Source: # Addiction and Substance Use *Wanting, relief, shame, and the next cue* ## 25.1 What addiction is The loop can be named in six words: wanting without liking; cue, use, relief, shame, cue. That is not poetry. It is a working sketch of how a brain learns a shortcut. A substance use disorder is a pattern of substance use that causes harm or distress. Its signs match modern diagnostic lists: - Taking more than intended. - Wanting to cut down but unable. - Spending a lot of time obtaining, using, recovering. - Cravings. - Failure to fulfil obligations. - Continued use despite problems. - Giving up activities. - Using in dangerous situations. - Tolerance (needing more for the same effect). - Withdrawal symptoms. Addiction is not a lack of character. It is a learned loop in a nervous system that still has to go to work, parent, and sleep. Shame is often the next cue, not the cure. ## 25.2 Common substances - Alcohol. - Opioids (heroin, prescription painkillers). - Stimulants (cocaine, methamphetamine, ADHD medications used off-script). - Cannabis. - Sedatives (benzodiazepines, sleep medications). - Hallucinogens. - Tobacco / nicotine. A substance is not the only possible loop. Impulsive patterns in spending, sex, driving and binge eating can work the same way. Those patterns can share the same cue–relief–shame circle. They still need their own care, not a single slogan. ## 25.3 Why the body learns the loop Dopamine, the brain's reward messenger, plays a central part in addiction. A cue predicts relief. The prediction itself becomes the hunger. After a while the person may not even like the substance. They want it. That is the line worth keeping: wanting without liking. Stress, trauma, untreated anxiety or depression, loneliness, and easy access make the loop cheaper to run. Families do best when they seek specialised support — de-addiction centres and family groups — rather than arguing a person into virtue. ## 25.4 Treatment - Detoxification: medically supervised withdrawal when stopping is itself dangerous (alcohol, benzodiazepines, some opioids). - Rehabilitation programmes — residential or day — for structure, not as a prison of shame. - Medication-assisted treatment for opioids and for alcohol, when a licensed clinician chooses it. - Therapy: CBT, motivational interviewing. - Support groups: AA, NA, SMART Recovery — company that knows the loop. - Relapse prevention: a lapse is data, not a verdict that the person is finished. - Treat co-occurring mental health conditions. The drink is often holding a door shut on anxiety, trauma, or depression. Do not stop a dependent alcohol or benzodiazepine pattern at home without medical advice. Withdrawal can seize. This is a medical emergency. Never try to stop alone at home over a weekend; get medical help. ## 25.5 Family — support without enabling A key question for families is: how can you support someone without enabling them? Enabling is paying the fine, hiding the bottles, and calling the boss with a new lie. Support is: stay, name the danger, offer a ride to a clinic, keep the house safer, refuse the lie, do not abandon the person. Stigma delays care. A family that treats addiction only as disgrace will get secrecy. Secrecy feeds the cue. ## 25.6 Harm reduction Not everyone is ready or able to stop at once. Harm reduction aims to reduce the dangers of use while working toward safer lives, for example by providing access to treatment, safe-use education, overdose-reversal medicine such as naloxone, and clean equipment. Evidence shows that these approaches save lives and bring people closer to treatment. ## 25.7 A short story A STORY FROM ORDINARY LIFE — RAFI, THE THIRD EXCUSE Rafi told his sister the late trains were the reason. Then the stomach. Then the office. The bottles were in the spare tyre well. After a shake that looked like flu, the casualty doctor did not lecture. He asked how much, how long, and whether anyone at home was safe. Detox first. Then a clinic and a group. The sister stopped inventing stories for his manager. She started driving him on Thursdays. The loop did not vanish in a week. It stopped being a secret. ## Key points to remember A teaching check, not a diagnosis. - Wanting without liking is a learned prediction, not proof that a person is weak. - Withdrawal from alcohol or some sedatives can be medically dangerous. - Medication-assisted treatment is care, not a moral defeat. - Treat the anxiety or trauma that the substance was silencing. **IF TONIGHT IS DANGEROUS** Unconscious, seizure, chest pain, or a person who cannot be roused: emergency services. Poison or overdose: casualty now. 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