• About 1 in 20 Australians has an addiction or substance abuse problem. (Megan Markham on Unsplash)Source: Megan Markham on Unsplash
There is debate on what the most addictive substances are. So why the disparity and what can you do?
By
Rob Pegley

16 Jan 2020 - 8:45 AM  UPDATED 4 Nov 2020 - 11:58 AM

There are the obvious and very visible, destructive addictions to illegal substances such as heroin and crystal meth, that can take hold of people and decimate their lives completely. But there are also the more insidious, but seemingly innocuous habits involving our phones or caffeine or sugar. So which are the hardest addictions to break?

Rats apparently find sugar more addictive than cocaine.

Alcohol can be more harmful than crack or heroin. David Bowie found cigarettes harder to give up than any other drugs; Bowie’s wife Iman said, “It was his last vice - he couldn’t stop. He said it was the hardest thing to give up.”

There is debate on what the most addictive substances are. American website the Addiction Center has heroin, alcohol and cocaine as their top three, followed by barbiturates and nicotine. But psychologist Stanton Peele writing in Psychology Today insisted everyday vices such as love, junk food and nicotine were worse.

The reason for such disparity is that there are different measures being used: how quickly you can become addicted; how strong the cravings are when you try to stop, as well as the damage caused by the addiction.

Many measures also fail to take into account how hard it is to stay off of a substance for a sustained period of time without relapse, rather than to stop in the short term.

During the holiday season, all addictions tend to be at their most powerful.

Many addictions come to a head with stress, lack of structure, and financial and family issues.

Christmas and New Year should be a time of great joy, but it’s often the busiest time of year for rehabs. New attendees at AA spike, often as a result of people ruining their family Christmas. Domestic Violence increases by 20 per cent over the Christmas break.

Alcohol 

About 1 in 20 Australians has an addiction or substance abuse problem.

Alcohol continues to be the most widely used social drug in Australia. Just under one in six Australians drink at risky levels.

How do you know if you have an addiction? For alcohol there is an AA test which provides a good starting point.

Many people look into the abyss if their behaviour starts causing problems and simply stop. Others realise they can’t do so easily, and either seek help or struggle on.

The reason Class A drugs such as heroin appear at the top of addiction lists is the rapidly visible effects they can have on people’s lives. There are acute short-term physical and mental issues that are often irreversible; and finances are decimated very quickly. Alcohol can have the same effects, but can be a slower burn.

Gambling and 'process addictions'

There is another addiction that affects lives very quickly, but doesn’t even involve a substance.

“The underrated hidden killer right now is gambling,’’ says Philip Van Rooyen, a residential care worker and counsellor with the Haymarket Foundation, a homeless centre in Sydney.

“Lots of meth addicts stay up for days and fall into all-night VIP rooms, use online sports betting, or just good old poker machines.”

It is estimated some 200,000 Australians have a gambling problem. Gamblers lost some $25bn last year, a new record. Australia has 20 per cent of the world's poker machines, biggest number per capita in the world.

Van Rooyen regularly sees the problem at first hand: “Every weekend I take people from rehab to Gamblers Anonymous, and of the many elderly women there, some 90 per cent have done jail time for fraud. I had no idea of the huge amounts embezzled and spent until I witnessed it. If you give a [drug] addict, alcoholic and gambler $50,000 each, the [drug] addict and drinker will take some time to go through the money, but a gambler can get rid of the money in just one or two bets in a few hours.”

Gambling is known as a ‘process addiction’ (also known as behavioural addiction), involving risk-taking behaviours rather than substances.

Other process addictions are love and sex addictions, which can equally ruin someone’s life - and those around them very quickly. In many ways the infidelities that can follow compulsive behaviour related to love or sex addictions, seems less forgivable than those involving substances. They just feel like inexcusable behaviour, rather than an addiction. But as Sydney psychotherapist and counsellor Marryam Chehelnabi says, "Anyone who has been through love or sex addiction will tell you that it’s harder to give up than heroin.”

Finding a recovery option

With all addictions - process or substance-based - there are solutions.

In the case of alcohol addiction, there are physical cravings that occur physiologically, which stop after 72 hours of detoxing. From then on it becomes a battle to overcome the mental obsession that takes people back to a drink, despite all obvious reasons not to.

A detox centre can help people medically through those first few days. Rehab gives people a longer break (usually around four weeks) from triggers until they feel strong enough to deal with compulsion. It then helps to avoid people and situations involving alcohol where possible - sometimes for weeks, months or even years. Together with 12-step programs, fellowship groups with other alcoholics, and counselling, full recovery is possible.

The solution is similar with substances like heroin, cocaine and crystal meth - a break from the substance via detox and rehab allows the physical addiction cycle to be broken – Narcotics Anonymous is one organisation that can provide ongoing support.

And in some ways, avoiding situations with drugs in future can be easier than with alcohol, because it’s less common in society. A choice has to be made to avoid old environments. Taking that first step into detox - possibly via a GP - can be the hardest part.

Likewise with gambling, once the first step in seeking help has been made, then a 12-step program, the fellowship of GA, or counselling, can all help to relieve the problem. Apps need to be deleted from smartphones, certain websites blocked, the pokies avoided; but with decent support the gambling can stop.

With all of these addictions though - alcohol, drugs, gambling, even cigarettes - the solution has one huge thing in common: total abstinence.

One drink is too many. If you avoid the first drink, you can’t get drunk. The first joint or line does the damage.

When abstinence isn't an option

So what do you do when abstinence isn’t an option? What do you do, for example, if the compulsive behavior is related to food? 

Disordered eating is estimated to affect over 16  per cent of the Australian population - around the same as dangerous drinking levels.

“Yes, the surrender is very hard,” says Marryam Chehelnabi. “And yes, there is that thing that we need to ‘walk the tiger’ three times a day when we eat our ‘abstinent meals’.”

Chehelnabi is the founder of Changes Psychotherapy, and previously worked for a number of years with clients at South Pacific Private hospital, a rehab centre on Sydney’s Northern Beaches. She goes on to explain how the concept of abstinence works for people with eating disorders.

“Abstinence is possible. It's not like alcohol or drugs where you never go near the substance again, it’s defined differently for people with eating disorders. Compulsive eaters get help to identify what their compulsive behaviours and foods are (the foods that they can't stop eating), and then they define sobriety or abstinence from when they stopped eating those certain foods. Most of them refrain from refined sugar and/or refined flour, but each individual defines their own abstinence with the help of their sponsor and a dietitian or nutritionist.”

As Chehelnabi also points out, as if having to face your demons every day when eating food isn’t enough, there are also societal pressures to deal with. “We have a society that glorifies being thin and we are socialised to believe that thin equals beauty and success. This is reinforced on social media, in fashion, in film and music, so recovery from an eating disorder requires people not only surrender their compulsive eating, but also their addiction to controlling weight."

These can include Bulimic behaviour (can't stop throwing up or purging) or Anorexia (can't stop restricting or starving). Or it can manifest as over-exercising, constant weighing, crash dieting, diet pills, or weight loss surgery to name a few.

Van Rooyen agrees that food addictions can be very powerful.

Food Anonymous is a very interesting fellowship, which is similar to AA and recommends calling your sponsor daily, and sharing what you are eating daily. FA have a weight goal such as your recommended body mass index. FA is very directive, but that can also be problematic for people with Anorexic habits, who can lock into deprivation easily, and it can become a negative approach for them.”

Smoking: the hardest thing to quit?  

Van Rooyen has recovered from addictions to alcohol and drugs himself, a process which lead him to his career helping others. And like Bowie, he knows what addiction was the hardest for him to break.

“I gave up cigarettes eight or nine years ago, and I’m amazed at how I still crave a puff after all these years,” he says.

Smoking remains the leading cause of preventable deaths in Australia. Like alcohol though, which is the most harmful drug to society as a whole, it is still widely socially acceptable to some degree. Smoking causes little disturbance to people’s lives - until it kills them or causes physical damage.

The reason that giving up cigarettes can be the hardest addiction to break, is almost a synthesis of all the points touched upon in this article: On the surface, it isn’t always visibly damaging your life in the way that gambling, alcohol or drugs are. Yes, it can kill - more than any other drug - but that seems an abstract issue to deal with down the track. If at all. The impetus for abstinence is perhaps not as strong and obvious as other substances. The rock bottom that other substances often lead to, doesn’t occur until it’s perhaps too late.

As for nicotine itself, it provides almost instant calm to the addict. Not only is the drug compelling, but there’s a ritualistic nature to smoking - it’s almost like a substance and process addiction combined.

Combine these two issues and you have a substance that people continually return to before quitting for good - if at all.

Not only is the drug compelling, but there’s a ritualistic nature to smoking - it’s almost like a substance and process addiction combined.

A plan is needed that can be similar to drugs and alcohol, but with a few added complexities. Rather than the cold turkey of alcohol detoxes, a tapering off with patches or chewing gum can be a better bet. Quitting alcohol for a while may also be necessary to avoid willpower levels being lowered. Counselling to deal with underlying anxiety can help. And perhaps a sport or hobby needs to be added to distract from the ritualistic behavioural issues.

Like David Bowie found, it can be the hardest thing to give up. Van Rooyen identifies with recent research that shows it takes an average of 30 attempts to stop smoking for good.

“It took me 10 years in recovery, being clean and sober from alcohol and drugs, before I could even quit smoking," says Phil. “And I had to use Champix [a 12-week course of prescribed medication as an alternative to nicotine] to get off them,” he adds.

“It’s a very powerful and insidious addiction.”

Maybe the hardest of all.

 

Rob Pegley is a Sydney-based writer who has spent more than 13 years in recovery from his own addictions. He regularly speaks to new patients in rehab.  

For crisis support: Lifeline 13 11 14 or lifeline.org.au. For alcohol and drug support: 1800 250 015 counsellingonline.org.au. For gambling support: 1800 858 858 or gamblinghelponline.org.au

Addicted Australia premieres Tuesday 10 November, 8.30pm on SBS and SBS On Demand. The four-part documentary series continues weekly on Tuesdays at 8.30pm and will be available with simplified Chinese and Vietnamese subtitles. 

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For more information: sbs.com.au/AddictedAustralia