Untold Faces of Addiction: Navigating Complexity and Injustice

“Addiction is the only disease that convinces you that you don’t have a disease. It’s cunning, baffling, and powerful.” (Mc Clernon, 2024)

“I wish I had a friend who could have taken me by the hand and said: Don´t go down that road.” (AIDS-Fondet, 2023)

“Growing up, I had a lot of insecurity. I fought with eating disorders. I couldn’t cope with looking in the mirror. When I was about 15, I started drinking. As soon as I drank, I became a different person. That, to me, was freedom – but it later became prison.” (Mc Clernon, 2024)

“Once upon a time I was gone and woke up, maybe after a cardiac arrest. I don’t know if anyone did anything to me during that time, but I couldn’t stand on my feet after being unconscious.” (AIDS-Fondet, 2023)

Addiction has different faces, and personal narratives may vary significantly. However, human elements of addiction stories often remain untold, especially among vulnerable populations and minorities.

Dangerous alcohol consumption kills one person on Earth every 12 seconds and 39.5 million people worldwide battle drug addiction. (BZgA, 2021; United Nations, 2023)

This number calls for action, and society’s attitude towards addiction may discourage individuals from seeking help. Often, addiction is seen as a treatable medical condition and classified as a criminal problem with legal consequences. Furthermore, it is historically associated with moral failure and stigmatization. What is often misunderstood is the reality that addiction is a complex and long-lasting brain disease and not merely a choice or moral problem (Contie, 2015).

It is connected to damaged key brain regions responsible for pleasure, decision-making, and emotional response. Addiction can hijack them and disrupt normal brain pathways that reward health behaviors. Substance abuse creates intense pleasure in the reward circuit, leading to a reduced ability to feel pleasure from natural rewards and increased drug tolerance (Contie, 2015; National Institute on Drug Abuse, 2020). For example, chocolate can increase dopamine levels by 50%, while sex can cause a 100% increase. Drugs such as crystal meth, can increase dopamine levels by up to 1,000% above baseline, contributing to their highly addictive potential. (Robb-Dover, 2021) The chemical changes in dopamine lead to the brain’s increased craving and tolerance for drugs, as well as depressed mood and impaired brain function. (Contie, 2015)

Genetic and environmental factors, such as family history and childhood trauma also contribute to the risk of substance dependence, as emotional stress lies at the core of the psychological component of addiction. (Ruisoto and Contador, 2019) Pursuing pleasure through excessive unhealthy behavior, such as substance use, serves as a coping mechanism to temporarily alleviate this underlying stress. Considering trauma and diverse forms of emotional stress as a risk factor for addiction, it is important to focus on historically marginalized communities such as indigenous groups and LGBTQ+ members. Prevalence of addiction is higher among these minority groups due to a combination of unequal access to resources and psychological support, historical and ongoing trauma, discrimination, social stigmatization, as well as a lack of cultural competence in treatment. Addressing injustices that disproportionately affect vulnerable and marginalized populations, and decolonizing addiction, and our approaches to treatment, can empower individuals and communities to address addiction in culturally relevant ways. (Dale, E. et al.,2019; National Institute on drug abuse, 2023)

Let’s delve into specific examples to understand these complexities in the context of addiction:

Indigenous people in colonized countries such as New Zealand, Australia, Canada, and the US experience higher rates of addiction than non-indigenous populations, and are at increased risk of alcohol use disorders, including alcohol dependence. Significant trauma during the period of colonization, including forced displacement, loss of cultural identity, and the introduction of substances like alcohol by colonizers has had long-lasting effects on individuals and communities (Dale, E. et al.,2019). However, conventional addiction treatment methods may not adequately address the unique cultural needs of indigenous individuals such as historical trauma, cultural dislocation or language barriers. This lack of culturally competent services can be a barrier to effective prevention and treatment.

While indigenous communities struggle with the historical traumas of colonization, minorities in the urban environment like the LGBTQIA+ communities are also affected by historical injustices and a lack of culturally sensitive addiction narratives and treatment approaches.

“Society´s homophobia affects your self-esteem. I have been exposed to a lot of homophobia at school and on the streets when I was younger. Experiences that I realize have had a heavy impact on my life to this day.” (AIDS-Fondet, 2023)

The LGBTQIA+ community is one of the many marginalized communities that are burdened by social stigmatization, which can contribute to a low sense of self-worth. Some may resort to substance use as a coping mechanism. The quote comes from a young man involved in chemsex practices, which refers to a subculture involving drug use during sex, mainly affecting gay and transgender men. Chemsex has become well-organized and easily accessible, with a lower barrier than before, facilitated by apps for obtaining party drugs. In Denmark, thousands of gay men were involved in chemsex with an overrepresentation of individuals in Copenhagen and those living with HIV. Commonly used chemsex drugs include highly addictive substances such as crystal meth and GHB. Crystal meth, in particular, is noted for its powerful effects on dopamine levels, affecting judgment and making treatment challenging. People may perceive chemsex as an escape from everyday life, a way to release inhibitions, or as a means of enhancing pleasure, but continued drug use can result in a dependency that can pose serious threats to their health and Wellbeing. However, seizures, strokes, and cardiac arrest can be consequences of chronic use or overdoses of chemsex drugs. Furthermore, serious consequences of chemsex do not only include drug addiction but also other health risks such as sexually transmitted diseases, sexual assault, and psychological issues such as psychosis (AIDS-Fondet, 2023). The LGBTQIA+ community is one of the many marginalized communities that are burdened by social stigmatization, which can contribute to a low sense of self-worth. Some may resort to substance use as a coping mechanism. The quote comes from a young man involved in chemsex practices, which refers to a subculture involving drug use during sex, mainly affecting gay and transgender men. Chemsex has become well-organized and easily accessible, with a lower barrier than before, facilitated by apps for obtaining party drugs. In Denmark, thousands of gay men were involved in chemsex with an overrepresentation of individuals in Copenhagen and those living with HIV. Commonly used chemsex drugs include highly addictive substances such as crystal meth and GHB. Crystal meth, in particular, is noted for its powerful effects on dopamine levels, affecting judgment and making treatment challenging. People may perceive chemsex as an escape from everyday life, a way to release inhibitions, or as a means of enhancing pleasure, but continued drug use can result in a dependency that can pose serious threats to their health and Wellbeing. However, seizures, strokes, and cardiac arrest can be consequences of chronic use or overdoses of chemsex drugs. Furthermore, serious consequences of chemsex do not only include drug addiction but also other health risks such as sexually transmitted diseases, sexual assault, and psychological issues such as psychosis (AIDS-Fondet, 2023).

“I want to forget all the shit I’m carrying around emotionally and that is too overwhelming, to run away from myself.” (AIDS-Fondet, 2023)

Due to the taboo nature of chemsex, many individuals feel uninformed, leading to further consequences of chemsex:

“I didn’t know nothing at all. I would have liked to be more informed earlier. It’s often only described as something fun and rosy by bloggers and in videos.” It was easy to be enticed: “Then I was offered such a funny pipe and thought it was weed”, but it was Crystal Meth, and then I kept doing it; I had to learn the hard way.” (AIDS-Fondet, 2023)

This highlights that awareness should be comprehensive and take into account the physical, psychological, and social aspects of each person. It goes beyond an exclusive focus on substance use, and we need to consider cultural, historical, and societal contexts. Effective treatment involves a holistic approach that incorporates therapy, support networks, and coordinated efforts by authorities and healthcare systems to combat homophobia and discrimination.

In summary, the different faces of addiction highlight the need for a paradigm shift in our understanding and approach to this complex issue. To address addiction, particularly in vulnerable and marginalized communities, a critical step forward is to decolonize it. Decolonization, the reversal of colonization, involves breaking up the social structures that maintain the colonial ideology. Colonization has imposed Western norms and erased the acceptance of different sexual identities and indigenous people by locals and led to the criminalization of these communities. The marginalization, stigmatization, and invisibility of LGBTQ+ and indigenous people in formerly colonized regions highlights the lasting effects of historical injustices. Therefore, decolonizing addiction involves recognizing these injustices, cultural fault lines and social stigma towards indigenous people or LGBTGIA+ members as they negatively affect their mental health (Smye, V. et al.,2023; Kimber, N., 2022). The aim is to empower communities, promote inclusivity and combat addiction in a way that considers their history and incorporates diverse cultural perspectives.

Ongoing oppression and marginalization in these communities, highlights the importance of preventing addiction and high relapse quotes and improving treatment outcomes. If home is a community that has suffered from state-imposed violence and economic marginalization for generations, getting off drugs that were used to escape that environment can be very difficult. Healing the society to heal the individual is crucial to improve living conditions for all and justice where it’s due.