'We still have so much to learn about addiction'

Before I began working in inpatient rehabilitation services, my knowledge of addiction was limited., and mostly gleaned through media. Critically acclaimed films such as Trainspotting and Requiem For a Dream highlighted just some of the impact of substances to global audiences. When my co-workers and I discuss addiction, all of us have a specific thing that we have either read, seen or heard about which changed our perspective on addiction.

For me, it is the powerful and thought-provoking TED Talk performed by Johann Hari – 'Everything we know about addiction is wrong'. Shared in 2015, it now sits at 11 million views.

Hari begins speaking about his own personal experiences with addiction within his family, which sparked his interest in the topic. He addresses the anniversary of the UK and USA criminalising drug use and punishing them because we believe this will deter people from taking substances. Hari spent time travelling the world learning about addiction, from scientists and from addicts on the streets of Brooklyn. He discusses what we 'think' we know.

This includes how we often portray addiction as being about 'chemical hooks'. On Hari's journey, he met with Dr Bruce Alexander, whose research found that rats placed in a cage with water laced with morphine would drink it repeatedly, and eventually die. But Dr Alexander then created 'Rat Paradise' – a cage with other rats and plenty of toys and tubes for them. None of the rats overdosed, and almost all of them did not drink the morphine-laced water. Hari felt this was an important discovery about the role of our environment and addiction, saying 'What if addiction is about your cage?'

Hari goes on to discuss studies conducted in Portugal, which was the first country to decriminalise drug use. He discusses the impact of our support systems and our need to bond with someone or something. After watching this, I remember looking at the impact of Portugal's forward thinking in the present day; studies show the rates of addiction, overdose and HIV have reduced.

When I think about this TED Talk and the patients I work with day-to-day, I think about how there are people working within this service who still hold a belief of addicts being able to just 'stop'. When I think about ward environments, and about 'Rat Paradise', it becomes more and more apparent that we still have so much to learn when it comes to addiction and its complexities.

Hannah Irving, Higher Assistant Psychologist

In the Realm of Hungry Ghosts was the second book I read by Dr Gabor Maté. Maté suggests that 'The difference between passion and addiction is that between a divine spark and a flame that incinerates. Passion creates, addiction consumes.' And for a time, this book did consume me.

Maté showcases how behavioural addictions like gambling, working, and social media share the same brain circuits as substance-based addictions. Addiction is defined as 'any behaviour that gives you temporary relief, temporary pleasure, but in the long-term causes harm, has some negative consequences and you can't give it up, despite those negative consequences.' Maté doesn't minimise the risk of substance addiction, but encourages readers to reflect on their own behaviours, and challenges divisive and harmful beliefs about substance addiction.

Working in a busy male acute mental health ward in one of the country's most deprived regions, I encounter difficulties with addiction daily, specifically to drugs and alcohol. After a difficult day, it is easy to focus on the things that I lack as an Assistant psych – 'I'm not trained in motivational interviewing', 'What if I say the wrong thing?', 'Will I make this worse?' It's a cocktail of self-doubt and hopelessness which inevitably affects the way I tolerate and engage with others. Maté inspired me to concentrate on what we all have in common rather than focusing on what separates us as human beings.

By understanding that pain is central to all addictive behaviour, we see that attempts to escape pain often create more pain. Maté asserts, 'Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experiences. A hurt is at the centre of all addictive behaviours. It is present in the gambler, the Internet addict, the compulsive shopper, and the workaholic. The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden – but it's there.'

Maté's book was an all-consuming, sometimes upsetting reminder that whatever self-doubt I have, at least I am used to working with individuals who are in pain. 

Emily Watson, Higher Assistant Psychologist

Beautiful Boy is a film that chronicles the symphony of hope and despair, painting an intimate portrayal of an addiction's relentless grip. It draws from David Sheff's memoir Beautiful Boy: A Father's Journey Through His Sons' Addiction and Nic Sheff's memoir Tweak: Growing Up on Methamphetamines. The narrative takes us through the cyclical journey of survival, relapse, and recovery, with a focus on Nic's father's desperate efforts to support his son in healing from drug addiction.

Nic's story is invaluable to anyone working with individuals battling addiction – it offers insight into the intricate dynamics at play under such difficult circumstances. The film's honest depiction of addiction's complexities has enriched my understanding as an Assistant Psychologist in a working-age male acute ward. Although our involvement is relatively short-term, we liaise with community teams and specialist services to connect those interested in more long-term support for addiction.

Substance misuse is increasingly recognised as a chronic relapsing condition where recovery can be multifactorial and a non-linear process. Nic's relapse patterns are echoed throughout his recovery. We witness moments where Nic engages with rehabilitation, rekindles his passion for writing, attends family dinners and reconnects with his siblings. Yet these traces of hope are juxtaposed by his downward spiral into worsening addiction, relying on more addictive drugs like methamphetamine.

This portrayal has reinforced my concept of managing expectations as a crucial part of the therapeutic process. When supporting service users battling addiction, this can be a vital component of their relapse prevention plan, following referrals to specialist services. In my professional role, it underscores the importance of compassion and empathy, fostering a non-judgmental approach that helps to destigmatise addiction to promote a realistic recovery.

Beautiful Boy also captures the various types of support systems surrounding Nic, encompassing familial love, friendship and romantic love. We are particularly drawn to the relentless, unwavering commitment of his father, which was the most profound representation of social support. The message was that addiction was not something that could be overcome in isolation. However, the film does not shy away from the need for specialised care and intervention, for both Nic and his family. Towards the end, we witness the immense courage it took for his father to place his trust in specialist services to care for Nic. Clinically, this has reinforced the importance of involving caregivers in the treatment process, keeping them informed, where appropriate, and adopting a holistic approach to ensure comprehensive support for an individual and their family.

To conclude, Nic's and his father's journey has deepened my resolve to be more intentional about managing expectations of recovery and the importance of professional help-seeking. Recognising the importance of a robust support system has made me increasingly aware of attempting to involve caregivers where appropriate in a person's treatment.

Irene Joy, Higher Assistant Psychologist

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