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Appendix 1: Common myths about drugs use

TABLE 1-A1: Common myths about drug use.†
Myth Truth Discussion Implications
Once an ‘addict’, Not all people who use drugs develop drug-use Most people with a substance use disorder will resolve the The clinician’s role should be to limit
always an problems. Population studies show that most disorder, with or without treatment. Most people resolve their the potential health consequences that
‘addict’ 126,127 people who develop a substance use disorder will substance use disorder as they mature and take on other interests are likely to outlive the problematic
resolve their drug issues and habituated use, most and responsibilities, such as employment, marriage and raising a use of substances and reduce the risk
without ‘addiction treatment’. family. Most people in the United States resolve their substance of death before, during or after the
use disorder by the age of 30 years. Divorce, unemployment, substance use disorder has been
contact with the criminal justice system, stigma and exclusion can resolved.
increase the duration of a substance use disorder.
To be dependent is Dependence is a normal state of physiology, People become dependent on several medications. This means Maintenance prescribing should not
to be ‘addicted’ 128 whilst ‘addiction’‡ is a state of mind. that their body will have an adverse reaction if they stop the be time-limited, and dependence on
medication. It does not talk to patterns of use or the negative the medication is no indication of
consequences of the drug – most people dependent on drugs impaired functioning. 9
have positive outcomes: for instance, hypertensive medications,
insulin and methylphenidate are all medications people use
dependently and usually with no additional drug-seeking, excess
dosing and purchasing from the illicit economy. Another example
is coffee – many people need their first cup of coffee but are not
addicted to it. ‘Addiction’ is when the drug takes on undue
salience and meaning – the person actually disrupts their life and
responsibilities to ensure that they get the drug, and the patterns
of use are erratic, compulsive and they take higher doses than are
beneficial. Simply put, the drug becomes one of their primary
relationships. People often refer to OST medications as ‘addictive’.
Whilst it can be ‘addictive’ to a small minority of people, many
will be dependent on it and enjoy significant benefits from the
medication without causing a disruption in their life and find that
they are able to stabilise their situation.
Abstinence is The use of drugs is fluid and can be both There is limited literature on the comparative outcomes of Abstinence should not be a criterion
essential before beneficial and problematic. Abstinence from controlled/reduced use compared with abstinence for substances for determining functionality or
being able to assist certain drugs may be beneficial or detrimental to other than alcohol. Studies comparing outcomes of controlled or someone’s character. Assistance or
people in other the individual. Most studies have shown that reduced use versus abstinence from alcohol confirm that treatment should not be delayed until
areas of their life, people who moderate or down-titrate to abstinence is the safest goal, but evidence supports the value of someone has achieved abstinence.
and is essential for abstinence do as well, if not better than those reduced drinking approaches as part of the spectrum of
the resolution of who aim for immediate abstinence. Change is a interventions for alcohol use disorder.
substance use process and drug-related problems are often only
disorders 124 resolved when other problems are resolved.
OST, opioid substitution therapy.
†, In 2010 The Lancet published a list of 12 myths about people who inject drugs and HIV, to address misconceptions and stigma held by clinicians. 124
‡, The word ‘addiction’ is problematic when applied exclusively to drugs. The state of mind that leads to ‘addiction’ can be applied to relationships and behaviour.

http://www.sajhivmed.org.za 111 Open Access