Sometimes using drugs makes sense

One of my long-time friends has Dissociative Identity Disorder – what they once called multiple personality. Getting to know her and her people over many years has helped me to see that it’s not a mental illness at all, it’s a coping mechanism.

I see so many parallels with this thing we call addiction.

For my friend, dissociating was a sane response to an insane situation, which in her case was a long childhood of non-stop physical, sexual and emotional abuse. When her little-girl self couldn’t handle what was happening to her, she found a way to check out. Some other “person” that her amazing brain had created would emerge to take the pain and heartbreak, and then retreat deep inside with the memory to protect my friend from having to know it ever happened.

Being able to dissociate so completely as a child was a brilliant strategy for her at the time. She thinks it probably saved her life, allowing her to take repeated abuse that any fully present child could never bear. The coping mechanism she’d unconsciously developed helped her manage through unmanageable times.

But in adulthood, this tool that she’d relied on since she was a toddler started to become a problem. She was no longer living a life of abuse, but she still reacted to high-stress situations by falling back on that old coping mechanism. And things often went badly as a result.

Her “switching” wasn’t a conscious act, so sometimes the full-grown woman with years of work experience was gone and a helpless child was in her place, with not a clue how to do the job. Or an angry, drunk customer would throw hot coffee at her, and the hothead personality who existed to punch first and ask questions later would emerge and deck the customer.

Over time, this beautiful coping mechanism that had seen her through terrible years began to interfere with her ability to work. It affected her friendships and relationships. She self-isolated out of fear that anyone who learned the truth about her would reject her. Her dissociating left her highly vulnerable to all kinds of dangers; more than once, she woke up in strange places far from home, with no clue as to how she got there.

She owed her life to her ability to “switch.” But in a changed situation, it had become the thing that was causing her the most harm.

Consider substance use disorder through a similar lens. 

Technically, it’s also a mental illness, presuming that someone’s substance use meets at least three of the 11 criteria laid out in the DSM-V psychiatric manual. In fact, people whose primary “mental illness” is a substance use disorder now account for a quarter of the 30,000 cases a year in BC of people detained and treated against their will under the Mental Health Act.

But is it a mental illness? I’ve been spending a lot of time these past few months talking with people living homeless in our region, and the drug use I’ve seen looks very much like a coping mechanism to me. A sane response to an insane situation.

Who among us could live the dystopian life of a modern homeless person in an affluent society for more than a few days without turning to drugs as a way to check out of the misery? Not to mention all the misery suffered in the runup to homeless. Painful childhoods, histories of abuse, intergenerational trauma, brain injury, disability - off you go into a life of being constantly hated on, and these days hunted multiple times a day by bylaw officers intent on taking all your possessions away. 

If all that and more are going on in your life, drugs that take it all away for a bit make total sense.

Like my friend’s unconscious dissociating, however, what starts out as a useful tool to soothe a savaged soul can end up being your most obvious problem.

Using street drugs at a level that lets you check out of your life is definitely not compatible with jumping through the hoops that await anyone trying to get off the streets, for instance. It also makes the neighbours very unhappy, to the point that they’re soon supporting political initiatives to round everybody up and force them into substance treatment. 

The toxic chemical soup that's now the illicit drug supply adds a whole other layer of misery, bringing death, nerve damage and chronic infection. Soon enough, the only thing anyone is talking about is the need to force people to stop their drug use, like that's the only problem.

That’s how it was for my friend, too. She was poked, prodded and counseled by so many psychiatrists, all of them focused on eliminating her coping mechanism, as if all would instantly be well if she just quit using that tool she needed so badly. 

Nobody asked to help her explore why she needed that coping mechanism in the first place, or how she was supposed to manage in some future new life if she couldn’t fall back on it at times of high stress. Nobody said hey, girl, hurray to you for discovering a coping mechanism that kept you going through some really heavy stuff, but now let’s go find some new tools that won’t get in your way quite so much.

She had to do all that work on her own. (And she did.) It took many years, and many retreats back to the old ways before she was fully ready for a different way of doing things. 

These days, she’s still got a few of her people on hand if needed, but she’s got a whole range of new coping skills, too. She can still dissociate, but it’s no longer the only coping mechanism she has.

In theory, there’s a lot more services and systems to manage harmful substance use than there was for my friend and her Dissociative Identity Disorder, and a lot more people who do understand substance use as a coping mechanism. 

But there’s also a big chunk of the public – the ones with the biggest influence on government thinking, it appears – who believe that if people just didn’t use illicit drugs, there would be no crisis on our streets. They are easily swayed by political rhetoric that maintains that falsity, and messaging that blames, shames and criminalizes substance users for “choosing” to use unregulated substances.

Between the general lack of understanding and the deliberate political posturing, we’re in quite a state.

We’re stressing out about the drugs, but not about the underlying reasons for using them. We’re fixating and fighting over substances as if all the answers lie there, even while the crisis on our streets intensifies and the harmful shaming of people just trying to get through a hard day rages on. 

People living homeless have a lot of stuff to cope with. They use substances to cope. Whatever “treatment” there will be for that, it starts with the stuff underneath.