The question caught me off guard as I presented at a regional mental health conference. My initial thought was a quick “no” that I kept to myself. Such a reaction is one that I have learned usually means I need to look deeper.
I had described neurodiversity as variations in brain styles and how we experience the world. Earlier, I had encouraged participants to look beyond diagnostic categories when thinking of neurodivergence, explaining that while the term originally applied to the section of the DSM cast as neurodevelopmental disorders, those we are born with or develop early in life. I then expanded that, since its inception, the term has been cast to an array of experiences that alter our perceptions.
My counterpart answered that substance use is often a strategy utilized by people, many of whom are neurodivergent, to cope with life. That’s true. Many socially anxious and autistic people turn to alcohol in social situations. Similarly, people might self-medicate with other substances, either to alleviate some of the distress created by living in a world not designed for people who think and feel like you do.
Still, while certainly a dynamic to be explored, not everyone who uses substances is otherwise neurodivergent.
A few of the conference attendees approached me afterward. They expressed that substance use alters our brains. I thought about it. I’ve known a few people who have struggled with cognitive difficulties sustained after prolonged substance use. Images of the egg commercials in the ’90s and that nasty phrase, ‘Fried their brain,’ unfortunately came to mind.
Are displays of insult and pity all we have to offer? Is an altered brain, by definition, inferior? The word, ‘fried’ implies damage beyond the point of return. I thought of a friend who has shared with me their life-changing experiences with psychedelics that both unlocked new levels of understanding and perhaps previously undetected mental illness. I don’t think of them as a person whose brain is broken, much less by their choice.
In substance abuse prevention, there is an emphasis on choice because we control our choices. Yet, other risk factors for substance use and its effects are sometimes ignored. We know, for example, that people who have experienced severe traumas like war or child abuse are at much higher risk of using substances, as are people with mental health conditions, a family history of substance use, or who grow up in poverty (Brattström and colleagues, 2015).
Are people who choose not to use somehow better?
A majority of adolescents and young adults will experiment with mind-altering substances, but only a small fraction will develop a dependence. Similarly, I believe that when described well enough, most people will face an addiction of some sort in their lifetime. It might not be drugs, but when we add spending, gambling, gossip, compulsive competition, texting, and gaming, who is left?
I’m still not sure if substance use disorder is a neurodivergence, but I would not be so quick to say it isn’t. There is such a thing as acquired neurodivergence, as a result of a brain injury. If substances reshape a person’s brain so much as to fundamentally change how they experience the world day to day, maybe it could be described as a type of neurodivergence, too?
I’ve found that rarely do our experiences fall into these neat little boxes of trauma, neurodivergence, mental health, substance use, and self. Life is messy and people are multidimensional. Still, it’s beautiful when the concept of neurodiversity gives light to a person’s story and assists them in making meaning of it.
Maybe, consideration of substance use disorders as complex experiences reaching beyond the label of addiction could spark more compassion than an image of a fried brain.
In a world that has become increasingly addicted to judgment, I think we could all use a decent dose of that.