Truths and Misconceptions: Addiction

Sue Macintosh and Allison Mackinley

Image: Sue Macintosh, Harm Reduction Specialist, and Allison Mackinley, Nurse Practitioner, both members of the Addiction Medicine Consult Service (AMCS) at LHSC.

December 6, 2023

“The opposite of addiction is connection,” says Allison Mackinley, Nurse Practitioner on the Addiction Medicine Consult Service (AMCS) at London Health Sciences Centre (LHSC). 

The AMCS is part of Adult Mental Health Inpatient/Outpatient Services at LHSC and the team works with inpatients at LHSC who need assistance managing their addiction while in-hospital. The team was established in partnership with Regional HIV/AIDS Connection (RHAC) and Canadian Mental Health Association Thames Valley – Addiction and Mental Health Services (CMHATV AMHS). Mackinley is a third-party Team LHSC member from CMHATV AMHS.

“When it comes to addiction, there’s a whole package that comes along with it, it’s not just substance use,” explains Sue Macintosh, Harm Reduction Specialist on the AMCS team. Macintosh has lived experience with addiction and is a third-party Team LHSC member from RHAC. “There’s shame, guilt, PTSD, and other mental health issues. When a person puts down a drug, they can still be sick.”

Misconception about addiction: A person has chosen to be addicted to their substance of use.

Truth about addiction: There is a cascade of events that leads to an addiction.

“No one wants to grow up to live around an addiction,” Macintosh says. “A person can start using recreationally and it can turn into self-medication. Maybe something they repressed when they were younger didn’t come out until they were an adult and using was their way of trying to repress the emotions again. Maybe they come from a bad home with lots of trauma. There is a lot around addictions.”

A person experiencing addiction is doing what they can to manage their emotions or their situation. “If a person is unstably housed, living in a tent, or on the street, they may use a drug like crystal methamphetamine to stay up all night to make sure they don’t get robbed or assaulted,” explains Mackinley. 

“Someone may have been in a lot of pain and got medicine for that, says Macintosh. “Then, maybe at some point their doctor stopped prescribing it to them and went looking elsewhere for it to manage their pain.”

There are a number of reasons why a person may use drugs or alcohol as an adult. Often, it is due to managing, or repressing, pain or trauma in a way the person feels it helps them in the moment.

Misconception about addiction: A person experiencing an addiction is weak.

Truth about addiction: “If anyone has taken the time to hear and understand the hardships some of our patients have gone through, they wouldn’t think they’re so weak,” Mackinley says. 

Addiction is a coping mechanism and the circumstances that led to the development of an addiction are vast. 

“Addiction is powerful. You don’t necessarily think about anything else in your life except for your next hit. No one wants to be there, but they are in that place doing what they can to deal, or not deal, with their pain, trauma, shame, guilt or mental health issue,” Macintosh explains. “Anyone experiencing addiction knows it’ll ruin their life until they do something about it. A person needs help to get through it though.”

As Mackinley stated, “the opposite of addiction is connection.” People are looking for something to bond to in their life, and instead of joining a sports team or other group, their connection is through drugs and alcohol. But in order to replace drugs and alcohol, a person needs to feel connected to someone or something, and address the underlying issues only when they are ready. 

Addiction support looks different for people at different stages of their journey.

Misconception about addiction: The approach to quit a substance is the same for everyone.

Truth about addiction: There is diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), with the DSM-5 being the most current version, that notes severity points for symptoms such as mild, moderate or severe and can score a person’s severity on that scale. A person’s level of severity of addiction informs on different approaches to treatment or management of the patient’s addiction. 

“Addictions at different stages are certainly treated differently. The level of expectation of a person attending treatment when they’re living rough in a tent will be different from a person who lives in a house,” Mackinley explains. “If a person lacks money, stable housing and is just focused on getting through each night, it can be hard for someone to attend an appointment. Especially if their ID or phone was stolen.”

Addiction impacts people of all socioeconomic and cultural backgrounds. There is no one-size-fits all approach to managing and treating a person’s addiction. It will look different depending on the specific needs of the individual, but what is needed for all is compassion and connection.

Misconception about addiction: Addiction is a moral failure.

Truth about addiction: When a person is in the grips of addiction, however they got to that place, they can feel powerless to it. 

And when someone is able to go a week or two without using, if they relapse, they are often filled with feelings of guilt and shame.

“It’s a horrible feeling. It’s like losing a fist fight and the whole world is seeing it happen,” Macintosh explains. “You know you’ve let others down and you’ve let yourself down.”

The addiction has enormous power. 

“A person can feel powerless in the grips of addiction, but they are not helpless. It’s not about people not wanting to be clean. For them to start looking for help is enough to get the ball rolling on building a new connection,” Macintosh says.

Misconception about addiction: A person can be cured of an addiction.

Truth about addiction: There is no cure for addiction. The addiction can be arrested, paused, but the management of the addiction is lifelong.

“I think it’s important for people to have compassion before understanding,” Mackinley notes. “You may not understand or agree with the choices a person experiencing addiction makes, but lead with kindness. You don’t know a person’s life or story, just be kind.”

“A person will always have that addiction,” Macintosh explains. “And if and how they seek and make other connections looks different for everyone.”