Why don’t substance users seek treatment? Shame is the number-one reason.

Our society does not see substance use and loss of control as a disease process; rather, we see those with substance use and mental health issues as weak. Society needs to change this view to reduce shame so users will seek treatment.

We must start with a comprehensive integrated approach. Health professionals and society must consider an overarching approach, not one-size-fits-all.

Substance use falls into three categories: mild, moderate and severe. It has been segregated from the rest of health care and treated very differently from other chronic conditions, such as hypertension. 

The brain doesn’t care what drug is being used (alcohol, tobacco, marijuana, gambling or ice). The brain’s reward system goes into action and, for some users, it becomes a matter of survival.

For mild users, the treatment explores users’ and family concerns, possible counselling, GP referral for mental health issues and education on the effects of the drug.

In moderate users, the symptoms are more noticeable to family and workmates. Use becomes problematic and begins to affect daily life. At this point, the focus is on reducing harm: needle exchange, methadone maintenance, cutting back weekly use, referral to a GP for any mental health issues/trauma and counselling. An outpatient treatment and support group might help.

For severe users, I suggest harm reduction – such as drinking responsibly – is not an option, as the mid-brain is affected with drug craving, tolerance and withdrawal. The best treatment is detoxification, rehabilitation and counselling for mental health issues/trauma, family therapy and ongoing relapse prevention (eg 12-step programs, SMART Recovery groups). Ongoing abstinence is most likely required.

The good news is there is hope for recovery.

Intervention starts with family, friends and the workplace, but they need support and education first.

Motivating users of any level to enter treatment is a challenge, yet it happens, so don’t give up hope: “If you build it, they will come.”

John Falcon

Psychologist, addiction specialist