The Psychology of Addiction – Zainab’s Story

About 11 million people inject drugs, of which 1.3 million are living with HIV, 5.5 Million with Hepatitis C and 1 million with both HIV and Hepatitis C. – WHO

Drug addiction is a real and scary phenomenon.

But why do people take drugs and how does addiction occur?

I hope reading the true story of a patient of mine, Zainab (not her real name) will help you see through the eyes of someone who’s been there, what addiction is really like.

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I met Zainab while she was on admission for yet another sickle cell crisis.  She had been diagnosed with sickle cell disease in infancy. Since then she had battled recurrent painful crises. But the painful episodes that racked her body and left her drained were becoming more frequent so her Haematologist invited me to see her.

The private room where she lay was quiet except for the beeping of the cardiac monitor. Her mother was by her bedside looking worried. Zainab struggled to a sitting position when she saw me. I smiled behind my face mask and introduced myself. She nodded and smiled in return. Propped up by pillows, she looked thin and exhausted in her flowered hospital gown but had an intelligent expression on her face.

I found a chair by the corner and sat facing her. I had gone through her medical records so I knew about her Pethidine (a strong pain killer) addiction. I also knew about her struggle with depression, her failed engagement and the fact that she wanted to die.

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What is Drug Addiction?

Drug addiction is the physical and psychological inability to stop taking a drug or substance even though it’s causing psychological and physical harm.

When someone is addicted to a drug it seems to take control of the person’s life and quickly becomes more important than their own family, values and goals.

Addicted people quickly find themselves stuck in a cycle of craving (intense longing), sudden drops in mood and rising distress that is only relieved by using the drug.

Their lives become centred on their drug use making it difficult to manage day to day life.

All goal oriented activity becomes solely geared towards obtaining the drug.

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I informed Zainab that we would be talking about intensely personal matters so she opted for her mother to leave us. As the woman turned to leave, I couldn’t help but agree with her daughter’s decision. Being a mother myself I could relate with this mother’s pain and knew that she would only worsen her suffering by staying to listen.

One of the hardest things in the world is watching the pain of someone you love, especially your own child.

Zainab gained my respect in that instant without even realizing it. Here she was, ill and in pain but still thinking of her mother’s welfare.

Her voice was surprisingly strong when she looked at me, shook her head and said ‘’ I don’t know where to start’’

I brought out my notepad and pen, reclined in the chair and replied ‘’why not start from the very beginning.’’

For the next one hour, I listened closely as Zainab walked me through the events that led up to her pethidine addiction, suicidal thoughts and eventual hospital admission.

It all started 2 years before, shortly after her best friend Aisha’s wedding. Before then she had been happy and content despite having the occasional painful crisis.

Life was good. She was top of her psychology undergraduate class and the pride of her parents.

‘’So Aisha got married.’’ I stated, interrupting her. ‘’How did that make you feel?’’

‘’I was scared’’ she replied without hesitation. ‘’ Scared of what my future would hold’’

She went on to explain how her friend’s wedding had brought up dormant fears and insecurities that had plagued her all her life – the fear that she was really invisible to others, seen only as the girl with sickle cell disease and not for who she really was. She was terrified of being seen this way and of being alone for the rest of her life. If all everyone saw when they looked at her was a burden and someone to be pitied, how would they even get to know her much less love and marry her?

‘’ All my life I’ve always known that people don’t really see me’’ she sighed ‘‘you know?’’

I nodded my understanding. She continued ‘‘I’m the girl with sickle cell disease that should be pitied – not Zainab’’ she concluded. ‘‘just the sickler’’

There was silence as the full meaning of her words hit home.

‘’ Do you feel like you are somehow less than other people?’’ I ventured. She smiled and nodded in response ‘‘All the time’’

She went on to tell me of the suitors that had come. How she had dated them – some for weeks, others a few months.

It was hard to tell whether it was the suitors themselves or the fact that she never gave them the chance to really get to know her, but either way all her relationships fell short of marriage.

The end of each relationship took its toll on her self-confidence. Eventually she was left alone and afraid at a time when she desperately needed to feel loved and secure.

That was when she stopped enjoying life and living became a drag and a bore, she recounted.

She would entertain dark self-critical thoughts that led to bouts of low mood that soon spiraled into full blown depression.

The more she neglected herself the more frequent her painful crises became resulting in recurrent hospital admissions. Her academics suffered and soon her entire life began to unravel.

She had reached the end of her rope one hot Sunday afternoon after being discharged from hospital when she discovered codeine.

Zainab paused, wiped the tears that now filled her eyes and finished by saying ‘’my parents did all they could to help but I was too far gone by the time they realized something was wrong.’’

Why do people use drugs?

Most people use drugs simply for the pleasure and excitement it brings. But sometimes, like in Zainab’s case, it’s to escape unbearable emotional pain.

Zainab began experimenting with codeine cough syrup at a time when she desperately sought relief – of any kind. Codeine became that relief for her. It didn’t judge or belittle her (like people did) and best of all it gave her a feeling of relaxation and calmness.

When she used she was freed from her negative thoughts and pain and the world was alright again.

Unfortunately this effect quickly evolves into addiction with serious complications like convulsions and even death.

In 2018 Nigeria banned the importation and production of codeine after large scale addiction was discovered among youths in Kano and Jigawa states.

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‘‘How did you go from Codeine to Pethidine?’’ I asked when she regained her composure.

‘‘I was on admission for a painful crises.’’ She reminisced ‘‘the nurse gave me Pethidine and it really helped. After that I started asking for it myself.’’

I jotted down salient points as she spoke. Noted how she went from using the drug to numb her pain to seeking it to relieve emotional pain and low moods.

She explained how getting and using Pethidine was all she could think about. She lied to her nurses about her level of pain and manipulated them into giving her the drug at all cost.

She lost her appetite then lost weight but still used Pethidine.

She broke off her engagement to Haruna when he confronted her about her using.

‘‘Haruna?’’ I quickly interjected ‘‘when did you get engaged?’’

‘‘After Codeine but before Pethidine ‘’ was her strange reply. But I understood what she meant.

She chuckled ‘‘I wish he had found me first though’’

I smiled but found it sad not amusing. She explained ‘‘Nothing compared to how Pethidine made me feel. That was when I knew I needed help.’’

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The Cycle of Addiction

It starts innocently enough. The drug helps relieve boredom, stress and pain – nothing more.

The user’s in control and uses the drug only to help weather life’s frustrations. With the drug as an ally he can escape at will from the worries life brings.

But soon the drug is needed not only for its pain or stress relieving properties but simply to get by and prevent withdrawal symptoms.

Symptoms like;

• Anxiety
• Poor sleep
• Watery eyes
• Runny nose
• Chills and stomach cramps are all typical of opioid withdrawal.

Stopping the drug at this stage not only causes negative symptoms but cravings (intense longing and desire) as well.

At this point the drug seems to take control of the addicted person and a vicious cycle develops. First the craving then drug use followed by a drop in mood (when the drug wears off) then further craving.

Addictive Beliefs and Positive Outcome Expectancy

Apart from the chemical properties of the drug itself, a user’s addictive beliefs and positive outcome expectancies (belief that using the drug will make him feel good) both serve to further deepen his level of addiction.

Addictive beliefs are deep rooted ideas that a drug user comes to hold about the abused substance.

For Zainab, Pethidine helped soothe her fear of being unloved and alone. Living ‘clean’ without the drug was likened to being exposed to the pain that had driven her to use in the first place.

Most drug users are truly undecided about quitting because of these  beliefs. They‘re unable to see the legal, medical and psychological implications of their actions. Or else wrongly believe that the benefit of their drug use outweigh these negative consequences.

Examples of addictive beliefs include;

• Beliefs about the usefulness of the drug
• Many people use drugs because they genuinely belief (at least initially) that it has its benefits.
• The belief that they need the drug to function

– After several failed attempts at quitting most drug users come to wrongly believe that they cannot live without the drug.

• The expectation that using the drug improves social and intellectual functioning
• The belief that drug use helps relieve anxiety, boredom, tension and depression.

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By the time she rounded up her story we were both emotionally exhausted. She from explaining herself to a questioning professional for the first time and me because I understood and empathized with her pain and suffering.

I thanked her for her openness and sincerity then explained the pathway to recovery.

The key was to reduce the strength of her addictive beliefs thereby reducing her cravings and increasing her level of control.

She would be given medicines to counter her symptoms of withdrawal and also to help with her underlying depression.

She would also need inpatient rehabilitation and multidisciplinary care involving her Hematologist, the Psychiatrist and myself (her Psychotherapist).

The road to recovery would be steep, I explained, but we would be by her side every step of the way.

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Zainab is currently still undergoing rehabilitation and is well on her way to full recovery.

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Drug addiction is merely the symptom, the real underlying ‘disease’ is the depression and feeling of loneliness, fear, frustration, poverty or boredom that drives people to use these harmful substances in the first place.

Addicts are victims.

 

I would love to hear from you! Please share your thoughts and leave a comment.

 

Questions? We’ve got answers ! Please Ask the Therapist.

 

Warm regards,