A deeper look at addictions

First published on Jubillee+
www.jubilee-plus.org/Articles/438850/Jubilee_Plus/Research/A_DEEPER_LOOK.aspx

Dr Joss Bray MBBS MRCPsych FRCGP is a specialist substance misuse doctor and also leads Gateway Church Northumberland. He is also the founder of www.competentcompassion.org.uk
 

Introduction

Addiction will probably affect all of us in one way or another. Either personally or through a family member or a friend. In any case, it certainly affects societies as a whole and the church as part of that society.  There are many different things that people can get addicted to.
 
The common ones we think of are drugs, alcohol and cigarettes [1]. But there is a much longer list, ranging from caffeine to gambling, pornography and sex. Obesity in some cases can be termed a food addiction, and exercise can become an addiction as well.  You will probably be able to think of others as well. The point here is that wherever there is a “reward” of some sort, there is the potential for addiction.
 

Definitions

There are several definitions of addiction, which is also referred to as dependence. However, there tends to be the same core behaviours demonstrated in any addiction, which relate to the activity involved – whether drugs, alcohol or gambling etc. These usually include:

-- Doing something which the person knows to be harmful but being unable to stop.
-- Needing an increasing amount of the activity to produce the same effect and satisfy the drive for it.
-- Craving for the activity
-- Withdrawal symptoms (which can be physical or psychological or usually a mixture) when unable to do the activity.
-- Doing the activity to the exclusion or detriment of other important activities.
-- Actively seeking what they are addicted to and often engaging in uncharacteristic behaviour as a result.

-- Former Army Major Justyn Larcombe’s downward spiral began with a small bet placed online in 2009 during a rugby match, but soon the addiction was so strong it took over his life. In three years, he gambled away £750,000; his savings, the equity in his house, money his wife had given him to look after and then when all that was gone, he started using his company credit card. When his employers found out, they sacked him. Now he has turned his life around, is campaigning to help others with gambling addictions and runs a Recovery Course at Tonbridge Baptist Church [2].
 

Numbers

It is difficult to be precise about the exact statistics in the UK due to the nature of the problem and there will be many more people who are using drugs/alcohol, for example, in dangerous amounts without actually being addicted. However, the available figures show:

-- The number of people who show signs of alcohol dependence in the UK is approximately 9% of men and 4% of women [3].
-- The number of people aged 15 to 64 and known to be using heroin, methadone, other opiate drugs, or crack cocaine is approximately 0.8% of the population [4].
-- Around 1 in 11 (8.8%) adults in England and Wales aged 16 to 59 took an illicit drug in 2013-14. However, this proportion more than doubled when looking at the age subgroup of 16 to 24 year-olds (18.9%) [5].
-- There is a growing problem with people using “novel psychoactive substances” - including “legal highs” and synthetic cannabis but the numbers are not clear.
-- There is an increase in the number of people reported to be addicted to “prescription” drugs i.e. drugs prescribed for them, as well as addiction to “over the counter” medications that do not need prescriptions but that can still be addictive.
-- Around 10 million adults in UK smoke cigarettes: 21% of men and 19% of women. Two-thirds of smokers start before the age of 18 [6].
-- Therefore in a group of 100 people, there could be, on average, 6 people who are addicted to alcohol, 1 addicted to drugs and 19 addicted to nicotine. A person could be addicted to 1 or more of these. There could also be people addicted to pornography, gambling and so forth.
 

Causes [7]

There is no simple single cause for addiction. There is some evidence of genetic influences which means if a close relative has an addiction there may be more risk of a person developing it. However, this is not particularly useful in practice. There just needs to be an awareness of a possible vulnerability in this area. Conversely it is certainly possible to develop an addiction even with no family history.
 
Early life traumas including abuse certainly do seem to raise the risk and a difficult family life as a child and young adult is a common issue. Easy availability of the substance or activity can be important to initiate misuse then addiction as well as peer group pressure. Mental illness often coexists, particularly alongside drug and alcohol addiction, sometimes as a cause, sometimes as an effect and sometimes as both.
 
However, people who suffer from addiction may have had none of these issues, and no apparent underlying cause can be identified.
 
-- Craig, like many addicts, had a broken childhood. He recalls feeling very ‘remote’ and ‘distant’ from his parents, and at the age of nine his mother left after an affair, leaving Craig to grow up with his father. Craig does not blame his childhood for where he found himself, but does recognise it played a part. Craig tells me how through his early teens he became more and more preoccupied with pornography and how it went from ‘sneaking into his father’s stash and looking at the images on the DVDs’ to finding ways of watching them.
-- The more Craig immersed himself in watching pornography, the harder it became for him to form relationships, or concentrate on school or work. He believes that poor college grades are to do with a ‘constant preoccupation with sex’. After a failed engagement, Craig realised he needed help to form relationships in the real world and not seek solace in pornography [8].
 
Some substances and activities are more addictive than others i.e. people can get addicted after a shorter number of experiences using that substance or carrying out an activity, but this is not predictable for an individual person. One person may get addicted after one experience; another may not, even after several times. People sometimes describe themselves as having “addictive personalities” – and can go from one addiction to another. Although we do see this in practice, there is no agreed diagnostic term of “addictive personality” as yet.  
 
The bottom line is that addiction could happen to anyone. That is a message that is well worth remembering. An addicted person may look exactly the same as anyone else and they may easily be sitting next to you without you knowing.
 

Consequences

Some addictions are more harmful than others and in different ways. Clearly drug/alcohol/cigarette addiction has a particular set of problems. For example, about half of all life-long smokers will die prematurely, losing on average about 10 years of life [9] which would not be true, for example, for people addicted to pornography. They would have a different set of adverse consequences, although still potentially very harmful.
 
In particular, drug and alcohol misuse can lead to many physical and mental health problems too numerous to go into here but suffice it to say that every organ in the body can be affected and many conditions caused are terminal. Depression, anxiety and psychosis are far more common in people addicted to substances. The NHS just in England incurs £3.5bn a year in costs related to alcohol 10].
 
Relationship and marital breakdown is common. A huge amount of misery and anxiety can be caused to family and friends by the actions of an addicted person. This can be directly due to their actions when intoxicated or being desperate to get money, e.g. domestic violence. Or indirectly because of the stress of trying to help someone they love who will often be very difficult to help. Many children grow up without a father or mother or both because of addiction or abused or neglected by a resident addicted parent.
 
The addicted person can easily get into trouble with the law, even if the substance or activity they are addicted to is legal. Substance addiction is a major cause of shoplifting [11] and alcohol related disorder is a major problem in some areas [12].
 
-- Take the story of Darrell Tunningley [13]. By the age of 16 he was selling heroin and cocaine and funding a £300-a-day heroin habit before being jailed for five-and-a-half years for involvement in an armed robbery. Today he is a church pastor in Cheshire and married with two children. Watch this video from HTB.


https://www.htb.org/media/darrell-tunningleys-story

Finances are often affected adversely and jobs are often lost. The ability to find and stick with a new job is impaired and therefore people can end up needing benefits to survive, and even end up begging.  Homelessness, or inadequate and insecure housing, amongst people heavily addicted to drugs and/or alcohol is common. They often end up in hostels where drug and alcohol use is common and recovery is difficult.
 
Spiritually and psychologically, an addicted person often feels like a failure and worthless in themselves. They are usually aware of the damage their behaviour causes but are powerless to stop it. They end up doing things and justifying behaviour which they would not normally endorse. There is often a constant feeling of regret and guilt which can fuel the vicious circle of addiction to try and relieve their negative feelings towards themselves.
 
Of course there will be people who deny that they have a problem when confronted with what they are doing. Unfortunately they are deceiving themselves and others - which only delays getting the help they need.
 

Treatment

Treatment is a complex subject, but it is available “on the NHS” for people with addiction to drugs, alcohol and cigarettes. There is little provision for gambling and other non-substance addictions though. Sometimes these are addressed through psychological therapies outside of traditional addiction services.
 
Self-help groups are widespread, in particular those that adhere to the 12 Step Model [14] used by Alcoholics Anonymous. There are similar “Anonymous” groups such as Narcotics, Cocaine and Gamblers Anonymous and many more. The 12 step approach involves acknowledging a “higher power” - but that does not necessarily have to be God. Then there are 12 defined steps to work through on the path to recovery and regular meetings to attend. There are also parallel groups for families of people with addictions.
 
Vanessa, a recovering alcoholic, says. “A huge part of me staying well and sober is to regularly attend Alcoholics Anonymous meetings which I still do. In the twelve step programme God is mentioned alot and I began to slowly begin to trust the process of praying and believing that God really is my friend. How else could I be alive with the life I've lead?” Vanessa now attends the Vineyard Church in St Albans [15].
 
Another self-help grouping that is growing in popularity is called SMART Recovery [16]. Again, this is peer led and meets regularly in groups, but does not use 12 steps and there is no higher power. It works by people helping each other by sharing their knowledge, experiences and successes.
 
In terms of NHS drug and alcohol treatment, this is accessed either through a GP or other health professional, or people can usually self-refer to community services. Sometimes people enter services through the criminal justice system.
 
Treatment for drug and alcohol problems should always involve “psychosocial” elements i.e. talking therapy [17] which includes elements of motivational interviewing, cognitive behavioural therapy, relapse prevention, education, harm reduction and other therapies as well as counselling for those who need to deal with past traumas. Specific help may be needed for rehousing, benefits and debt management, parenting and other life skills. People may also need specific referrals for psychiatric or medical input if they have, for example, severe depression or Hepatitis C.
 
One thing to remember is that forcing or coercing people into treatment does not work. Someone has to want to change before they will try to change. However, there are things that can be done to help to increase motivation to that level, but harm reduction in the meantime is very important. A person has to be alive to be able to change - that is why needle exchanges and Hepatitis screening and vaccinations, for example, are essential.
 
Treatment itself usually includes prescribing medication at some point when appropriate. People with alcohol addiction will usually need a formal alcohol detoxification programme to stop drinking. This can be done at home, in a specialist residential unit, or in a hospital, depending on the particular person and their circumstances. People with opiate addiction, for example, heroin, will usually need to be stabilised on a prescribed legal alternative. This is usually done in the community, although they may need to go into a residential unit for this.
 
When someone is detoxed off their substance or stable on a prescription, this is only the end of the beginning of the journey. Ongoing support in community services and sometimes residential rehabilitation is needed to help prevent relapse, and also to help people gain the skills to live a life without substances. There are also medications available to help people stop using drugs or alcohol again.
 
Addiction can be seen as a chronic relapsing condition, which means that a lot of people have repeated episodes needing treatment.
 
Recovery is a lifelong process – but it is certainly possible.
 

The challenge to the Church

As we have noted before, there will be many people affected by addiction in the community and also in a church. This is not just the addicted person but their family as well. We need to:
 
-- Be aware
-- Realise that “there but for the grace of God go I”
-- Know that there are limits to what your church can do
-- Find out what is happening in your area with addiction; addiction statistics, local services, what other churches are doing, etc
-- Educate church members e.g. talk from local GP - help “them” become “us”
-- Think through what the church can do
-- Be sure that no one is looked down upon or marginalised
-- Take action
-- Regularly pray for the person/people affected
-- Create and keep a useful contacts list and seek help for more expertise if it is needed
-- Consider specialist training for the church as a whole
-- Have a team approach which is effectively led
-- Consider offering church based addiction programmes for example, Living Recovery [18] or CAP Release Groups [19]
 

Note from the author

Addiction is common and destructive. Churches should be able to recognise and help people with these problems which are sometimes complex and difficult to address.  
 
Aim for an atmosphere of “competent compassion” – where both qualities are present. One without the other will not work and can be disastrous. We need to be competent and know our limits as well as compassionate to share God’s heart for these people. They are often the most needy, but the least able to get help.
 
I have seen people’s lives transformed by good treatment and by the coming of the kingdom of God in their lives. These people can be just as much of the body – the church – as anyone, and we should be welcoming them in.
 
-- Dr Joss Bray
 
Disclaimer: The views and opinions expressed by guest contributors are those of the author. Although broadly in keeping with the objectives of Jubilee+, the views and opinions of the guest do not necessarily represent those of the Jubilee+ team and directors and/or other contributors to this site.

[1] Strictly speaking alcohol, nicotine in cigarettes, as well as caffeine are drugs but they are separated as they are probably better considered as specific problems
[2] http://www.bbc.co.uk/news/uk-england-kent-28243819
[3] https://www.alcoholconcern.org.uk/help-and-advice/statistics-on-alcohol/
[4] http://www.nta.nhs.uk/uploads/estimates-of-the-prevalence-of-opiate-use-and-or-crack-cocaine-use-2011-12-summary-report-v2.pdf
[5] https://www.gov.uk/government/publications/drug-misuse-findings-from-the-2013-to-2014-csew/drug-misuse-findings-from-the-201314-crime-survey-for-england-and-wales
[6] http://ash.org.uk/information/facts-and-stats/fact-sheets
[7] http://en.wikipedia.org/wiki/Addiction_vulnerability
[8] http://www.mentalhealthy.co.uk/addiction/addiction/pornography-addiction-real-life-story.html
[9] http://ash.org.uk/files/documents/ASH_107.pdf
[10] http://www.nta.nhs.uk/uploads/adult-alcohol-statistics-2013-14-commentary.pdf
[11] http://www.nta.nhs.uk/uploads/vfm-crimepresentationvfinal.pdf
[12] http://www.civitas.org.uk/crime/factsheet-alcoholcrime.pdf
[13] http://www.dailymail.co.uk/news/article-2280981/From-300-day-heroin-addict-church-pastor-How-ex-convict-involved-crime-11-turned-life-spread-word.html
[14] http://en.wikipedia.org/wiki/Twelve-step_program
[15] http://www.thevineyardchurch.co.uk/addictions
[16] http://www.smartrecovery.org.uk/
[17] http://en.wikipedia.org/wiki/Talking_therapies
[18] http://jubilee-plus.org/Articles/418208/Jubilee_Plus/Social_Action/Freedom_from_Addiction/LIVING_RECOVERY_CENTRES.aspx
[19] http://jubilee-plus.org/Articles/422076/Jubilee_Plus/Social_Action/Freedom_from_Addiction/CAP_RELEASE_GROUPS.aspx