MHM Magazine

2. It’s a chronic, relapsing condition. Anyone with an addiction is always one trigger away from going back to using. It’s crucial for doctors to ask about their history and to avoid medications that could trigger a relapse. The stakes are high — relapse can be dangerous or even deadly. So, What Is Addiction Anyway? DSM-5-TR defines a substance use disorder as substance use that leads to clinically significant impairment or distress defined by impaired control, social impact, risky use and pharmacological effects. It’s important to learn and use these criteria as there is a very fine line between social use and a disorder, and most people are in complete denial in the early stages of the disease. Why Are Some More Vulnerable? Addiction is an acquired disease of the brain. Everyone is susceptible to experimenting with drugs — a curious teenager, a stressed-out adult. But some are more at risk of continuing use and eventual addiction due to genetics, early trauma or current environmental stressors. For these folks, a single try can turn into a cycle of compulsive use, and using exposes them to dangerous situations, more trauma and more dysphoria which then compounds their using. All addictive drugs cause sharp spikes in dopamine and a heightened sense of reward in the brain. Physiological stimuli (such as food and sex) result in satiation of the reward centres and desensitisation of dopamine receptors with a subsequent reduction in craving for the rewarding activity. Drugs circumvent this through their unnatural and ongoing stimulation of dopamine release causing abnormally intense and long ‘highs’. In addition, with repeated use the brain learns to pair the reward stimulus with environmental cues (such as people, places and things) associated with drug use. Dopamine increases rapidly when exposed to these cues even without the presence of the drug and this results in craving even years after the last drug use. Ordinary, healthy rewarding activities lose their attraction in the face of the more potent reward of the drug and the person no longer has the motivation or desire to enjoy the simpler pleasures in life. All that is rewarding and motivating is the drug, everything else feels dull and unrewarding. Over time and repeated use the brain downregulates dopamine release and both the drug and life seem less and less rewarding. In addition, the ‘anti-reward’ system is triggered to maintain the brain’s homeostasis and the person starts to feel dysphoric when not using. Using moves from being about experiencing euphoria to just avoiding dysphoria. Unfortunately, the relief is short-lived as with ongoing use the dopamine release becomes increasingly attenuated and the dysphoria more intense and persistent. The downregulation of dopamine and disturbance of glutamate signalling also seriously impair executive functions such as self-regulation, decision-making, flexibility, priority-setting and monitoring of error. The addict is therefore genuinely unable to take the decision to stop using drugs and to stick to this decision, especially if s/he continues to be exposed to triggers that boost dopamine. Can Anything Stop It? The absolute safest choice is never to try drugs. Once addiction sets in, recovery is about stopping drug use, staying stopped, avoiding triggers, and building a meaningful, healthy life outside of drug dependence. It’s tough, but many who recover find renewed purpose and connection, often through programmes like Narcotics Anonymous, where they learn honesty, openness, willingness, and service. Real Stories, Real Lessons From my own experience, I’ve seen how addiction works behind the scenes. Some people manage to keep their lives together despite using — they appear outwardly fine, but inside they’re suffering. Others lose everything, ending up on the streets and fighting just to survive. The most inspiring are those who have hit rock bottom and then fought their way back. Their courage to surrender, face their faults, and commit to recovery is extraordinary. These individuals deserve kindness and understanding, not judgment. They’re often some of the most resilient and compassionate people you’ll meet once they’re on the path of recovery. They’ve learned that true strength is in honesty and humility, and they do their best every day to live without the drug that once controlled them. Final Thoughts Addiction isn’t just about a lack of self-control — it’s about brain chemistry, genetics, environment, and emotional pain. It’s a complex, often relapsing disease that requires compassion, understanding, and sometimes brave interventions. So next time you see someone struggling with addiction, remember - they’re fighting a battle inside that they didn’t choose. With proper support, treatment, and kindness, recovery is possible — and so is a life of purpose and connection beyond the drugs. References available on request. MHM | 2025 | Volume 12 | Issue 3 | Why addiction is more than just a lack of self-control MHM 16 | MENTAL HEALTH MATTERS | 2025 | Issue 3 H