Homelessness is inextricably tied up with mental illness and addiction. The following information on addiction is intended to provide some insights into this ailment and hopefully a better understanding of the challenges that persons who are homeless face in moving to a healthier, independent lifestyle.

Addiction is a complex issue. It doesn’t always fit a certain mold or follow a particular path. But there are some key things to know:

Nobody chooses to become addicted. A person may choose to do a drug or take a drink, but many people use without developing an addiction.

1. 1. Addiction doesn’t discriminate. Because it arises from such a complex combination of factors, addiction can happen in any family and at any socio-economic level.
   2. Stereotypes about addiction are misguided. People with addictions are not always whom you’d picture. Addiction can happen to people from all walks of life.
   3. Prolonged drug use changes the brain. For a person who is addicted, giving up a drug is not simply a matter of willpower. Fundamental and long-lasting changes to the brain make “quitting” extremely difficult.
   4. People with addictions are not a lost cause. They are human beings who deserve to be treated with dignity and respect — and your support can make a difference!

The clinical content of this website has been adapted from “Core Addictions Practice – Participant’s Resource Guide”; Fraser Health Authority, Vancouver Island Authority, Interior Health Authority; June 2008.

Causes of addiction:

Why do people use drugs, including alcohol? Why do people become addicted? The answers to these two questions are not the same.

As stated, many people use drugs without ever becoming addicted. People use drugs for the pharmalogical effects, or how using that drug alters them physically and mentally in that moment. But the reasons people become addicted are much more complex.

Why people use drugs:

There are five main pharmalogical reasons that people use drugs:

To relieve pain

• • To reduce spiritual and emotional stress
  • To increase level of activity and feelings of energy or power
  • To alter consciousness
  • To experience feelings of intoxication

These effects explain why an individual might use a drug at any given time, but do not explain why some substance users become addicted while others do not. For that, we need a model that incorporates the complex factors that lead to addiction.

The Bio-psycho-social-spiritual model:

There are many theories about the origins of alcohol and drug abuse, both the international addictions community and the Province of British Columbia have adopted the bio-psycho-social-spiritual model to guide treatment programs. This model rejects the idea that addiction is caused by any single factor. Instead, it treats addiction as arising from an interaction of diverse factors from different areas of an individual’s life.

To better understand the kinds of factors that can contribute to addiction, let’s break down the model’s components:

Bio refers to genetic risk factors that can predispose a person to addiction. This factor is purely biological and has nothing to do with a person’s environment or social interactions.

psycho refers to mental health factors, such as history of trauma or abuse, low self esteem, depression and anxiety.

social refers to cultural and family factors, such as poverty, unemployment, oppression, cultural shaming, intolerance and social pressure.

spiritual refers to factors such as a lack of meaning or purpose in life, lack of community, isolation and stigmatization. Sometimes biological, psychological, social and spiritual factors interact in such a way that makes a person extremely vulnerable to problem substance use and addiction. Problem substance use is complex and exists upon a continuum of severity.

To learn more, read about the Continuum of Substance Abuse  because the pathway to addiction will vary from person to person, different people will have diverse experiences and respond differently to treatment options. 

Characteristics of addiction:

Prolonged substance use changes the brain in many ways. Because of these changes, substance users may have experiences with tolerance, dependence and/or withdrawal and may be prone relapse.

Tolerance:

When someone uses a drug frequently, that person’s body starts to get used to it. When that happens, the person will become less sensitive to the drug and begin to need a higher dose in order to experience the same effect. Tolerance refers to that lowered sensitivity.

Tolerance helps to explain why substance users increase their use of a particular drug. Because the body starts to “tolerate” the drug, the user must take more to experience the same response.

Tolerance Fact: Tolerance develops faster when a drug is taken in a regular pattern than in a binge pattern.

Dependence: 

When someone uses a drug frequently, that person may develop a dependence on that drug. This means that they need to use the drug in order to feel physically and psychologically “right.”

Physical dependence is when a person has uncomfortable physical symptoms when he or she stops using a substance regularly and when using the substance again relieves these symptoms. Psychological dependence refers to “cravings” — intense wishes to use the substance — as well as a compulsive pattern of use and anxiety when the substance is unavailable.

Dependence Fact: Drugs that are injected or inhaled, like heroin or nicotine, are more likely to produce dependence than those that are swallowed.

Withdrawal: 

When substance users abruptly stop using a drug regularly, they may experience unpleasant physical and/or psychological symptoms. This is called withdrawal. Often withdrawal symptoms are the opposite of the effects caused by the drug itself.

Withdrawal symptoms associated with some drugs can be very severe. For example, for a person with a physical dependence on alcohol, withdrawal can include delirium tremens, the symptoms of which range from hallucinations to seizures. Severity of symptoms varies with type of drug, frequency of use, dosage, abruptness of discontinuation and other factors.

Withdrawal does not refer only to these immediate symptoms. There are also long-term effects of discontinuing chronic substance use, as the brain readjusts to normal functioning. These effects, which can last from six months to two years, are referred to as Post Acute Withdrawal Syndrome (PAWS). If you want to learn more about PAWS, please read Post Acute Withdrawal Syndrome.

Withdrawal Fact: The most intense withdrawal symptoms usually occur over the first three to six months of abstinence.

Relapse:

Relapse occurs when an individual who has made progress toward recovery resumes patterns associated with his or her problem substance use. Although those who relapse often feel guilty and disappointed, the vast majority do not give up on themselves or their ability to change. In fact, relapse is a common part of the change process and is more likely to occur than not.

There are many factors that may trigger relapse. Psychological stress from work or family can be a trigger. Also, social or environmental cues associated with drug use, such as running into someone from the past, or encountering places, objects or sensations associated with prior drug use, may contribute to relapse.
If relapse is viewed as a learning experience, it can refocus recovery efforts and lead to improved progress overall.

Relapse Fact: On average, relapse occurs four to seven times during the recovery process.

Pathways to recovery:

Since we know that the causes and characteristics of addiction are complex, it will come as no surprise that addiction treatment is similarly complex and that there is no one superior treatment for all problematic substance use. Addiction treatment is not just detoxification — the road to wellness requires a ton of community support. Also, since drug use often goes hand in hand with other risky health practices, sometimes the priority of treatment is to encourage safer drug use practices before reducing or stopping substance use itself, as in harm reduction.

Some things to know about the path to recovery:

Different treatment works for different individuals – There are many pathways to recovery just as there are many roads to addiction. One size does not fit all.

Recovering from addiction can be a long process – Sometimes, a lifelong one. For many, completing a treatment program is only the first step. But remember, occasional relapses do not mean failure.

Harm reduction is not the same as enabling drug use – Harm reduction is intended to promote safety and wellness and is often used to keep people engaged in treatment, or alive long enough to opt for treatment.

The continuum of care – We know that different types of treatment work for different individuals at different points in their progress. Here are the different services available: 

Withdrawal management – Also known as detoxification, these services provide a safe and supportive environment for individuals withdrawing from the acute effects of drugs or alcohol. Depending on an individual’s specific circumstances, detoxification may be carried out in a hospital setting (inpatient detox), in a non-residential day program (daytox) or at home (home detox).

Outreach services – Outreach or “field” services identify and engage individuals who are at risk of having, or are known to have, substance abuse problems. They attempt to facilitate health improvements for those who do not normally access fixed location services.

Sobering centres – Sobering centres provide a safe, sheltered environment to assist individuals recovering from acute intoxication. Many homeless shelters will not accept people who are intoxicated, so a sobering centre fills this void and helps to reduce demand on hospitals and jails. While there, individuals can also be connected to the network of mental health and substance use services available.

Outpatient services – For individuals who are attempting to change their own problem substance use without opting for residential care, outpatient services provide information, assessment, counselling and referral.

Intensive day/evening/weekend programs – These four- to five-week programs offer intensive group therapeutic sessions to those who have stable living situations but whose problem substance use has been very harmful.

Residential treatment – For individuals without stable living environments, residential treatment facilities provide a safe and substance-free living environment as well as intensive group and individual treatment.

Stabilization and transitional living residences – Also called “supportive recovery,” these facilities offer a safe, structured and substance-free living environment to those who need stabilizing before entering treatment and to those reintegrating into the community post-treatment.

Housing – Supportive housing is independent, subsidized housing linked to support services. The services may be provided on-site or on a drop-in basis. All forms of recovery rely on individuals returning to stable, safe and secure housing. Lack of safe housing keeps homeless people with addictions in a perpetual cycle of drug use.

Harm reduction – Harm reduction is a practice we all use in our everyday lives. To reduce the potential risks of driving, we wear seatbelts. To prevent a cut from becoming infected, we put on a bandage. Harm reduction is all about lessening the risks associated with our behaviours and promoting safer health practices and wellness.

Often the harm related to drug use comes as much or more from the associated risky behaviours than from the drug use itself. Therefore, the priority of harm reduction is to reduce negative health, social and economic consequences associated with drug use rather than to decrease drug use itself. Harm reduction is often the first or only link that drug users have to the health and social service system and, as such, can be a gateway to addiction treatment. It is important to note, though, that harm reduction does not rule out the long-term goal of abstinence — it emphasizes a move to safer practices in the meantime.

At the heart of harm reduction is the active participation of drug users, who are encouraged to make the choice to reduce the harm associated with their drug use. Harm reduction is based on incremental gains that can be made over time. Even for those who have difficulty abstaining from substance use, harm reduction can effectively prevent HIV, hepatitis C and other drug-related harms.

There are many forms of harm reduction related to drug use. One well-known service is Vancouver’s supervised injection site, Insite, which ensures that drug users use sterilized injection equipment and offers professional medical supervision and assistance to users on Vancouver’s Downtown Eastside. Harm reduction can also take the form of mat programs and shelters, as well as the Purpose Society’s Health Promotion Van, which offers mobile harm reduction services in the Tri-Cities, Burnaby and New Westminster.

Harm Reduction Fact: Research shows that Vancouver’s supervised injection site, Insite, has led to a reduction in overdose deaths and HIV and hepatitis C infection rates. There has never been a death at Insite.

Make a difference:

We encourage you to contribute to a more open, less judgmental society by committing to these three actions:

• • Suspend judgment.
  • Stamp out stigma of community members living with addiction.
  • Spread the word.

Substance abuse places a burden on our health care system and emergency services, and the road to wellness requires lots of community support: housing, support systems and jobs. Everyone benefits from the existence of community services that address substance misuse. Support programs and projects in your area, and you’ll help not only those with problematic substance use, but also your community as a whole.