Are you feeling Restless, Irritable, and Discontent?

Addiction fundamentally alters the brain’s reward and decision-making systems through well-documented neurobiological mechanisms. When substances like drugs (including alcohol and nicotine) are consumed, they trigger massive releases of dopamine in the brain’s reward circuit, particularly in areas like the nucleus accumbens and ventral tegmental area. With repeated exposure, the brain adapts by reducing natural dopamine production and decreasing the number of dopamine receptors, creating tolerance and requiring increasingly larger amounts of the substance to achieve the same effect. This neuroadaptation hijacks the brain’s natural reward system, making everyday activities less rewarding while the addictive substance becomes disproportionately important.

Over time, addiction also impairs the prefrontal cortex, the brain region responsible for executive functions like decision-making, impulse control, and weighing long-term consequences. This creates a neurological double-bind: the midbrain structures driving craving and drug-seeking behaviour become hyperactive, while the prefrontal systems that would normally regulate these impulses become weakened. Chronic substance use also disrupts stress response systems, making individuals more vulnerable to relapse during difficult periods. These changes help explain why addiction is recognised as a chronic brain disease rather than simply a matter of willpower – the neuroplastic changes can persist long after substance use stops, though the brain does have remarkable capacity for recovery with sustained abstinence and appropriate treatment.

The Challenge of Stopping

The challenge of stopping stems from the profound neurobiological changes addiction creates in the brain’s fundamental survival systems. The brain essentially learns to treat the addictive substance as necessary for survival, similar to food or water. When someone tries to quit, they face intense physical withdrawal symptoms as their neurochemistry struggles to return to homeostasis, combined with psychological cravings that can persist for months or years. The damaged prefrontal cortex makes it extremely difficult to override these powerful urges with rational decision-making, while stress, environmental cues, and emotional states can trigger automatic drug-seeking responses that feel almost involuntary. This creates a cycle where attempts to quit often lead to temporary success followed by relapse, which many interpret as personal failure rather than recognising it as part of the neurological reality of the condition.

Addiction appears progressive because tolerance drives escalating use over time, while the brain’s reward system becomes increasingly dysregulated. What begins as recreational use gradually shifts to compulsive use as natural dopamine production diminishes and neural pathways become more deeply entrenched. The condition typically follows a predictable pattern: initial experimentation leads to regular use, then to use despite negative consequences, and finally to compulsive use where the person continues despite severe impairment in major life areas. Additionally, chronic substance use often damages the brain regions responsible for insight and self-awareness, making it harder for individuals to recognise the severity of their condition. The progressive nature is also influenced by external factors – as addiction advances, people often lose social supports, employment, and housing, creating additional stressors that fuel continued use and make recovery more challenging.

Understanding addiction when you’re not “addicted” to alcohol or other drugs

The difficulty in understanding addiction, even among people with their own compulsive behaviors, stems from several key differences in how these conditions manifest and are perceived. While behaviors like sugar consumption, social media use, or shopping can indeed activate similar dopamine pathways, they typically don’t create the same level of neurobiological hijacking that occurs with substances like alcohol, opioids, or stimulants. Addictive drugs often produce dopamine surges 2-10 times greater than natural rewards, creating more profound and lasting changes to brain structure and function. Additionally, many behavioral compulsions allow people to maintain relatively normal functioning in major life areas, whereas substance addiction typically leads to progressive deterioration across multiple domains – relationships, work, health, and legal standing.

The social and cognitive factors also create barriers to understanding. Most people can relate to losing control occasionally – eating too much dessert or spending too much time scrolling their phone – but these experiences usually involve temporary lapses that can be corrected relatively easily through willpower or environmental changes. This creates a false sense of equivalency where people think “I can stop eating cookies when I want to, so why can’t they just stop drinking?” They don’t grasp that addiction involves a qualitatively different level of brain change where the substance has become neurobiologically essential, not just psychologically preferred. There’s also often a moral lens applied to addiction that doesn’t exist for other compulsive behaviours – society tends to view overconsumption of legal, socially acceptable things as personal quirks or minor character flaws, while addiction to illegal substances or excessive alcohol use carries heavy stigma and assumptions about moral failing, making it harder to see as a medical condition requiring treatment rather than simply better self-control.

A Word On Nicotine (Tobacco Products)

Yes, nicotine absolutely does release large amounts of dopamine, making it highly addictive despite being legal and socially accepted in many contexts. Nicotine causes an increase in dopamine levels in the brain’s reward pathways, creating feelings of satisfaction and pleasure.Research shows that nicotine, like opioids and cocaine, can cause dopamine to flood the reward pathway up to 10 times more than natural rewards.

This helps explain why nicotine addiction can be so powerful and difficult to overcome, even though people often view smoking or vaping as less serious than other forms of substance addiction. Repeated activation of dopamine neurons in the ventral tegmental area by nicotine leads not only to reinforcement but also to craving and lack of self-control over intake. The addiction develops through the same basic mechanisms as other substances – as people continue to smoke, the number of nicotine receptors in the brain increases, requiring more of the substance to achieve the same dopamine response.

What makes nicotine particularly insidious is its legal status and social acceptance, which can make people underestimate its addictive potential. The rapid delivery of nicotine to the brain (within 10-20 seconds when smoked) creates an almost immediate reward that strongly reinforces the behaviour. This is why many people who successfully quit other substances still struggle with nicotine, and why nicotine addiction often serves as a gateway that primes the brain’s reward system for addiction to other substances.

I want to preface this post by stating that the concepts and suggestions I’ve made below are my own thoughts, opinions, and suggestions based on my own experience working in the mental health sector and lived experience. There may also be numerous grammatical and logical errors. I know that you’re intuitive enough to understand what I’m attempting to describe and explain. Therefore, there will be no references section at the end. This is merely an expression of thoughts, a stream of consciousness (William James coined the term Stream of Consciousness).

Episodic, acute, and chronic anxiety can be miserable and debilitating. Individuals living with anxiety have generally experimented with many techniques to cope with anxiety symptoms, and they have often been practicing these techniques for months, years, or decades. Anxiety is life changing. Current treatment can be efficacious at reducing the intensity or frequency of symptoms for the vast majority of people living with anxiety, but only at best. I, myself, have tried the deep breathing technique commonly advised by mental health professionals, and it can be about as useful as taking a sugar pill. There is credible science that supports deep breathing exercises can improve symptoms and recovery rates for stress, anxiety and depression levels – but what about for an anxiety attack or a panic attack or intense chronic symptoms of anxiety?

Sometimes nothing is effective enough for immediate relief. It is my contention that building a relationship with a trained psychiatrist, specialised in this domain, is an essential first step. Your treating specialist(s) will need to have extensive experience and a comprehensive understanding of the debilitating impacts of anxiety, anxiety attacks, and/or panic attacks. I recommend psychiatry because you will need someone who can prescribe short-term medication, schedule 4 or greater, to alleviate the pain rapidly. All symptoms a person may experience from any condition in the anxiety family present a risk for searching for any immediate relief. This is true for you or me or anyone. Without prompt and effective medical care readily available, many people who do not have a plan for managing anxiety will potentially search for an unhealthy substitute to acquire relief.

These substitutes are often unhelpful long term but effective short term. We all know what they are: alcohol and other drugs, sexual promiscuity or sex addiction, love addiction, gambling, excessive or unhealthy eating habits, self-injury, addictive forms of gaming, impulse spending, co-dependent or dependent behaviours on people, people pleasing, running away (avoiding reality), raging, reckless driving and other criminal behaviour, and relying on pharmaceuticals (legally prescribes or otherwise) that will have long-term unhealthy side effects. People know how to “doctor shop”, and although this area of medicine is becoming much more regulated, it still occurs. Unfortunately, there are people who do require certain types of legal drugs, in a timely manner, to find relief as a means of not engaging in any of the previously mentioned behaviours.

Some people may not have much faith in the field of psychiatry or psychology – HOWEVER – you may find yourself in a situation one day where you will need a doctor who knows your history to increase the likelihood of prescribing medication to treat anxiety when you need it most. This medication usually has addictive properties. An ethical psychiatrist will usually be unwilling to prescribe more than a single repeat of potentially addictive medication to treat their patients. This is standard, regulated medical practice in Australia.

Anyone working in the drug and alcohol sector or has regular contact with a person living with anxiety, or any form of addiction, will know that patients – people – are not being seen in a timely manner top treat anxiety before the patient starts looking elsewhere. Even once the patient has accessed some type of medical care, the length of care is not long enough for the patient to be “well enough” after discharge or ending their hourly session, to be on their own in the community safely without becoming vulnerable to their condition in a short time and looking for more relief to ease their pain and improve their well-being.

If a person or a patient cannot depend on the medical system in the way they need to feel safe and well, they will almost certainly begin to lose faith and trust in health professionals, and ‘the system’. This perpetuates their internalised stigma being reinforced, yet again.

I am not saying the patient doesn’t have a significant responsibly of their own to make valuable choices outside of medical treatment. I quote what someone once said to me, “You may not have asked for this disease, but it becomes our responsibility to stay well”. That is our duty as the person living with a health issue of any kind. There are things we certainly must do (or not do) to stay as healthy as possible. The help make not be there in a timely manner the next time we need immediate help.

It can take weeks or more to enter a detox facility. It can take months to enter a rehabilitation facility. It can take months for an available appointment to open with a psychiatrist. It becomes our responsibility to know that even when we’re feeling well and back to “normal”, we must continue those relationships with medication professionals. It becomes our responsibility to try alternative medicines if that’s something you’re interested in. Let’s face it, psychiatrists cease their practice, our professional relationship has reached it’s potential for adequate, loving care, or we want to try something new.

Start the process of finding a reliable, qualified, and credible psychiatrist today. I would recommend finding a counselling psychologist or other mental health professional that you have a productive and friendly working relationship with – and if you want to practice Buddhism, or acupuncture, or hypnotherapy, or any other complementary and alternative medicine – do it. If you want to connect with God – do it. If you want to see a naturopath – do it. Whatever it is, this may very well be a lifelong journey for you. Based on my own experience, don’t stop because you think you’re “all better now”. The previously mentioned professions or treatment options or lifestyle choices can be extremely expensive, but I would encourage you to save for it, find less expensive options. Sitting in church is free, or listening to an online guru can be the price or maintaining your mobile service bill.

I once knew of a fellow peer in treatment alongside me who said he saved money for years to travel overseas to have a procedure not available in Australia at the time for this purpose. He wanted blood transfusions and heat therapy for chronic pain that didn’t doctors could not determine had physiological origins. The peer was sure it had to, and medical investigations in Australia come up negative. The peer explained the theory behind blood transfusions and heat therapy – he believed – were supposed to improve his blood circulation and blood flow to treat the chronic pain he’d been living with for years after a workplace accident. Even this procedure overseas proved ineffective in mitigating his chronic pain. So, next he tried the wim hof method. He changed is diet. He exercised differently. He tried hypnotherapy. Finally, he turned psychology to treat stress and process childhood trauma. He was being treated for this a private facility where I was a patient at that time. I lost contact with him after I ended my own treatment episode. I don’t know if he’s still living with chronic pain or not.

The following are some very basic and well-known strategies in the Western world of psychology that you can begin to practice today, and then practice every day after that too – even for 5-20 minutes:

– learning about anxiety – your specific “causes” and the conditions more generally

– mindfulness

– relaxation techniques

– correct breathing techniques

– dietary adjustments

– exercise

– learning to be assertive

– building self-esteem

– cognitive therapy

– exposure therapy

– structured problem solving

– support groups

My firm believe is this:

Strong, healthy, quality relationships are essential to treating anxiety and other psychological illnesses. This about your life today: are you lonely (romantically or otherwise), are you a stressed individual, do you regularly feel like you job is stressful or unfulfilling, do you feel sad a lot, are you feeling pointless a lot, or feeling helpless a lot, feeling shame a lot, getting angry a lot over considerably minor things? etc. etc. etc. I would strongly encourage talking to a professional and begin exploring what options you have available to you.

Try, explore, play with a few methods of treatment. However, this must take a priority in your life. It must balance will all the many other obligations and responsibilities people encounter daily.

Type alternative medications or approaches to psychology. There are so many. It can be fun to try out a few when your finances permit. Even planning a holiday every 3-6 months is taking care of your well-being.

Many blessings friends.

Psychological factors influencing drug use in Sydney’s gay community often stem from unique social and emotional challenges. Research highlights that stigma, discrimination, self-stigma, and internalised homophobia can lead to feelings of isolation, shame, and mental distress, which may increase vulnerability to substance use.

Additionally, the normalisation of partying in certain social settings, such as bars and clubs, has historically been a way for subcultural populations of LGBTQ+ individuals to connect and find community. However, this environment can also contribute to higher rates of drug use. Emotional coping mechanisms, such as using substances to manage stress or trauma, are also significant factors.

The biopsychosocial model provides a comprehensive framework for understanding alcohol and other drug dependency in the LGBTIA+ community. Here’s a breakdown of the factors:

1. Biological Factors:
   • Genetic predisposition plays a role, with some individuals being more vulnerable to chemical dependency due to inherited traits.
   • Neurobiological changes caused by substance use can alter brain function, making it very challenging to reduce or stop using substances despite the negative consequences occurring in the individual’s life.
2. Psychological Factors:
   • Trauma, such as adverse childhood experiences, peer bullying, neglect, authoritarian child rearing, seemingly innocuous societal messages, and/or discrimination, can lead to emotional distress and substance use as a coping mechanism.
   • Internalised stigma, homophobia, or transphobia can exacerbate mental health issues like anxiety and depression, increasing the risk of substance use and potential physical and psychological dependency.
3. Social Factors:
   • Experiences of ostracism, violence, or lack of acceptance and belonging can lead to isolation and substance use.
   • Social norms in certain LGBTQ+ spaces, such as bars or clubs, may normalise or encourage substance use.

This model underscores the importance of addressing all these interconnected factors in prevention and treatment efforts.

The Flux Study, also known as “Following Lives Undergoing Change,” is a longitudinal research project focusing on the lives of gay and bisexual men in Australia. Conducted by the Kirby Institute at UNSW Sydney, it examines various aspects of health, behaviour, and social factors, including drug use, sexual health, and the adoption of HIV prevention strategies like PrEP.

Key findings from the study include:

• Recreational drug use is common among gay and bisexual men, with substances like marijuana, amyl nitrite (“poppers”), and party drugs being frequently used. However, dependency rates are relatively low.
• Drug use is often linked to enhancing pleasurable experiences, including sexual enjoyment.
• The study has provided insights into how men mitigate risks, such as using biomedical HIV prevention methods alongside drug use.

The Flux Study is a collaborative effort involving organisations like the National Drug and Alcohol Research Centre, ACON, and the Victorian AIDS Council. It aims to inform health interventions and support services tailored to the needs of this community.

The Flux Study has provided valuable insights into the health and behaviours of gay and bisexual men in Australia. Here are some key findings:

• Drug Use: While recreational drug use is common, most participants reported infrequent use. Harm reduction strategies, such as not sharing injecting equipment, were widely practiced.
• HIV Prevention: There was a significant increase in the uptake of HIV pre-exposure prophylaxis (PrEP), with usage rising from less than 1% in 2014 to about one-third of participants by 2017.
• COVID-19 Impact: During the pandemic, participants reduced sexual contacts and adapted strategies to minimize risks in sexual contexts. Many also paused PrEP usage due to reduced sexual activity.
• Mental Health: A notable proportion of participants reported mental health challenges, highlighting the need for targeted support services.

There are several support services available for addressing mental health challenges, particularly for the LGBTIA+ community in Australia. Here are some key options:

1. QLife: A free, anonymous peer support and referral service for LGBTQ+ individuals. It operates via phone and webchat from 3 PM to midnight, 7 days a week. Phone: 1800 184 527. Their website provides a webchat service: QLife – Support and Referrals
2. Beyond Blue: Offers 24/7 mental health support, including phone and online counselling. They also provide resources tailored to the LGBTQ+ community. Phone: 1300 22 4636. Click the following link to Beyond Blue’s Wellbeing Action Tool: beyond-blue-wellbeing-action-tool_dec_2024_updated.pdf
3. Lifeline: A leading crisis support service available 24/7 for anyone in distress. They offer phone, text, and online counselling. Phone: 13 11 14
4. Head to Health: Connects individuals to mental health resources, including helplines, apps, and digital programs. Medicare Mental Health is a free service that connects you with the mental health support that is right for you. Phone: 1800 595 212 or visit their website: Home | Medicare Mental Health
5. WayAhead Directory: An online database to find local mental health services and resources. Phone: 1300 794 991
6. NSW Mental Health Line: A 24/7 telephone service providing advice and recommendations for appropriate care. Phone: 1800 011 511

These services are designed to provide immediate support and guide individuals toward long-term mental health care.