Crossing the addiction line

Many of us take part in activities that are often associated with addictive or compulsive behaviours - activities such as drinking or gambling. But not all of us are addicted to them. What constitutes addictive behaviour? When do we cross the line?

Addictions come in many forms. Street drugs, prescription medications, alcohol, and inhalants are all common substances of abuse. Gambling, sex, and shopping are often associated with compulsive or problem behaviour.

To get a clearer idea of what addictions look like and how they can be treated, we spoke to two experts on the subject: Wende Wood of the Centre for Addiction and Mental Health (CAMH), a key addiction and mental health teaching hospital in Canada, and Sam Waldner of Samuel Waldner Counselling and Addiction Services, who is a private practitioner and a proponent of 12-step programs (of which Alcoholics Anonymous is a famous example).

Wood says that the hallmark of addictive behaviour is that it interferes with a person's life - to the point where all of their energy and attention is given to that pursuit. This, she explains, is because certain activities (such as drinking or gambling) stimulate a "reward pathway" in the brain. As a result, the brain wants to continue with this activity, even in the face of negative consequences for the person involved. The desire for the "reward" becomes stronger than the impact of the negative consequences and so the behaviour proceeds. For example, a person with a gambling addiction may continue seeking entry to a casino after having been banned, or may cash in their life savings so that they can continue to gamble.

Waldner describes an addiction as a continuous involvement in a repeated behaviour that creates some kind of negative consequence. This also applies to a person who continues to pursue an activity despite harmful results - for example, a smoker who does not quit despite knowing the health risks they face.

Waldner says the key characteristics of addiction are two-fold: a loss of control (one's behaviour becomes unpredictable, for example continuing to drink despite having vowed to stop) and a strong sense of denial. Denial about having an addiction is a powerful factor in leading the person to continue with his or her habit, as the belief is strong that there is no real problem and that next time the outcome from the same behaviour will be different. "It's almost as if the person experiences a form of amnesia," explains Waldner.

Availability and addiction

What leads one person to depend on alcohol and another to shop compulsively?

Factors such as one's environment and one's genetic disposition can play a role, according to Wende Wood. For example, if one's parents are smokers, then exposure to role models who smoke can play a role in establishing this behaviour as acceptable - and this lays the groundwork for taking the first cigarette. Not everyone who smokes becomes addicted - so there is a certain genetic disposition to the amount of "reward" that gets delivered to the brain - but without that first exposure to the substance, the reward pathway cannot be established and the habit does not develop. Of course, not all children of smokers become smokers themselves; some may as a result of their environment decide never to smoke.

Wood also explains that availability of the substance of abuse is key. While the Centre for Addiction and Mental Health does not support the gateway theory of drug use (that use of certain illicit drugs such as marijuana or ecstasy is a "gateway" to use of stronger drugs such as cocaine or crystal meth), Wood acknowledges that some illicit drugs are more widely available than others and therefore are often the first drug that a person might try. And over time, as tolerance to the drug builds up, other types of drugs may then be sought.

Sam Waldner agrees that availability plays a role in developing a compulsive behaviour or abuse of a substance. He adds that peer involvement is also a factor. What different forms of addiction have in common, Waldner notes, is the same underlying issue: addictive disease. Thus, although a person may have a natural propensity towards one certain behaviour (e.g., gambling) and may first manifest an addiction in that area, the disease tends to eventually spill over into other activities. In other words, a person with a gambling habit may eventually start abusing prescription drugs or alcohol.

When addiction hits rock bottom

The term "rock bottom" is often used to describe the point at which a person with an addiction is forced to acknowledge that he or she has a problem - which can lead to their seeking help. But where is rock bottom? And how do people get there?

Wende Wood points out that "rock bottom" is a subjective term. For one person, losing everything may mean losing a marriage or their home, while for another becoming homeless is not yet the end. And what rock bottom looks like will naturally depend on what someone had as a starting point. Additionally, Wood explains that it is a common misconception that one needs to arrive at the so-called bottom before reaching for help - often various opportunities occur along the way where the person is open to receiving or asking for help.

Sam Waldner explains that often the person with the addiction needs to start feeling the pain from the consequences of their actions before he or she can start making changes. The process of feeling the pain is a lengthy one, as the pain often serves as a stimulus to start one's self-defense mechanisms. These protect and maintain one's self-esteem (through the denial that one is an addict), allowing one to rationalize and continue with the behaviour. In many cases, the loss of, or prospect of losing, a relationship or something of similar value can often help the person to recognize that there is a problem. Legal charges or an arrest (e.g., for possession of illegal drugs or driving under the influence) can also contribute to this awareness.

Waldner emphasizes that typically the person needs to hear a repeated message (with specific observations) from family and friends that they are seeing a problem. While this information will likely not serve as an immediate stimulus to seek help, the repetition of the overall message can help to counter the "powerful and long-maintained" element of denial.

Overcoming an addiction

Overcoming an addiction is not easy. But it can be done. Treatment will take on different specifics depending on the particular habit or substance used. But all treatments share one characteristic: they must be long-term in nature. Wende Wood and Sam Waldner agree that an addiction is a chronic disorder and that there is no quick fix.

Wood emphasizes that there is a difference between "detox" and treatment - detox will clear the substance of use out of one's system, but it is ongoing treatment that is needed, including seeking group or individual counselling, learning new coping skills, and, if possible, changing one's social environment (e.g., changing friends or moving).

While a medication called naltrexone (ReVia®) may play a role in treatment for alcohol or opiate addiction (it blocks the "high"), Wood notes that it is not a cure. (Generally, naltrexone serves as only one part of a treatment plan that most often includes counselling or attending a self-help group.) The use of methadone to assist in treating addiction to opioids (e.g., heroin, codeine, or oxycodone) is controversial - while some feel that it is a substitution of one addiction for another, the Centre for Addiction and Mental Health believes that it can be used safely in a supervised program. Nonetheless, methadone treatment is not a "cure" and, like all treatments for addiction, it requires a commitment from the person involved.

Waldner emphasizes that while addictions are chronic in nature, they are highly treatable. While the problem behaviour may cease with treatment, he explains, the underlying disease of addiction will remain and, as part of it, so will the denial around having the disease. Thus, the key to recovery is to continue to believe one needs help so that one will continue to seek help. Otherwise, one risks relapse. According to Waldner, in the scope of the 12-step model, this means "keep coming back" - that is, continue to attend meetings as part of ongoing treatment. He describes the situation as akin to that of a person with diabetes: while the condition may be brought under control with ongoing treatment, the disease does not go away and the person must actively maintain his or her recovery.

Where to find help in dealing with an addiction

Help is out there. Knowing where to find it when you need it makes a difference.

The following is a small sample of available services. For further resources, refer to the Community Support or Support Groups section of this website. Or search online for services in your region - or consult your doctor, pharmacist, teacher, or guidance counsellor. The blue pages and the yellow pages of your phone book also provide information on finding help.

  • Addictions Foundation of Manitoba:
  • Alberta Alcohol and Drug Abuse Commission:
  • Alcoholics Anonymous:
  • Canadian Centre on Substance Abuse:
  • Centre for Addiction and Mental Health:
  • Drug and Alcohol Registry of Treatment:
  • Kids Help Phone: 1-800-668-6868,
  • Klinic Community Health Centre:
  • The Motherisk Program: