Drug and Alcohol Relapse-Is it all in the mind?
Johannesburg expert speaks on South African Drug dependency
"Why can't I just stop? Drugs are ruining my life – they've cost me my job, my marriage, my kids – but I still use! Why can't I stop?"
William is a 37-year-old crack cocaine addict and he has been using since he was in his teens. He has seen relationships destroyed, friends overdose and die. He's lost his job more than once, and recently his wife finally left – and took his two children with her.
"I had a fight with the family and I told them I was going out for a while to clear my head. I don't really remember where I went, I just drove then I remember walking around. I had some money… and I used … I just used", says William.
"Even when people have been drug free - for months, even years – the tendency to relapse is strong. But we need to break the myth that this tendency is a failure of treatment – it is part of the disorder of substance abuse", says Johannesburg-based expert psychologist Dr Michael Niss.
And it is crucial to keep telling yourself that you have been clean before, and you can do it again. "The more you keep trying, the more likely you are to be successful", says Niss.
Many addicts feel that they are weak and this is why they keep losing the fight against drugs. "I keep losing the battle. Every time I use again, I feel terrible cos I couldn't win. I don't now why I'm so weak. I'm so strong with other things – why not with this?"
Experts now say that people like William aren't weak, that relapse isn't about moral fibre, it's not about how strong you are. "Drugs are as important to addicts as any relationship, more important than food – and there are parts of the brain that react to even the smallest signal to use."
Basically, the brain has two systems that are interconnected and operate together. We all have a 'reward system' that is there to help us survive. It drives us to seek shelter, eat when we are hungry. There is also a 'stop system', located in the frontal lobes that help us weigh the consequences of acting on our impulses. This system makes us stop and think when our impulse says, "Let's do it!"
For most of us, these two systems work together to keep us safe but, in a drug addict's brain, it's as if the reward system has turned rogue and blocks the stop system's warnings. When an addict sees something that triggers their brain's reward system, instead of stops being put in place, they are totally over-ridden.
"I don't always know what the trigger is", says William but he knows that they are not only his thoughts or emotions. "The environment plays a big part – where I used, who I used with."
What is helpful for patients is that research has now found that the reward system can be triggered very quickly and with triggers that are so small they may be outside conscious awareness. The triggers can be so fast that the message doesn't even have a chance to get to the frontal lobes before they are highjacked by the rogue reward system. "Triggers can be so small they come in under the radar before you even have a chance to mount a defence", says Niss who adds that this is empowering for patients who often feel that because they can't identify a trigger, it means they are weak. Often taking that first step towards getting help and information is the biggest and most important. Patients and their loved ones can call SADAG's 24-hour substance abuse toll-free helpline on 0800 12 13 14 or SMS 32312 for support and referrals for substance abuse.
Medication is in the trial stage in the USA, to slow things down a bit and try reduce the activity in the reward system in the hope that this will allow time for the frontal lobes to put good decision making in place. Future treatments will hopefully use medication and behaviour therapy together to reset the brain.
"I will be an addict all my life", says William, "I just don't want to be an addict who is using."
For more information, please contact the SADAG help line or
Cassey Amoore at SADAG on 011 262 6396/082 835 7650
Janine Shamos 082 338 9666
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