Although addiction is a choice, many people don’t understand the grasp the addiction will have on them until it is too late or the person that they once were doesn’t exist anymore. According to Bornstein & Pickard (2020) all addiction originates in non-addictive psychoactive drug consumption. Human consumption is goal-oriented to achieve a desired outcome. Some people may be in search of pain relief, stress relief, boredom relief, or to ease psychological suffering. When an outcome or reward from the drug experience is achieved, people will often chase after that experience (Bornstein & Pickard, 2020). Unfortunately, as drug tolerance increases, hedonia decreases, leading to more of the drug being used to achieve the same effect. Human beings are complex and on a biochemical level our body may misinterpret learning signals related to drug using behavior. In other words, insight and awareness is compromised when a person is spiraling into addiction. You mentioned that physicians usually say that addiction is a choice, but physicians only look at the medical point of view. As nurses and nurse practitioners our foundation is based in caring and empathy, not just medical. I feel that there are many pieces to addiction and it is not as straight forward as some are lead to believe. I have dealt with many friends and family who have dealt with addictions of different sorts, whether drugs or alcohol. My best friend was a heroin addict for years before she needed heart surgery (her rock bottom) and she decided to get clean. I think addiction also has to do with maladaptive coping mechanisms learned by the person to deal with issues they come across. It can explain why someone may choose to drink a glass of wine after a stressful day vs watch tv or work out to reduce stress. According to McDonnell et. al. (2018) early maladaptive schema (EMS) is defined as self-beliefs regarding oneself, others, and the world, developed in childhood as a result of cumulative negative experiences. Opioids are some of the most damaging drugs related to health outcomes and mortality. There is a direct correlation between addiction and high levels of EMS and those with opioid addiction have high levels of emotional dysregulations between EMS and maladaptive coping (McDonell et. al., 2018). The more we start to learn about the hold addiction has on people, the easier it will become to sever that attachment. I do feel that mental health is important in stopping addiction but the resources for follow up are not there. In the end we don’t know what someone is internally struggling with that has brought them to this point in their lives, but what I do know is it may start off as a choice but eventually mutates into something else entirely.
Bornstein, & Pickard, H. (2020). “Chasing the first high”: memory sampling in drug choice. Neuropsychopharmacology (New York, N.Y.), 45(6), 907–915. https://doi.org/10.1038/s41386-019-0594-2
Mc Donnell, Hevey, D., McCauley, M., & Ducray, K. N. (2018). Exploration of Associations Between Early Maladaptive Schemas, Impaired Emotional Regulation, Coping Strategies and Resilience in Opioid Dependent Poly-Drug Users. Substance Use & Misuse, 53(14), 2320–2329. https://doi.org/10.1080/10826084.2018.1473438
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