26 May 2022
Addiction is the most complex area of medicine. Why? Because it involves every part of a person: their history, relationships, socio-economic life, physical health, mental health, brain physiology etc. And with the ramifications of harmful drug use, you can also add risk of death, hospitalisation, cancer, palliative care, homelessness, incarceration and more.
Like most extremely complex subjects, addiction is riddled with contradictions. At the heart of it all is the dichotomy between the universality of vulnerability (‘there, but for the grace of god’), and the predictable precursors for chronic, life-threatening addiction and mental illness.
1 in 5 Australians will suffer an episode of mental illness in any given year, whether or not it’s diagnosed and/or treated. Furthermore, the disruption and threat of COVID-19, and the isolation of lockdowns, have made us all aware that our mental health is fragile.
On the flip side, research has demonstrated the connection between Adverse Childhood Events (ACEs) and mental illness. The connections are even more shocking with ACEs and substance abuse. Some of the research from large population studies shows a terrifying exponential graph linking the incidence of ACEs to addiction in adulthood. One ACE, and you’re a few times more likely than the general population to suffer from addiction. Two ACEs, and you’re many many times more likely. Three ACEs and we start to leave the charts…
Overlay across this mental health and addiction debate the fact that many drugs (depressants like heroin, stimulants like amphetamine. and hallucinogens like LSD) are classed as illegal. Dealers in illegal drugs are classed as the worst kind of human, and drug users suffer tremendous stigma also.
The AOD sector, families and carers, and other compassionate people in society say, ‘People who use drugs are people too and good people worthy of your respect and support. They are mums and dads and sisters and brothers and sons and daughters.’
But this message hits up against the stigmatising, usually unspoken question “If they’re good people why don’t they see what their drug use is doing to themselves and others, get their act together and stop?” Then we get in to a back and forth on that issue, discussing trauma and disadvantage.
But what if we flip this and listen to the words of people who use illicit drugs? To the mums and dads and sisters and brothers. It’s strange when you first hear it, but many of them will tell you, ‘I want to stop using. It’s killing me. I’m full of shame. I want to change. But actually, drugs saved my life.’
Vilified, criminalised, stigmatised, dangerous, unpredictable, unidentifiable, illegal drugs saved their life? How can they have a health benefit?
When I see people behave in a way I can’t understand, I ask myself, ‘What would be worse than that? What would be worse for that person than, for example, injecting heroin?’
The answer is suicide.
Many young people, disproportionately those who have survived childhood abuse and neglect, are in so much pain that they want to die. As a society, we are coming to grips with the impact of child sexual abuse, universally regarded as the worst of the ACEs. There are classroom photos of boys from religious schools in regional Victorian where every third boy has taken his own life. What if it turns out that drugs like heroin, might provide relief from extreme existential pain? Yes, this is dangerous. But also life-saving.
Adult survivors of child sexual abuse – that’s practically every second client at First Step. Sometimes I tell people, ‘I work for an organisation that supports adult survivors of childhood sexual abuse.’ I don’t mean to belabour this one particular form of harm, and it is certainly not universal in our client population, however, because it creates a visceral response of despair and anger when we are forced to think about, it’s a theme that can help us see the truth: illicit drugs sometimes save lives.
If we accept that this is true, then where do we go from here?
Well, as civil servants, politicians, health sector workers, philanthropists and voters we support the design of a service system that goes past the question of ‘Why the drug use?’ to ‘Why the pain?’. We seek to understand ACEs and prepare for complexity and co-occurring needs in the people who seek support for addiction. We create an environment of treatment and support that is non-judgemental, patient, strength-based and trauma-informed. We provide welcome, empathy and hope all day, every day. We provide all the help people want and need from one integrated team in one place. And we resource and continue to develop that ecosystem.
To call drug use a ‘choice’ is a gross oversimplification. People with a lived experience of chronic addiction tell us that for them it was a choice between the temporary oblivion of drugs and real, permanent oblivion. We can’t really call that a choice, can we?
If there is a choice to be made, it’s ours. It’s up to us as to how we will think of, interact with, and treat people who are living with addiction. Will we judge? Will we heap scorn? Will we think we know the answers? Will we look the other way? Or will we listen?
Chief Executive Officer