Professor Victor Lasebikan, a consultant psychiatrist and addiction specialist at the University College Hospital, Ibadan, explains in this interview with Sade Oguntola that addiction is not a moral failure or a sign of weak character but a complex brain disorder that Nigeria will require better public education, stronger policies, improved access to treatment and rehabilitation services, and greater collaboration among stakeholders to immediately address.

From a psychiatric perspective, why is addiction described as a brain disease instead of simply a lack of self-control? What actually happens in the brain?

Addiction is called a brain disease because repeated use of drugs changes the way the brain works. It is not simply a matter of weak willpower. Research has shown that addictive substances affect the brain’s reward system, especially the dopamine reward pathway, which controls pleasure, motivation, learning, and habit formation.

When someone repeatedly uses drugs, the substances hijack the brain reward system responsible for the experience of pleasure. The patient also begins to lose interest in normal activities such as eating, spending time with family, working, or achieving personal goals. This is why many people find it extremely difficult to stop using drugs without proper treatment.

Addiction can also be genetic or secondary to psychiatric disorders or become physical illness. A person’s environment, emotional well-being, and life experiences also play important roles. Individuals who grow up in environments where drugs are easily available or who struggle with depression, anxiety, trauma, or low self-esteem have a higher risk of developing substance use disorders.

Because addiction involves changes in the brain, it is a medical condition that can be approached through appropriate psychiatric intervention and other psychosocial care, counseling, medication, and rehabilitation.

What changes occur in the brain that makes addiction so difficult to overcome?

Addiction affects several parts of the brain, not just one area. Repeated drug use changes important brain chemicals such as dopamine and serotonin, which regulate mood, pleasure, motivation, and behavior. Over time, the brain adapts to these substances and begins to depend on them to function normally.

Genetics also contributes significantly. Some people naturally have a higher risk of becoming addicted because of inherited traits. When these genetic factors combine with repeated drug use and environmental influences, the likelihood of an individual developing addiction increases. This explains why addiction is regarded as a complex brain disorder rather than a personal weakness.

In Nigeria, substances such as tramadol, codeine, cannabis, and methamphetamine are commonly abused. Which of these causes the greatest psychiatric problems?

Every psychoactive substance has the potential to cause serious harm. Rather than focusing on one particular drug, it is important to understand that different substances affect the brain in different ways. Some stimulate the brain, others slow it down, while some distort perception and thinking.

One major concern among psychiatrists is the increasing number of patients who develop psychotic symptoms after using drugs. Sometimes these symptoms appear shortly after drug use, but in many cases, drug use reveals an underlying mental illness that had previously gone unnoticed. As a result, many patients are diagnosed with both a substance use disorder and another psychiatric condition.

Another growing concern is polydrug use. Many young people no longer use a single substance. Instead, they combine drugs such as tramadol, codeine, cannabis, alcohol, and other substances to produce stronger effects. These dangerous mixtures often referred to as “cocktails”, greatly increase the risk of severe mental illness, overdose, and other serious health complications.

Is drug abuse limited to certain social or economic groups?

No. Drug abuse affects people from every social class. Treatment centres receive patients from wealthy families, professional homes, religious backgrounds, and low-income communities alike. Addiction does not discriminate based on occupation, education, or financial status.

The internet has also contributed to this growing challenge. Young people now have easier access to information about different drugs, making experimentation more common. Unlike in the past, when many people started with alcohol or tobacco before progressing to stronger substances, some young people now begin directly with cannabis, methamphetamine, or other highly addictive drugs. This changing pattern has made substance abuse more widespread and difficult to control.

Many young people believe cannabis is natural and therefore harmless. What is your opinion on this?

That belief is misleading and can be dangerous. Although cannabis is a plant, being natural does not automatically make it safe. Many naturally occurring substances can be harmful to human health.

Cannabis has been linked to several mental health problems, particularly psychosis. The risk is even greater for individuals who have a family history of schizophrenia or other psychotic disorders. Research has also shown that long-term cannabis use may lead to structural changes in the brain, including reduced brain volume. These changes can affect motivation, memory, concentration, and decision-making.

In addition to its effects on mental health, cannabis can also harm physical health. Regular smoking increases the risk of chronic respiratory diseases such as bronchitis, while prolonged use has also been associated with reproductive health problems in both men and women. For these reasons, cannabis should never be regarded as harmless simply because it is natural.

What signs should parents look out for if they suspect that their children may be using drugs?

Parents should pay close attention to noticeable changes in their children’s behaviour and daily routines. One of the earliest warning signs is increased secrecy or withdrawal from family activities. A child who suddenly becomes unusually private or avoids communication may require closer attention.

Another important sign is a sudden decline in academic performance or a loss of interest in school and other responsibilities. Parents should also watch for changes in appearance and behaviour, such as wearing sunglasses indoors, using strong perfumes to hide unusual smells, or having unexplained marks on the body that could suggest drug injection.

While these signs do not automatically confirm drug use, they should encourage parents to have open conversations with their children and seek professional help if necessary.

Some young people claim that cannabis or alcohol helps them study better or improves their concentration. Is this claim true?

Some drugs may temporarily make a person feel more alert, relaxed, or focused. However, these effects are short-lived and can be misleading. With continued use, these substances gradually reduce memory, concentration, motivation, and the ability to make sound decisions.

Although users may believe they are performing better, the long-term effects are harmful and often interfere with learning, productivity, and emotional well-being. There is no scientific evidence that regular drug use improves academic performance over time.

When depression, anxiety, and addiction occur together, which usually comes first?

There is no single answer because the relationship works both ways. Some people already have mental health conditions such as depression or anxiety and begin using drugs in an attempt to cope with emotional distress. Others develop anxiety, depression, or other psychiatric problems after prolonged substance use.

Health challenges can begin at a very young age, even before someone starts using drugs. This is why every patient should receive a proper mental health assessment to determine the underlying cause and provide the most appropriate treatment.

If addiction is a medical condition, why are many people with substance use disorders arrested instead of receiving treatment?

This reflects a major weakness in the current system. Addiction should be treated as a health condition rather than simply a criminal offence. Unfortunately, many individuals with substance use disorders are punished instead of being offered psychiatric care and rehabilitation.

Where a person has committed a criminal offence, the legal process should continue, but this should be combined with appropriate medical treatment. Addressing both the legal and health aspects of addiction offers a better chance of recovery and reduces the risk of future drug-related problems.

Why do we condemn drug use on one hand, yet drugs are often glorified in music, movies, and social media?

This is largely due to weak enforcement of existing policies. When celebrities and social media influencers portray drug use as fashionable or desirable, they indirectly encourage young people to experiment with drugs. Although regulations exist, they are often not properly enforced. Stronger monitoring and responsible media representation are essential to reduce the normalisation of drug use.

Some people argue that individuals have the right to do whatever they want with their own bodies, including using harmful substances. What is your response?

From both medical and ethical perspectives, protecting life and health remains a priority. Substance use that threatens a person’s well-being should never be viewed simply as a personal choice without consequences. Healthcare professionals have a responsibility to provide treatment and support for individuals struggling with addiction, rather than ignoring the problem.

What is the biggest misconception Nigerians have about drug addiction?

One of the biggest misconceptions is that addiction results from poor character or lack of discipline. Many people rely on rumours, social media, or misinformation instead of seeking advice from qualified healthcare professionals.

The truth is that addiction is a complex medical condition with biological, psychological, and social causes. Effective treatment requires professional assessment, counselling, rehabilitation, family support, and, where necessary, medication.

How common are drug-related psychiatric cases in your clinical practice?

Drug-related mental health problems have become increasingly common. A large proportion of patients seen in psychiatric clinics today have substance use disorders or mental illnesses that are directly or indirectly linked to drug abuse. This highlights the growing burden of substance use on Nigeria’s healthcare system.

Have you encountered any particularly memorable cases of addiction?

Yes. One of the most heartbreaking experiences involved a young person from a well-educated and financially stable family. The case demonstrated that addiction does not discriminate. Regardless of a person’s educational background, occupation, or social status, anyone can become addicted if the risk factors are present. It also showed how difficult recovery can be once addiction becomes severe, reinforcing the importance of early prevention and treatment.

Is addiction common among professionals?

Yes. Addiction affects people across every profession. Doctors, lawyers, teachers, clergy, military personnel, law enforcement officers, and many other professionals have all been treated for substance use disorders. Addiction should therefore be seen as a public health issue that affects society as a whole rather than a problem limited to a particular group.

Some people believe that drug users are arrested while those responsible for supplying drugs often escape punishment. What is your opinion?

Tackling drug abuse requires addressing both the demand for drugs and their supply. As long as illegal drugs remain easily accessible, substance abuse will continue to increase. Effective enforcement should therefore target both drug traffickers and users, while ensuring that individuals living with addiction receive appropriate medical care. (Nigerian Tribune)