None of these approaches is entirely wrong. Yet none of them is sufficient

Η κλινική εμπειρία, αλλά και η σύγχρονη ψυχολογική θεωρία, δείχνουν ότι η εξάρτηση μπορεί να γίνει καλύτερα κατανοητή αν την δούμε πρωτίστως ως μια ιδιαίτερη μορφή σχέσης. Clinical experience, as well as contemporary psychological theory, suggests that addiction can be better understood if we view it primarily as a particular form of relationship.

In this case, the substance is not merely an object of consumption. It becomes a tool for managing psychological tension. It becomes a way of coping with anxiety, loneliness, shame, disappointment, or a vague inner distress that the individual struggles to put into words.

From this perspective, addiction often functions as a particular mechanism of self-regulation. Where the psychological system struggles to endure or process an emotion, the substance offers an immediate, predictable, and short-term effective solution.

It is not merely a biochemical process. It is a neurobiologically reinforced, yet psychologically organized experience.

Contemporary research in the neuroscience of addiction has shed significant light on the role of reward circuits, dopaminergic activity, and reinforcement-based learning mechanisms. However, biology alone is not sufficient to explain why two people exposed to the same substance may follow entirely different paths: one may develop an addiction, while the other may not.

At this point, the importance of the developmental and psychological dimension becomes evident.

Throughout the therapeutic process, many people who develop addictive behaviors describe a common experience: that, at some point in their lives, the substance functioned as a solution. As a way of temporarily relieving an inner distress that could not find other means of expression or processing.

Over time, however, this solution turns into a problem. The substance begins to shape everyday life, influence relationships, and often profoundly affect the individual’s sense of identity.

Addiction, therefore, does not arise solely from the pharmacological effects of a substance. It is the result of an encounter:
between a particular individual, with their own psychological history, and a substance that offers a rapid mechanism of relief.

From this perspective, treatment cannot be limited solely to stopping substance use. Abstinence is often a necessary step, but it does not constitute treatment in itself.

If the substance functioned as a means of regulating the psyche, then the therapeutic process is called upon to help the individual develop alternative ways of understanding, expressing, and managing their experience.

The treatment of addiction is, to a great extent, a process of reconstruction.
A reconstruction of one’s relationship with the body, with emotions, with other people, and ultimately with oneself.

In an era where speed, immediate gratification, and the avoidance of discomfort are culturally reinforced, addiction cannot be understood solely as an individual problem. It can also be viewed as a symptom of a broader social condition: one that often demands greater psychological endurance from the individual than they are able to sustain.

Perhaps, then, the most meaningful question is not only ‘how does one stop using,’ but rather what made the use necessary in the first place.

However, both history and therapeutic practice suggest something different: addictions do not emerge in a vacuum. They arise during periods of social distress, disconnection, and loss of meaning.

Social Disintegration and Psychological Pain

Émile Durkheim described as early as the 19th century the concept of anomie: situations in which social bonds weaken and collective narratives no longer hold the individual together.

In such environments, people do not simply ‘fail.’ They are left without a framework of meaning.

Psychological pain does not disappear when it has no space to exist. It transforms.

Erich Fromm put it simply: when a person cannot truly be, they try to numb themselves. In this context, addictions are not an abnormality—they are a form of adaptation

History: When Societies Fracture

The connection between social crisis and addiction becomes particularly clear throughout history. In the 19th century, China experienced profound political, economic, and cultural disintegration. During the same period, opium use spread massively.

The Opium Wars were not merely commercial conflicts. They revealed how addiction can function:

• as a social anesthetic

• as a means of control

• as a response to a reality that had become unbearable

Addiction flourished where social cohesion had already been fractured.

From History to the Present Day

Matsa, in the book

In the book We Searched for People and Found Shadows, Matsa summarizes it aptly:

The culture of addiction emerges as a response to the culture of decline.

Today, the forms have changed, but the underlying structure has not.

In place of opium, we now find: substances, screens, compulsions, and addictive relationships.

Zygmunt Bauman spoke of a liquid society, in which nothing remains stable long enough to provide a sense of security.

Within this fluidity, addiction often functions as a false form of stability.

Addiction as an Attempt at Self-Regulatio

In the psychology of addiction, Edward Khantzian’s self-medication hypothesis suggests that substances are not chosen randomly. They are used to regulate emotions that cannot otherwise be endured.

The narrative approach of Michael White goes a step further: addiction is not an identity, but a story of survival amidst difficult life circumstances.

Concurrently, Michel Foucault helps us see how modern societies:

• individualize pain

• shift responsibility to the individual

• and often pathologize what does not “work”

A personal therapeutic reflection

In my therapeutic practice, I do not encounter people who “failed.” I encounter people who tried to endure conditions that could not accommodate human vulnerability.

That is why, for me, therapy is not limited to abstinence or behavioral control.

It is a space for:

• de-blaming pain

• reconnecting with meaning

• and rewriting the story of the self within the relationship

We do not treat substances.

We treat life ruptures.

And this, almost always, is a deeply relational and social process, not an individual failure.

Bibliography

Durkheim, E. (1951). Suicide: A Study in Sociology (Trans. J. A. Spaulding & G. Simpson). London: Routledge. (Original work published 1897).

Foucault, M. (1977). Discipline and Punish: The Birth of the Prison (Trans. A. Sheridan). New York: Pantheon Books.

Fromm, E. (1955). The Sane Society. New York: Rinehart & Company.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. American Journal of Psychiatry, 154(4), 505–513.

Maté, G. (2008). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Toronto: Knopf Canada.

White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. New York: W. W. Norton & Company.

Bauman, Z. (2000). Liquid Modernity. Cambridge: Polity Press.

Matsa, K. (2018). We searched for people and found shadows. Athens: Agra.

Addiction is often treated as an individual pathology or a lack of self-control. This dominant perspective, though widespread, overlooks a crucial factor: identity. In practice, addiction is not just about the relationship with a substance or a behavior, but about a person’s relationship with themselves and the story they have learned to tell about themselves.

Narrative therapy proposes an alternative framework for understanding, in which the problem is not identified with the individual, but is understood as a dominant narrative that has gained excessive influence in their life (White & Epston, 1990).

Identity: a stable characteristic or a dynamic process?

Contemporary sociological approaches describe identity as a continuously forming process, a product of social relations, cultural discourses, and personal experiences. The way an individual perceives themselves is influenced by the narratives that prevail around success, competence, autonomy, and responsibility (Giddens, 1991).

In the context of late modernity, the individual is called upon to be constantly functional and self-regulating. Psychological distress is often privatized and interpreted as personal failure, rather than as a social or relational phenomenon (Bauman, 2000).

Under these conditions, addiction can transform from a behavior into an identity: from “I use” to “I am the one who…”

Addiction as a Mechanism of Emotional Regulation

Clinical data show that many forms of addiction do not begin with a search for pleasure, but with the need to regulate internal states, such as anxiety, inner tension, and shame. Use initially functions as an adaptive response to conditions of nervous system overload or identity ruptures.

In clinical practice, this often does not appear as “resistance to change,” but as a difficulty imagining oneself without the addiction. Not because one does not desire change, but because addiction has become the primary organizing framework of meaning and self-understanding.

According to Alexander (2008), addiction cannot be adequately understood in isolation from the social context in which it develops. When social connection weakens and demands for autonomy increase, addiction often functions as a substitute for meaning and belonging.

Over time, however, this “solution” ceases to be functional and transforms into a dominant narrative, which begins to organize the past, the present, and expectations for the future.

Stigma, Discourse, and Social Identity

The social discourse surrounding addiction critically contributes to the formation of an individual’s identity. The pathologization and moralization of use reinforce shame and limit available self-narratives.

Thus, addiction is presented as an individual failure, while in reality, it often constitutes a symptom of broader social and relational pressures.

As Foucault (1978) has shown, discourses around normality and deviance do not merely describe reality, but constitute it. The individual does not only experience use as a problem, but often learns to experience their very self as problematic.

Narrative Therapy: De-identification and Re-authoring Identity

Narrative therapy focuses on de-identifying the person from the problem and highlighting alternative life stories. Change is not limited to discontinuing use, but to broadening identity and possibilities for meaning (White & Epston, 1990).

Therapy becomes essential when the individual does not merely seek to stop something, but to understand what need the addiction served and what other story can gradually take its place.

Through the therapeutic process:

• the problem is externalized,

• moments of resilience and values are recognized,

• the individual reconnects with aspects of themselves that had been silenced.

The more stories a person has about who they are, the less power addiction has to define their life.

Conclusion

Addiction is not an identity. It is a story that developed under specific psychological, social, and relational conditions.

Therapy is not just about abstinence, but about the restoration of meaning, complexity, and the freedom to choose one’s self.

Bibliography (APA 7th)

Alexander, B. K. (2008). The globalization of addiction: A study in poverty of the spirit. Oxford University Press.

Bauman, Z. (2000). Liquid modernity. Polity Press.

Foucault, M. (1978). The history of sexuality: Volume I – An introduction (R. Hurley, Trans.). Pantheon Books.

Giddens, A. (1991). Modernity and self-identity: Self and society in the late modern age. Stanford University Press.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W. W. Norton & Company

It is no coincidence that for many people, this period is accompanied by an increase in substance use or other addictive behaviors.

The Social Normality of Excess

Alcohol, food, and overconsumption are an integral part of festive culture. Substance use is not merely tolerated; it is often expected. “Come on, it’s the holidays,” “we only live once a year,” “it’s okay these days.”

Within this framework, the boundary blurs. Excess is legitimized, and for some people, substance use becomes the most direct way to integrate, de-stress, or escape.

When Holidays Activate Memories

Holidays do not only bring the present. They also bring the past. Losses, relationships that were not mended, family dynamics that repeat, roles that seem frozen in time. For people who have experienced trauma, loneliness, or chronic relationship difficulties, this period can act as an emotional multiplier.

In this context, substance use often does not appear as a search for euphoria, but as an attempt to regulate intensity. A way to “lower the noise,” even temporarily.

Not Weakness, But an Attempt at Relief

International literature is clear: stress and emotional burden increase the likelihood of substance use and addictive behaviors. The World Health Organization notes that alcohol consumption increases during festive periods, while studies show a strong link between chronic stress and vulnerability to substance use.

This shifts the discussion. Substance use does not need to be seen as a lack of self-control or personal failure. Very often, it is a human attempt to manage difficult emotions, in an environment that leaves no room for them.

The Pressure to “Be Well”

Perhaps one of the most challenging aspects of the holidays is the unspoken demand for joy. Sadness, fatigue, ambivalence seem almost inappropriate. When there is no room for difficulty, internal tension grows, and with it, the need for immediate relief.

At this point, substance use is not the problem. It is a symptom of a context that struggles to accommodate human experience as it truly is.

A Different Perspective

Holidays do not cause substance use. They often merely illuminate what already exists within a person’s inner landscape. When the perspective shifts from guilt to understanding, space is created for greater awareness, care, and, potentially, different choices.

Perhaps the most useful question during this period is not “what am I doing wrong?”, but “what am I trying to endure?”.

Narrative therapy invites us to view substance use within the context of a person’s life and relationships, not in isolation from them. Especially during periods like the holidays, this perspective helps to acknowledge the difficulties that coexist with joy, without rushing to fix them, but with space to articulate them.

Sources

World Health Organization. (2018). Global status report on alcohol and health.

National Institute on Drug Abuse. (2022). Stress and substance use.

Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130.

In psychotherapeutic practice with individuals striving to negotiate their relationship with addiction, a phrase recurs repeatedly:

“I’m in control.”

I encounter it very frequently, and almost never do I hear it as a sign of weakness. On the contrary, I view it as a human endeavor for stability, normalcy, and self-determination. It is natural for an individual to want to feel in control, even when struggling with something as complex as an addictive behavior.

Simultaneously, this particular phrase often functions as a common voice of addiction. A voice that reassures, blurs, or conceals. In this article, we explore why it appears so often, what it truly means, and how narrative therapy helps individuals reconnect with their own voice and personal agency.

Why Addiction Often ‘Whispers’ That There Is Control

Addiction uses the phrase ‘I’m in control’ as a strategy to remain in the background.

This specific thought often arises when the individual:

• attempts to avoid the anxiety or fear of change

• desires to maintain an image of self-restraint

• feels that if they ‘open up’ about the issue, they will need to confront painful emotions

• fears the loss of normalcy

• wishes to protect themselves from shame or self-criticism

None of these indicate weakness. They indicate an effort to survive. Addiction merely capitalizes on these needs and creates a convenient narrative:

“Don’t worry, there’s no reason for change.”

The problem is not that the individual is ‘lying to themselves’. The problem is that the voice of addiction is confused with their own voice.

Narrative Therapy: The Separation Between the Individual and Addiction

One of the most useful tools in narrative therapy is externalizing dialogue.

In this approach:

• addiction is treated as a separate influence,

• not as a characteristic of personality.

In this way, a new space opens up: the space where the individual can recognize their own true voice.

Often, this leads to questions such as:

• When does the voice of addiction grow stronger?

• At what moments does my own voice become clearer?

• Which of my values want to be heard?

Change begins not from opposition, but from clarification.

Personal Agency: Small Indications That Our Own Story Is Reviving

Personal agency, the ability to choose and direct our lives, does not disappear in addiction. It often merely becomes obscured.

Its reappearance can be subtle but significant:

• a pause before an impulsive act

• a moment of mindfulness

• a thought that asks: “Does this help me?”

• a small change in the way we speak to ourselves

• an acknowledgment of difficulty without self-blame

These small signs compose a new narrative: the narrative where the individual once again has influence over their life.

The real question is not “who is in control.”

In the realm of addictions, the discussion is often limited to whether the individual ‘has control’. However, this dichotomy (having/not having control) is restrictive and often unfair.

The essential question is:

What story about myself do I want to live in? A story where I need to convince myself that everything is under control? Or a story where I acknowledge the complexity of my experience and simultaneously see the strength and values that already exist within me?

Narrative therapy offers the tools to help individuals identify:

• moments of resilience,

• the values they wish to uphold,

• the connections they desire to build,

• the life they want to write from now on.

Addiction has a strong voice, but not the only one. Addiction may whisper ‘I’m in control’ to remain invisible. But our own voice is not lost. When we begin to discern it, it can speak something much more truthful:

“I choose the story that supports me. And I take steps towards it.”

This is not excessive self-confidence.

It is the essence of change.

One of the most critical, yet often invisible, elements of this design is speed. How quickly I play, how often I press “spin,” how short the interval is between two bets or two outcomes.

And here the question becomes very specific:

Why does a gambling game tend to become more addictive the faster it is?

1. Speed as a “Structural Characteristic” of the Game

In the literature, we refer to “structural characteristics”: the embedded elements of a game that influence player behavior, such as speed, event frequency, how often one can bet, how quickly one is paid, the size of winnings, etc. (Auer & Griffiths, 2022; Griffiths, 1993).

Studies show that games with high event frequency, such as slot machines, online slots, or fast casino games, are particularly preferred by individuals with gambling problems and are associated with greater difficulty in stopping and larger financial losses (Auer & Griffiths, 2022; NSW Department of Customer Service, 2020).

In simple terms: the more frequently you can “play a round,” the more easily the game becomes continuous, without pauses, without time for thought, without a breath.

2. The Brain in a “Fast Reward Cycle” Mode

Gambling is not merely “a bad habit.” It is linked to the same reward systems in the brain involved in substance addictions: dopamine, reinforcement learning, reward anticipation.

• In fast-paced games, the brain is exposed to:

• Continuous succession of stimuli (sound, movement, lights, results)

• Countless small “outcomes” (small wins, “near misses,” losses disguised as wins)

• Intermittent reinforcement, the so-called “partial reinforcement,” where you don’t win every time, but often enough to keep hoping (Griffiths, 1993).

This pattern is extremely powerful for creating repetition and habit. Slot machines, for example, have been described as one of the most potent ways to create “flow”: a state where the player loses a sense of time, money, and even their body (Schüll, 2014).

3. The Short Time Window and the Loss of Thought

Every learning behavior requires a “cycle”: action → consequence → processing → decision on “what to do next.”

In a slow game (e.g., a classic lottery, a weekly draw), this cycle allows time: the person can think, discuss, regret, make a plan.

In a fast game like electronic machines or online slots, the interval between two button presses can be a few seconds or even less (Auer & Griffiths, 2022).

Research shows that as game speed and frequency increase:

• The player’s ability to make a conscious pause decreases

• “Impulsive” decisions increase

• Persistence in the game is reinforced, even when losses are already significant (NSW Department of Customer Service, 2020).

Indeed, experimental studies have shown that when mandatory pauses of a few seconds are imposed, problematic gamblers do not continue longer than non-problematic ones, indicating that speed appears to fuel the difference (Auer & Griffiths, 2022).

4. It’s Not a “Passion for Risk”; It’s a Product of Design

There is now strong literature indicating that electronic gaming machines (EGMs, slots, etc.) combine a set of characteristics that make them particularly dangerous: high speed, continuous play, easily accessible bets, intense audiovisual stimuli, “near misses,” losses presented as wins (Griffiths, 1993; NSW Department of Customer Service, 2020).

At the same time, recent policy analyses emphasize that fast, continuous games with high event frequency and a high Return to Player (RTP) percentage are associated with an increased risk of problematic gambling, especially when “dressed up” with intense sensory stimuli (NSW Department of Customer Service, 2020).

The picture, therefore, is not moralistic (“some people have no self-control”), but systemic: these are products designed to:

• keep the player in a rapid alternation of stimuli,

• maximize playing time, and consequently, the money they will lose.

The player was not “born” to get stuck on a slot machine. The slot machine was designed for the player to get stuck on it.

5. The Player’s Experience: From Enjoyment to the “Machine Zone”

Many players describe a state where “everything else fades away”: there is no time, no thoughts of bills or obligations, only the machine or screen in front of them – the so-called “machine zone” (Schüll, 2014).

In this zone:

• the brain does not realistically evaluate wins and losses

• the player experiences a peculiar “relief” from other emotional burdens

• speed leaves no room for questions like “what am I doing?”

Empathy is crucial here: many people are not “just chasing profit.” They often seek a temporary respite from anxiety, loneliness, shame, or pressing experiences. Fast-paced gaming offers this respite, albeit falsely and temporarily, again and again, with every button press.

Addiction, therefore, is not just an “attraction to the game,” but also an escape from something else. And the faster the game, the more automated this escape can become.

6. What Does This Mean for Prevention and Treatment?

If we accept that speed is not a simple “technical” element but a central risk mechanism, then:

Harm-reduction measures cannot focus solely on the “responsible player,” but also on the responsible product.

Policies such as slowing down game speed, mandatory pauses, restrictions on continuous betting, and the design of less stimulating environments can reduce risk without relying exclusively on individual “self-control” (NSW Department of Customer Service, 2020).

At the same time, in clinical practice, understanding speed as a factor in addiction helps us to:

• de-moralize the player’s experience (“you are not weak; you have been exposed to a very powerful system”)

• work on recovering pauses – to reintroduce time between impulse and action

• address not only the game but also underlying issues: loneliness, trauma, anxiety, feelings of shame.

7. A Different Narrative

Instead of the simplistic phrase “fast games are for those who don’t know when to stop,” a scientific and empathetic perspective suggests something else:

Fast games are designed to make stopping difficult. The player is not “the problem”; they operate within an environment that utilizes every available mechanism to keep them engaged.

And precisely because we know this, we can view addiction not as an identity, but as a relationship: between the person, the game, and the context.

A relationship that, however strong it may be, can be renegotiated, slowed down, and acquire pauses. And within these pauses, the person can rediscover themselves.

This narrative, however “scientific” it may seem, rarely helps. More often, it causes harm.

Because every time we define addiction exclusively as a disease, the person begins to see themselves only through the prism of this definition. Identity shrinks. The “I” becomes: “I who am problematic,” “I who have something wrong inside me,” “I who probably won’t change.”

However, modern research shows something different: addiction is not an identity. It is a process of learning, attachment, and emotion regulation. It is a translation of pain into behavior. It is biology and circumstance seeking balance.

And this is the crucial distinction: addiction is not “me.” It is a strategy, often inadequate, painful, but a strategy nonetheless. Something that perhaps once helped. Something that can be transformed today.

The pathologizing narrative, however, does not allow for this. It traps the person in a label. It forces them to see themselves through a narrow medical lens, as if all dimensions of their life—social, relationships, traumas, and anxieties—have no place in what they are experiencing.

In reality, addiction is a dialogue between the person and their environment. Something shaped by biology, life history, social contexts, cultural messages, and above all, relationships.

And this dialogue often takes the form of an internal voice. A voice that is often confused with personal identity:

“I can’t cope without it.”

“I need something to calm down.”

“This is just how I am.”

But this voice is not you. It is a habit that became a survival mechanism. It is the psyche trying to regulate itself with whatever it found. It is biology seeking balance. It is the nervous system that has learned a path and repeats it.

The scientific turning point is here: whenever someone begins to see that “addiction is something I have, it is not something I am,” it creates space for change.

Because I don’t need to change myself, only the relationship I have with what once served me.

And so, identity reopens. The person becomes a subject again, not a symptom.

They rediscover the right not to be defined by need, impulse, or use.

To see themselves with a phrase that research confirms and the soul needs:

“I am not my addiction. Addiction is a story that can be rewritten.”

1. Neurobiology of Alcohol Consumption — Effects on the Brain

Alcohol use — whether occasional or chronic — affects critical brain functions and structures. Alcohol disrupts neurotransmitter systems (e.g., GABA, glutamate, dopamine), impacts neuronal plasticity, and over time is associated with structural changes (cortical thinning, reduced volume in subcortical structures) that have consequences for memory, executive function, and impulse regulation (NIAAA, 2024).

Of particular concern is exposure during adolescence: data show that adolescent consumption is linked to accelerated gray matter loss, disrupted white matter maturation, and functional deviations in networks involved in attention and reward control (Lees et al., 2020).

Large systematic neuroimaging reviews confirm that alcohol exposure is associated with measurable alterations in brain structure across the lifespan, indicating that the effects are not limited to “acute” behavior but impact brain biology long-term (Karoly et al., 2024).

The dose-response relationship is complex: despite the common narrative of “safe” moderate quantities, the literature does not provide certainty that there are doses without any neurobiological cost; the picture depends on age of exposure, drinking patterns, genetic and environmental factors, as well as comorbidities.

2. Sociological and Cultural Dimensions — The “Culture of Consumption”

Alcohol consumption is a social act; it symbolizes rituals, belongs to networks of recognition, and is defined by rules, values, and structures. Its proximity to the concept of the “culture of consumption” means that the act of drinking itself acquires identity and meaning within society (White, 1997).

2.1 Who defines “normal”?

From this perspective, it is not enough to ask why some cannot stop; we must ask why some are socialized to view consumption as a foundation of social recognition. “Excess” becomes a problem only within the framework of social expectations and limits (White, 1997).

2.2 Power, Body, and Biopower

Based on Foucault’s theory, social norms around alcohol use function as technologies of power: they not only prohibit or punish, but produce ideas about what is “normal,” “healthy,” or “pathological” (Foucault, 1978). Public health policies, medical standards, and social stereotypes compose the framework within which individuals self-regulate (biopower).

2.3 Gender and Social Class Analysis

The social interpretation of consumption differs significantly by gender and class position:

• In men, overconsumption may be considered socially tolerated or acceptable. In women, similar behavior is stigmatized.
• In less privileged social groups, consumption is often stigmatized as a “moral failing,” while in upper classes it is treated as a cultural practice.

Consequently, understanding use requires an intersectional perspective: gender × class × age × cultural context.

2.4 Critique of the Alcohol Industry and Legalization

The modern alcohol industry shapes and promotes consumption through marketing, advertising, social messaging, and access. The legalization of use is not based solely on scientific data but also on economic and political interests. The industry constructs a “culture of consumption” that reinforces the normalization of intoxication and the social acceptance of overconsumption, while simultaneously stigmatizing bodies and groups that do not conform to standards or develop problematic use.

3. Psychological Perspective: The Need to Investigate Deeper Causes

The social organization of consumption influences how individuals make sense of their experience. Consumption often appears as a way to regulate emotions, manage trauma, or fill an existential void.

Michael White’s (1997) approach encourages us to shift the question from “why can’t you stop?” to “what role does drinking play in your life?” — that is, to view use as an answer to personal and social issues, not merely as a biochemical phenomenon.

Therapy is not just about “stopping drinking,” but about discovering, processing, and changing your relationship with alcohol, your body, and the social conditions that encourage consumption.

4. Conclusion

Alcohol is not merely a substance that causes harm — it is a multidimensional phenomenon, touching upon:

• neurobiology (brain and behavior),
• society and culture (rules, gender, class, rituals),
• psychology (meaning, trauma, emotion regulation),
• power and normalization policies.

A critical look at the alcohol industry reminds us that use is not disconnected from political and economic interests: legalization, advertising, and the “culture of consumption” encourage behaviors often presented as “normal,” while society stigmatizes and excludes certain individuals.

A comprehensive approach must combine neuroscience, sociology, psychology, and a critical perspective on social structures and the industry, to fully understand the complexity of alcohol consumption and propose meaningful interventions.

In my sessions, I often see that behind every drink lies a personal story. Every person carries traumas, losses, and needs that are not easily expressed. When we approach these experiences with listening and empathy, we do not focus solely on “stop drinking,” but on the meaning of consumption and how it connects to the individual’s life and identity.

As Michael White says: “Every story behind the drink deserves to be told. Our job as therapists is to create a space where the individual can hear their own story and discover how to rewrite the chapters of their life, without the drink defining who they are.”

Bibliography (APA 7th)

Foucault, M. (1978). The history of sexuality, volume 1: An introduction. Vintage.

Karoly, H. C., Hutchinson, J. M., & Smith, K. L. (2024). Structural brain changes associated with alcohol consumption across the lifespan: A systematic review. Neuroscience & Biobehavioral Reviews, 150, 105–124. https://doi.org/10.1016/j.neubiorev.2023.12.005

Lees, B., Winstone, L., & Jackson, C. (2020). Adolescent alcohol exposure and white matter development: A meta-analysis. Frontiers in Neuroscience, 14, 112. https://doi.org/10.3389/fnins.2020.00112

NIAAA (National Institute on Alcohol Abuse and Alcoholism). (2024). Alcohol’s effects on the brain. https://www.niaaa.nih.gov/alcohols-effects-on-the-brain

White, M. (1997). Challenging the culture of consumption: Rites of passage and communities of acknowledgement. Dulwich Centre Publications.

World Health Organization (WHO). (2024). Global status report on alcohol and health. https://www.who.int/publications/i/item/9789240066083

1. The “New” Cannabis — Potency and Composition

In recent years, the composition of cannabis has changed dramatically: THC (tetrahydrocannabinol) concentrations have increased significantly, while CBD (cannabidiol), which can counteract some of THC’s effects, is often found in smaller percentages (Health Canada, 2023; Link Springer, 2024). Methods of use (smoking, oils, edibles, vaping) also differentiate the absorption, duration, and intensity of effects (Mayo Clinic, 2023).

2. Risks and Consequences of Use

Frequent THC use is associated with poorer memory, attention, and concentration (Canada.ca, 2023). The use of high-potency cannabis increases the likelihood of psychotic episodes by up to five times, particularly in vulnerable individuals (Di Forti et al., 2022). Furthermore, early use in adolescence is linked to an increased risk of depression and anxiety disorders (Stylianakis et al., 2024). Long-term use is associated with respiratory problems and increased cardiovascular risk (The Cardiology Advisor, 2024; ACC, 2025).

3. Dependence and Social Impacts

Cannabis can cause Cannabis Use Disorder, characterized by tolerance, withdrawal syndrome, and loss of control over use (NIDA, 2024). Its use is often associated with reduced academic and professional performance and an increased risk of traffic accidents (SAMHSA, 2023; CDC, 2023).

4. Potential Benefits and Therapeutic Uses

Science does not overlook the potential therapeutic properties of cannabis, primarily through CBD, which appears to help with chronic pain, nausea, and sleep disorders (Health.com, 2023). In Greece, studies show an improvement in the quality of life for patients receiving medical cannabis, but also deficiencies in guidance and protocols (Releaf UK, 2024; Stylianakis et al., 2024).

5. Critique of the Literature

Most studies on cannabis are observational rather than randomized clinical trials, thus showing correlations rather than causal relationships (The Lancet Psychiatry, 2024). Many do not adequately differentiate between THC and CBD, and there are also publication biases, with negative or neutral results appearing less frequently (Link Springer, 2024).

6. The Greek Reality

According to the EPIPSY survey (2019), approximately 8.2% of students aged 16–18 have used cannabis, while 50% consider its use harmless (Damianakis & colleagues, 2019). Greek healthcare professionals recognize the potential of medical cannabis but call for more data and regulation (Stylianakis et al., 2024).

7. Psychotherapeutic Approach and Deeper Understanding

During the therapeutic process, the goal is not merely to cease use, but to explore the ‘why’. Cannabis use is often a symptom—not the root of the problem. According to the Self-Medication Theory, substance use can function as a way to manage internal pain, traumatic experiences, or emotional distress (Khantzian, 1997). For others, use may represent an escape from a difficult reality or a response to broader psychosocial and cultural pressures—impoverishment, racism, social injustices, or the loneliness of modern life. Therefore, essential therapy is not limited to detoxification but seeks a deeper understanding of the meaning behind the use.

“As a therapist, I often wonder not only when and how much someone uses cannabis, but primarily why. What story does its use serve? What void does it try to fill? Every person I meet carries their own narrative—sometimes filled with loss, sometimes disappointment, sometimes silent resistance against a reality that does not accommodate them. For some, cannabis acts as a way to “numb” unbearable feelings; for others, as a temporary bridge to the calm they lack. If we view use through this lens, it ceases to be merely a symptom to be eliminated and becomes a message—an attempt by the individual to care for themselves in the best way they know at that moment. Our job then is not to remove the symptom, but to listen to the story that created it, to illuminate it, and to help the person compose a new narrative—a narrative where care does not come through use, but through connection, meaning-making, and freedom of choice. “

Conclusions

Cannabis is neither innocent nor absolutely dangerous. The essence of intervention lies in information, prevention, and a therapeutic approach that recognizes the person behind the use. Knowledge—not fear—is the basis of prevention.

References (APA 7th Edition)

Canada.ca. (2023). Health effects of cannabis. Government of Canada. https://www.canada.ca/en/services/health/campaigns/cannabis/health-effects.html

Centers for Disease Control and Prevention (CDC). (2023). Health effects of marijuana use. https://www.cdc.gov/cannabis/health-effects/index.html

Di Forti, M., et al. (2022). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI). The Lancet Public Health, 7(6), e427–e436.

Health.com. (2023). Marijuana: Benefits and risks. https://www.health.com/condition/chronic-pain/marijuana-benefits-risks

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.

Mayo Clinic. (2023). Medical marijuana. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855

NIDA. (2024). Cannabis (Marijuana) Research Report. National Institute on Drug Abuse.

Releaf UK. (2024). Greek study: Medical cannabis boosts patient quality of life. https://releaf.co.uk/blog/greek-study-medical-cannabis-boosts-patient-quality-of-life

SAMHSA. (2023). Risks of marijuana use. Substance Abuse and Mental Health Services Administration.

Stylianakis, A., et al. (2024). Assessing the market readiness for medical cannabis in Greece: A qualitative study of patient perspectives. ResearchGate.

The Cardiology Advisor. (2024). Cannabis use and cardiovascular risk.

The Lancet Psychiatry. (2024). High-potency cannabis and mental health: A review.

World Health Organization (WHO). (2023). Cannabis: Health and social effects of nonmedical use. Geneva: WHO.

Damianakis, P., & colleagues. (2019). Epidemiology of cannabis use among adolescents in Greece (EPIPSY Study). Drugs and Alcohol in History Journal, 6(1), 43–52.

However, there are certain elements that are useful for understanding which addictions may be more difficult, depending on the frame of reference. The question “difficult in what respect?” is crucial here.

Social and economic consequences:

If we are talking about social and economic consequences, alcohol appears to have the most severe impact. According to relevant research, it surpasses even “harder” substances like heroin and cocaine, in terms of:

• causing violence (interpersonal and domestic),

• accidents (e.g., driving under the influence),

• the overall burden on health and social welfare systems.

Addictive potential:

If we examine addictive potential (i.e., how quickly and intensely addiction develops), heroin and cocaine are at the top of the list, due to:

• the immediate reinforcement of reward circuits in the brain,

• intense physical and psychological dependence,

• and the severity of withdrawal symptoms.

Social availability and social acceptance:

If we weigh social availability and social acceptance, alcohol and gambling are particularly difficult cases. On the one hand, because they are positively portrayed by the media and culture as forms of entertainment. On the other hand, because they are legal and often not even recognized as problematic until serious consequences emerge.

Gambling, specifically, is often covered by the “cloak” of investment or strategic entertainment, making the addiction indistinct and socially acceptable.

Conclusion

Addiction is not merely a biological or psychological phenomenon, but an experiential relationship with a substance or behavior that holds meaning and a role in the individual’s life.

For this reason, there is no absolute answer to what constitutes “the most difficult” form of addiction. Perhaps the most honest formulation is: The most difficult addiction is the one that has not yet been recognized.