Addiction - the overlooked dark secrets

We all have a picture in our minds of heroin addicts or alcoholics, usually sad homeless people who live only for their next drink or drug 'fix'. But behind closed doors, hundreds of thousands of Britons are addicts - and many of them don't even know it.

We all have a picture in our minds of heroin addicts or alcoholics, usually sad homeless people who live only for their next drink or drug 'fix'. But behind closed doors, hundreds of thousands of Britons are addicts - and many of them don't even know it.

Addiction to painkillers

Most people don't realise that painkillers we can buy from our chemists can cause 'addiction' too. About one in five people who have chronic headaches, and most people who have headaches every day, actually have them because of the painkillers they're taking. It sounds really odd, but if you take painkillers regularly, you can get a 'rebound' headache when they wear off. The automatic response to this headache is - guess what - to take more painkillers. The risk is particularly high for combination painkillers including codeine-based products and another ingredient, and for migraine medications like triptans - the new National Institute for Health and Clinical Excellence (NICE) guidance on headaches suggests that people taking these medicines on more than 10 days a month, or other painkillers on more than 15 days a month, may be suffering from medication-overuse headaches.

What can I do?

If you think you might have this problem, do speak to your GP. To get over the problem, you'll have to stop the painkillers you're taking completely. Your GP may be able to suggest an alternative which will help in the short term, or to refer you to a hospital clinic. The headaches will be worse in the short term, but most people are feeling much better within a few months (one of my patients described it recently as 'getting her life back'). Drinking enough fluid, eating a balanced diet, regular exercise and perhaps getting counselling will also help.


In generations past, many people were unaware of the risks of alcohol. Unlike smoking, where there is no 'safe limit', it is perfectly possible to enjoy alcohol in moderation without doing long-term harm to your body. But definitions of 'moderation' vary enormously - and all too many people are unaware how easy it is to exceed recommended limits.

What can I do?

Doctors use several tools to identify how likely it is that you have a problem with alcohol. If you complete a validated tool like the AUDIT tool and it suggests you're at increased risk, do speak to your doctor. Ideally, take a drink diary with you - but be honest.

Nicotine addiction

People who have never smoked may not understand quite how addictive cigarettes are - and they are designed to give as much of a 'high' as quickly as possible to keep people addicted. Small wonder so few people who try to quit fail.

What can I do?

Talk to your GP or pharmacist about the local smoking cessation service. There are hundreds of smoking cessation counsellors working in the NHS - they can give you advice about how to avoid your individual 'triggers' for reaching for a cigarette, and how to motivate yourself to stop. Many of my patients tell me that just identifying a reason which is really relevant to them (whether it's the damage they could be doing to their child through passive smoking or the risk of chronic obstructive lung disease has helped them to quit successfully. You may also be offered medicine to help you quit, and to weigh up the various options.

Addiction to food

Most of us think of chocolates or cakes as 'treats', but for some, comfort eating becomes an addictive vicious cycle. Maybe you eat because you feel bad about your life, then you feel bad about your weight or not controlling your eating and you eat to forget how bad you feel. Some people feel so bad about binge eating that they make themselves sick or take laxatives. This combination is called bulimia.

What can I do?

You need to recognise that it's not the eating that's the problem, but how you feel about yourself. Cognitive behavioural therapy - where a counsellor helps you to understand how negative thought patterns trigger harmful behaviour and how you can break the cycle - can be hugely helpful. Do talk to your GP.

Addiction - why bad things happen to good people

Technically, anyone who craves something when they don't have it is an addict. However, doctors usually talk about addiction when that craving, or the behaviour that results, is having a real impact on your life. Nobody takes their first drink, or cigarette, or even drug, with a plan to become an addict. So why does it happen so often?

We know people who become addicted to hard drugs often have problems at home which may go back to childhood. But many alcoholics started off drinking within safe limits, and allowed their intake to creep up. With many drugs, including alcohol, your tolerance increases as you take more. This means people may not recognise they're getting addicted until it's too late.

Being addicted doesn't mean you're weak or a bad person, but it does mean you need help. Your doctor certainly won't judge - he or she will probably be delighted that you've been brave enough to step forward.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.