Addiction: Trapped in desire

I was 15 and looked like I was 12, but it was easy to get hold of the stuff: ecstasy, cocaine, benzos. I had already smoked weed before I started spending weekends with my father in Zurich. I was constantly arguing with my mother at the time . She was strict about mobile phone rules and curfews: I was the only one who had parental controls on my phone and had to be home by 10 p.m.

My father wasn't the reason I started going to Zurich more and more often – I wanted freedom. I joined a group of people in the park. Many of them were baby-faced like me, and we weren't allowed into clubs. They all used drugs, and not just a little, and not just simple stuff. I was curious and didn't think anything could go wrong.»

Addiction is always multifactorial. It cannot be attributed to a single cause.

Three stories of addiction

Ben*, now 19 years old, is one of three contributors who talk about their addiction in this dossier. Different substances led to their downfall, but their stories have a lot in common. The addiction crept up gradually and those affected still denied it even when the consequences were obvious.

«I went to school high for a year and graduated with top marks,» says Noah*, 18. «Why should I change anything?» Claudia*, 52, describes herself as a «master of denial». «You buy white wine and discreetly pour it into PET bottles. You suspect that this is not good, and you push the thought aside. You run a spotless household and make sure your family has everything they need. Everything is fine.»

Family factor

What causes people to turn to drugs? Why do some become addicted and others do not? Why are young people particularly keen to experiment with substances? What gives them the strength they need to deal with them? This dossier addresses these and other questions. The focus is on addiction to psychoactive substances such as alcohol, nicotine, cannabis, medication and so-called hard drugs.

We want to know what distinguishes experimentation from problem consumption, how to talk to teenagers about drugs – and what to do if your offspring is caught smoking weed or is drunk and hanging over the toilet bowl.

Genes play an important role, but so does the environment. Sometimes one is stronger, sometimes the other.

Wolfgang Sommer, addiction researcher

Addiction research has been investigating the question of what makes people susceptible to addiction problems for decades. One thing is certain: addiction is always multifactorial. It cannot be attributed to a single cause, but results from an interplay of various influences. Researchers have identified several risk factors in this regard, starting with genes.

«Addiction often runs like a thread through family histories,» says Philip Bruggmann, chief physician at the Arud Centre for Addiction Medicine in Zurich. According to the US National Institute on Drug Abuse, 40 to 60 per cent of the risk of becoming addicted to drugs can be attributed to our genetic makeup. What exactly does that mean?

« Genes play an important role,» says Wolfgang Sommer, addiction researcher at the Central Institute of Mental Health in Mannheim, «but so does the environment. Sometimes one is stronger, sometimes the other.»

Genes and environment interact

The issue is complex: «An increased risk of addiction cannot be attributed to a specific gene. Rather, around a hundred genes play a role, interacting in different ways.» Gene variants influence biological processes, but also personality traits that make people more or less susceptible to addiction.

Risk factors include mental illness and a predisposition to it, but also characteristics such as low frustration tolerance, problems with emotional regulation, low cognitive abilities or weak executive functions. The latter are the mental abilities that facilitate social adaptation and cooperation, enable us to plan and implement actions, and postpone our own needs.

Genetics is not destiny

The good news is that such skills are not solely determined by genes. «We can train them,» says Sommer, «from early childhood.» This requires appropriate learning experiences, made possible by reliable and loving caregivers who enable the child to develop and stimulate their mind, and who teach them values and consistency.

Without this fertiliser, Sommer knows, even the best seeds will not thrive. Or, to put it another way: «Genetics is not our destiny, but rather a framework that allows for a wide range of development possibilities.» Good environmental conditions can therefore compensate for genetic risk. On the other hand, neglect, ongoing family conflicts, an addicted parent and traumatic experiences are factors that increase the risk of addiction, as are poverty, a low level of education and easy access to drugs.

You suspect that this is not good, and you push the thought aside.

Claudia, 52

Genes are the most significant factor when it comes to dependence on stimulants, such as cocaine or amphetamines. These are chemical compounds that increase the activity of the central nervous system and are found as active ingredients in party drugs or, in low doses, in prescription medications such as Ritalin.

«Dependence on stimulants is largely due to genetic causes,» says Sommer. «Or rather, it is closely related to ADHD – the disorder massively increases the risk of developing a dependence.»

Addiction and ADHD

According to the researcher, the reason for this lies in the neurobiological characteristics of ADHD, in particular an altered response to dopamine. This neurotransmitter plays a central role in attention and motivation. It is released in response to positive stimuli, such as when we flirt, play sport or eat something delicious, but also in response to danger or warning signals.

«In people with ADHD, the system specialising in dopamine is less sensitive to such stimuli. This means they are more easily distracted and find it harder to concentrate,» says Sommer. «While stimulants have a motivating effect on most of us, they often help people with ADHD to achieve greater inner peace and clarity.»

We humans want to reduce unpleasant feelings by any means necessary.

Wolfgang Sommer, addiction researcher

This self-medication effect, as well as typical interpersonal and emotional problems associated with the disorder, made adolescents with ADHD more susceptible to drug use in general and stimulant abuse in particular.

«However, it is also a fact,» emphasises Sommer, «that treatment with low-dose stimulants significantly reduces the risk of addiction in people with ADHD. This is because these medications help them to better regulate their stimulus processing. That is why early detection is so important.»

What happens in the brain?

Nevertheless, researcher Sommer is convinced that «there is no addictive personality that is predestined for dependency.» Rather, it is an ancient learning process inherent in all of us that gradually paves the way to addiction. It is human nature to try by any means possible to reduce unpleasant feelings and enjoy good feelings.

In each situation, the reward system registers the unexpected, positive consequences of our behaviour – and generates a learning signal so that we repeat this behaviour in the future. «This reward learning teaches humans and animals to find their way in their environment,» says Sommer. «It is crucial for the development of survival behaviours such as foraging or reproduction.»

We therefore consume substances for similar reasons as we meditate, have sex or eat sweets. «The difference is that drugs interact more directly and intensely with the reward system than conventional positive stimuli.»

Claudia recalls: «As teenagers, we all appreciated the effect that a drink has: you become exuberant and relaxed, and you dare to talk to people.» Noah once gambled away large sums of money while high on cocaine: «On coke, you're full of energy and feel capable of anything.»

Substances make it possible to adapt our mental state to a situation and its requirements, says addiction researcher Sommer, «as long as we use them in a controlled manner. With repeated use, the risk of losing control increases.»

Young people are only capable of rational thinking to a limited extent.

Toni Berthel, psychiatrist

Puberty: a rollercoaster ride

Young people are considered particularly susceptible to drug use. «Initially, their willingness to experiment and their daredevil behaviour are due to changes in the brain,» says Toni Berthel, a psychiatrist and addiction expert from Zurich. During puberty, the brain undergoes a reorganisation. This change takes place gradually. The prefrontal cortex, which is responsible for impulse control and planning, among other things, is the last to be affected, between the ages of 20 and 25.

«Until then, young people are only capable of rational thinking to a limited extent,» says Berthel. As a result, teenagers are less able to control their impulses. And – also due to the changes taking place in their brains – fewer stimulating stimuli reach their reward centre. This means that at this age, it takes more to feel a rush or a sense of happiness.

On the one hand, it is our control centre that causes an emotional rollercoaster ride during puberty. «On the other hand, however, it is also the enormous physical changes that lead to uncertainty,» says Berthel. At the same time, adolescents have to cope with their central developmental task: «Detaching themselves from home, developing their own identity and finding their place in society.»

The worries and tensions that accompany this need to be balanced out. According to Berthel, there are different strategies for doing this: «You can cope with difficult feelings by enduring them, or you can escape them by numbing yourself and running away.»

Intoxicating experiences give young people a sense of belonging and make it easier for them to fit in.

Toni Berthel, psychiatrist

When teenagers smoke cannabis, get drunk, smoke cigarettes or try party drugs, according to addiction experts, it is about more than just substance use. «Of course, as parents, we think: that's bad!» says Berthel. «But young people use these substances precisely because it feels good.»

«Intoxicating experiences are part of it»

Intoxication, i.e. the deliberate loss of control, has a long tradition in our cultural history when it comes to so-called initiation rituals – ceremonies that mark a person's transition to the next phase of life, a new social status or a different group.

«Adolescence is a time of transition,» says Berthel. «Intoxicating experiences are simply part of that. They give young people a sense of belonging and identity, making it easier for them to separate from their parents and connect with their peers.»

Different substances depending on peer group

The role that substances play during adolescence therefore also depends on the peer group. Anyone who was a teenager in the 1900s will remember that skaters and hip-hop fans smoked weed, techno fans were more likely to experiment with ecstasy, and alcohol was not only popular with punks.

Even today, every clique has its own characteristics – and plays a central role for its members: it is the antechamber to society, where teenagers prepare themselves for its challenges and initiate developmental processes among themselves that would not be possible in their parents' homes. «Having a place in the group is crucial,» says Berthel. «That's why parents fall on deaf ears when they urge their children to find new friends for fear of bad company.»

Education is important

The new smartphone, the first monthly salary, going out, alcohol: «During puberty, young people are exposed to many new opportunities,» says addiction expert Berthel. Using these responsibly is not usually something that comes naturally at first.

«It is normal for them to lose control at times, and for parents to worry. In most cases, it is unfounded to talk about addiction in connection with substances. We should not be too quick to pathologise young people when they go overboard – the vast majority only do so temporarily.»

You don't want to repeat a bad hangover too quickly.

Karina Weichold, psychologist

Crossing boundaries as a step in development

Addiction specialist Philip Bruggmann is also aware that only a small minority of young people develop an addiction. «Nevertheless, education is extremely important,» he says, «especially with regard to newer phenomena such as poly-drug use, which we observe primarily among young people.»

Sometimes young people need to cross boundaries in order to recognise them, according to Karina Weichold, professor of psychology at the University of Jena, whose research focuses on addiction prevention. To a certain extent, she says, youthful recklessness has a developmental function, encouraging teenagers to tackle the numerous challenges of this phase of life.

«A teenager who comes home drunk may also be demonstrating his independence from his parents – he wants to take a step forward in his developmental task of making more autonomous decisions.»

Where does problem consumption begin?

Learning to drink alcohol responsibly can also mean overdoing it sometimes, says Weichold: «Anyone who has suffered a bad hangover is unlikely to want to repeat the experience any time soon.» The same applies to cannabis consumption. Weichold strongly advises against it, but also offers some reassuring words: «Those who try it will not immediately become long-term cannabis users; other risk factors must also be present.»

The psychologist refers to findings from several studies that came to a similar conclusion: among young people who were classified as socially competent, psychologically robust and equally stable in terms of their self-esteem, there were many who had experimented with marijuana but did not consume it regularly. According to the results, there were more stable young people in this group than in the group of peers who smoked cannabis excessively or had never tried it.

ignore reality

Nevertheless, the question remains: where does experimentation end and problematic consumption begin? «At first, smoking weed was about having fun,» Noah recalls. «Once, we went shopping straight after. In the middle of the shop, we got the giggles. It was legendary.»

Noah is convinced that he had no problems back then. «They came when I no longer needed company or a special occasion to smoke a joint,» he says. «I was no longer doing it for fun, but to block out reality, things that were going wrong.»

I wanted to be the best at something – even if that just meant being the one who took the most pills.

Ben, 19

Claudia also talks about wine as a narcotic she used to try to drown the pain of old wounds. And Ben consumed alcohol according to the motto «the more, the better». «In the end, it was all about attention,» he says. «I wanted to be the best at something, just like I used to be at school – even if it just meant being the one who took the most pills.»

When drugs become a crutch

If a pill makes us feel happy, a few drinks make for a lively evening or a joint makes us laugh, that's no cause for concern, says addiction expert Toni Berthel.

«It becomes problematic when fun and social factors take a back seat and we gradually need the substance to support our functionality: when motivation and relaxation, feelings of happiness and concentration, confronting problems and everyday requirements can only be achieved with its help.» Or, as psychotherapist Kinga Gloor puts it: «When drugs become a crutch.»

We can rejoice in success, but we grow through failure.

Kinga Gloor, psychotherapist

It is often young people with a history of problems who need this support because they come from difficult family backgrounds or have ADHD or underlying mental health issues, according to the counsellor and therapist at the Centre for Addiction Disorders in Bülach, Zurich. However, her experience also shows that the assumption that addiction problems only affect those who have always had a difficult life is too simplistic.

« Puberty is a huge challenge in terms of emotional regulation,» says Gloor, «and that goes for everyone. I have many clients who were completely unremarkable before. Former top students, for example, who couldn't cope with being left behind at secondary school. Anyone who was always at the top and finds themselves in the middle of the pack needs a certain amount of self-esteem to avoid becoming discouraged. If that self-esteem isn't very strong, a substance that makes everything a little less important may come in handy.»

Addiction prevention starts early

According to Gloor, one thing is certain: addiction prevention begins many years before adolescence. It starts with caregivers who recognise and take the child's needs seriously, providing them with a warm and loving home. Caregivers who also promote independence, allow the child to have their own experiences and encourage them to find solutions themselves. Caregivers who believe in the child's abilities, «including, and above all, their ability to deal with frustration,» says Gloor.

«We can rejoice in success, but we grow through failure.» Our role models play a key role here, even on a small scale: «How do we react when we don't succeed at something? Do we bury our heads in the sand? Or do we persevere and remain confident that things will go better next time?»

Self-esteem, dealing with failure, self-efficacy – unwieldy terms for the inner conviction that one can overcome difficulties and achieve goals: that, says Gloor, is what matters. «The stronger young people are in this regard, the more likely they are to trust themselves to overcome crises on their own, rather than seeking crutches in alcohol, cannabis or similar substances.»

*Names changed by the editors