm reduction such as navigating the health care system and community involvement.

“All of our approaches are based on best practice; it is based on science and evidence. We know that interventions like [harm reduction] are very helpful for all members of our community, not just folks that access our service and that is important to remember,” said Storm.

Storm has been in a number of different roles in the organization for almost a decade and has seen a shift in how addictions are approached but believes there is still a long way to go.

“One of the biggest things is that we need to shift this to a health crisis. In North America drugs are still criminalized and therefore the people who use drugs are criminalized; unless we can shift the public perception to acknowledge that this is a social crisis and a health crisis, we won’t make a ton of headway,” said Storm.

Theoretically, education is the starting point for change but in reality, to have a significant change, we need to look at our laws and policies which are at the root of the problem. Storm gives the example of when Mike Pence was governor of Indiana, USA, and cut safe injection programs. HIV rates increased extremely quickly, proving that harm reduction programs being taken away can have incredibly detrimental effects on society.

“Substance use is going to happen anyway, look at prohibition, when it happened people were still finding ways to drink, which [alcohol] is also a substance we tend to lose sight of in these conversations,” said Storm. 

Decriminalization of personal possession of substances and seeking to acknowledge this as a health concern would be the next step. Furthermore, increased access to safer supply programs for people who deal with addictions such as fentanyl, a pharmaceutical-grade alternative would be beneficial. 

Street supplies are dangerous because people don’t know what they’re getting anymore. Even if there are harm reduction supply programs, it is not enough to interrupt the root of the problem. As long as there are street supplies, people in this vulnerable situation will be at risk.

Programs like StreetWorks are about reducing risk, it’s an essential piece of that large puzzle when it comes to combating addiction mentioned earlier. While some people might look at harm reduction as a band-aid on a serious wound, it’s still a necessary band-aid that prevents further damage to society.

There are a lot of inaccurate stereotypes that are placed on people who face addiction; when in reality most people who access harm reduction resources want to overcome their addiction and sought help. There is just very limited help organizations like these can provide due to funding and resources.

The wall society has built around people dealing with addictions has demarcated them from regular society, only feeding ready-to-hand stereotypes. Not only that, but the price of addiction rehabilitation treatment is incredibly high in Canada, which makes one wonder who these services are aimed at.

British Columbia recently decriminalized small amounts of opioids and unfortunately overdoses increased since then. While there are some flaws in the model and it’s still too early to tell, it’s a step in the right direction, one that Ontario could learn from.

When asked about the decriminalization in BC, Storm did not comment but noted concern about another situation that BC is facing.

“Drug trends tend to move West to East in Canada, and what we’re seeing in BC right now around inhalations is very concerning in terms of overdose deaths of people who are smoking their substances,” said Storm. “The current CTS model in Ontario does not allow the inhalation of substances so we are leaving out a large population of people who use these substances and are at risk of overdose. We need to make sure that our services are as inclusionary as possible.”

Niagara’s CTS has been operating since December 2018. It’s staffed by harm reduction workers and paramedics through a collaboration with Niagara EMS. People can come in and use their own pre-obtained substances under supervision.

“We know that world-wide there has never been a death under a supervised consumption site, and to date, we have reversed over 800 overdoses,” said Storm. “Five years ago I said that we would never have a consumption site in Niagara and here we are, times are changing and we are making some progress.”

Provincially, there is a limit on the number of CTS that are funded, and we have reached that limit.

More recently, a state of emergency on mental health, addictions and homelessness was announced in the city of Thorold earlier in the summer and since then the city of Niagara Falls joined in. Unfortunately, the progress has been put on hold due to the upcoming Niagara elections. You can read more about it here.

“A state of emergency can be very symbolic in showing that we have a crisis here. We are also in a housing crisis, and these things can be very intertwined. More people [are] experiencing homelessness, and that increases instability in someone’s life,” said Storm. 

Storm then elaborates saying that it’s very common that when one of their clients gets housed, their substance use also changes, often decreasing their substance use.

Funding across the board is then essential. The state of emergency touches on three problems that are intertwined, fixing one would alleviate the others.

“When we are looking at shifting these approaches, whether programming or policy-related, it needs to include the voice of people who are using drugs. The old saying ofbuild it and they will come’ is not always the case when we are talking about something that is so heavily stigmatized, so we really need to look at what the reality is for someone that is using substances and how these changes may or may not affect their life, and they need to have that input as we make these changes,” said Storm.  

There is also involvement from this population in setting up programs. Having the voices of people who have directly been impacted or dealt with addictions is crucial in coming up with a plan that works, and more people could benefit from it.

For those wanting to learn more and to start helping, embracing education and empathy, whether it’s personal or to those close to us, is a great starting point. Starting a conversation with a family member or a friend who has stigmatizing views toward this population may be hard but necessary.

“There are a lot of great books out there: In the Realm of Hungry Ghost by Dr. Gabor Maté, and Chasing the Scream by Johann Hari, which looks at the historical war on drugs and how we ended up here are good learning resources,” said Storm.

Ultimately, addictions are a mixture of individual and social determinants. At the end of the day, it’s still a heavily stigmatized topic but nonetheless a health concern that is severely underfunded and misunderstood.  

“All of these drug laws and policies are not rooted in evidence; some are rooted in racism and disproportionately affect certain populations in our community. Keeping an open mind to hearing a different perspective and exploring it is incredibly powerful,” said Storm.

Addictions not only need to be rethought, but they also need to be reframed.  

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