Sugar, Sex and Substances: Why It's Hard to Make Changes

Joanna Eveland, M.D.
Joanna Eveland, M.D.

A lot of us want to stop, reduce, or change how we use a substance in our lives. But it can be hard. We've evolved, as a species with bodies that are particularly attuned to rewards and incentives -- things like sugar, sex or any substance that increases the amount of dopamine released in our brain. Sometimes, preferring these things can be harmful, since we don't exist in the same environment our bodies have evolved to help us survive in.

Knowing a little bit about how the brain works can help if you want to end an addiction, slow your use, or reduce the harm caused by a substance.

What's the Connection to HIV?

People use substances for all kinds of reasons -- to help them cope with trauma, find community, relieve stress, or to ease suffering caused by a mental illness, to name a few. But when I worked as an HIV specialist, I noticed that many of my patients were getting sick -- not from HIV -- but from something caused by over-use or misuse of a substance. Patients got lung cancer from smoking, or diabetes because they couldn't give up eating sweets.

People with HIV actually have higher rates of substance use. One in four people living with HIV report alcohol or drug use at a level warranting treatment. In addition, the rate of cigarette smoking is two to three times higher among adults who are HIV-positive than HIV-negative.

Substance use can also put people at risk of HIV infection -- for instance, people who use injection drugs without access to clean needles may be at a higher risk of HIV. Substance use might also can increase the risk of sexual HIV transmission if a person is making decisions about sex that he or she wouldn't make sober.

The impact of substance use may be higher for people with HIV, since both HIV and substance use cause the immune system to react abnormally over long periods of time. People who have HIV and also use substances are probably increasing the amount of inflammation that's happening in their body and increasing their risk of heart disease, cancers and neurological problems. One recent study suggested that smoking cigarettes is more damaging for people with HIV than HIV itself.

HIV and substance use can both be connected to trauma, and people with HIV have higher rates of trauma exposure than the general population. Experiencing any kind of traumatic event, especially early in life, can change your brain in ways that make you more likely to get hooked on something.

People living with HIV are motivated to stay healthy. Receiving an HIV diagnosis can be difficult, but for many of my patients, it is also a wake-up call for them to focus on their health. This might include things like eating a healthier diet or cutting down on alcohol and substance use.

This excerpt was cross-posted with the permission of Read the full article.