Who falls to addiction who is unscathed

Of course, no two traumas are the same; in fact two people can go through the same experience and emerge with hugely different outcomes. One might be relatively unscathed, while the other might experience profound trauma. But adverse childhood experiences come up in spades, as does, almost inevitably, stigma. Substance misuse including alcohol is a natural way for homeless individuals to try to dull the pain of such a traumatic existence. And then people who were never using drugs start during homelessness.

And we do know that people start using drugs in the hopelessness of homelessness. The homeless environment provides the means to numb that pain, because there is drug use in every hostel, within the same rooms that you are sleeping in.

They can become new patterns for people in those surroundings. All of those things would be the clean water. We can clearly extrapolate the link between drug use and traumatic living environments.

In my own experience, in the hostels, recantations of horrific past experiences are commonplace. They died when I was young. I guess life really got messy after I got kidnapped at I buried that for a long time. To this day I wake up in a sweat dreaming about it. I thought those men were going to kill me. Just constant flashbacks and nightmares. But the first time I totally lost me head was when I was I thought there were worms crawling all over me. I was always given tranquillisers.

Then when I was staying in the hostels I totally lost the head. There were dealers living there and they kept offering to give me trays of tranax [strong, street xanax].

Eventually I caved in. There was nothing but drugs and people suffering. Not the worst hostel in town, but it was bad enough. Everything just got worse. My head was totally out of joint. I really felt like I wanted to die. I think a lot of people in there felt the same. I was desperate. It was only with the help of a brilliant GP who works with homeless people that I started to cut back, back, back, bit by bit. It was pure luck she accepted me because nobody wanted to take me on.

It only made me feel more worse. I felt like a waste of space. Safetynet cite a rough figure of 80 per cent of their homeless cohort, who present with mental health challenges, having dual diagnosis.

However, there is considerable evidence to suggest that both elements of dual diagnosis are interwoven and completely cross-fertilised. Turning away a sick patient seeking help from the emergency department seems like a violation of human rights. Aimee went there — suffering and desperate for help. To be refused access to mental health facilities shows how people with dual diagnosis fall through the cracks.

The fact that budgetary remarks were made to Aimee about refusing her treatment is unacceptable; dual diagnosis is a potentially fatal state — through overdose or suicide. And childhood adversity is also strongly associated with poverty. So childhood adversity and poverty are the two key preceding states for drug use and for homelessness. About seven or eight people put their hands up. It is so prevalent in inner-city areas where there is deprivation and drug use. That was a big shock for me, when I suddenly went into this whole community which had been devastated by the young deaths, because there had been so many people addicted to drugs.

We would do better to consider what we have in common, what we share; to consider homeless individuals as people, some with more complex needs than others. For a start, we need a complete systems overhaul on how we care for people experiencing dual diagnosis — particularly for homeless individuals who are the most structurally vulnerable of all.

For too long the dual diagnosis issue has been shelved by the Health Service Executive. It is crucial that people get seen to at the moment of reaching out. Left too long, they are at risk of death. There needs to be psychiatrists with specialisation in addiction, therapists, activities, jobs within the centres with a hope of continuation outside — something meaningful.

And they all need to be working in a multidisciplinary way. There should also be housing supports available. But these structural changes will never happen until we can simply acknowledge the humanity of the homeless people we encounter on the street, and be thankful for our privilege. A powerful cultural narrative focusing on the power of illegal drugs to disrupt otherwise stable, happy lives dominates our media and political discourse, and shapes policy responses.

However, the narrative has resonance far beyond the political arena and underpins most media coverage of drug addiction and the drug storylines of popular culture. In reality the likelihood of individuals without pre-existing vulnerabilities succumbing to long-term addiction is slim. Addiction, unlike use, is heavily concentrated in our poorest communities — and within those communities it is the individuals who struggle most with life who will succumb. Compared to the rest of the population, heroin and crack addicts are: male, working-class, offenders, have poor educational records, little or no history of employment, experience of the care system, a vulnerability to mental illness and increasingly are over 40 with declining physical health.

Problem cannabis use is less concentrated among the poor, but is closely associated with indicators of social stress and a vulnerability to developing mental health conditions. Most drug users are intelligent resourceful people with good life skills, supportive networks and loving families. These assets enable them to manage the risks associated with their drug use, avoiding the most dangerous drugs and managing their frequency and scale of use to reduce harm and maximise pleasure.

Crucially they will have access to support from family and friends should they begin to develop problems, and a realistic prospect of a job, a house and a stake in society to focus and sustain their motivation to get back on track.

In contrast the most vulnerable individuals in our poorest communities lack life skills and have networks that entrench their problems rather than offering solutions.

Their decision making will tend to prioritise immediate benefit rather than long-term consequences. The multiplicity of overlapping challenges they face gives them little incentive to avoid high risk behaviours. Together these factors make it more likely that, instead of carefully calibrating their drug use to minimise risk, they will be prepared to use the most dangerous drugs in the most dangerous ways. And once addicted, motivation to recover and the likelihood of success is weakened by an absence of family support, poor prospects of employment, insecure housing and social isolation.

In short what determines whether or not drug use escalates into addiction, and the prognosis once it has, is less to do with the power of the drug and more to do with the social, personal and economic circumstances of the user. Unfortunately the strong relationship between social distress and addiction is ignored by politicians and media commentators in favour of an assumption that addiction is a random risk driven by the power of the drug.