A mother once sat in my office and said, “Therapist, I searched his room and found tramadol tablets hidden inside his Bible.” She was trembling. Her son was nineteen. A first-year university student. A boy who had been singing in the church choir the previous Christmas. She had no language for what she was looking at. She had no framework. She had no map.
That is why I am writing this article.
Addiction does not knock on the door and introduce itself. It comes quietly, disguised as relief, an escape route, and a coping mechanism. It comes as belonging, as the thing that finally makes the noise in someone's head go quiet. By the time a family notices, the person they love is often deep inside something they do not fully understand themselves. And the family's response however loving can sometimes make things worse.
This article is for every Nigerian parent who has found something they cannot explain. For every partner watching someone they love disappear into a bottle or a pill. For every employer watching a brilliant employee unravel. For every person reading this who quietly recognises themselves in these words.
What Addiction Actually Is
Let us start with the science, because the science matters enormously for how we respond.
Addiction is clinically known as Substance Use Disorder (SUD) and it is classified by both the American Psychiatric Association (DSM-5) and the World Health Organization as a chronic brain disorder. Not a moral failure. Not a lack of willpower. Not a consequence of a weak character or a spiritually compromised life. A disorder of the brain.
The DSM-5 defines Substance Use Disorder as a pattern of use that leads to significant impairment or distress, with at least two of eleven specific criteria present within a twelve-month period. These criteria include: taking the substance in larger amounts or for longer than intended; persistent desire or unsuccessful attempts to cut down; spending a great deal of time obtaining, using, or recovering from the substance; craving; failure to fulfil major obligations at work, school, or home; continued use despite social or interpersonal problems; giving up important activities; use in physically hazardous situations; continued use despite physical or psychological harm; tolerance; and withdrawal.
Severity is classified as mild (2–3 criteria), moderate (4–5 criteria), or severe (6 or more criteria).
This classification matters because it determines how we should respond. You do not pray away a brain tumour and then expect the person to recover through faith alone. You do not shout at someone with hypertension and expect their blood pressure to normalise. A brain disorder requires brain-focused, evidence-based clinical intervention alongside every other support that love and community can provide.
The brain changes caused by addiction are measurable on imaging scans. They are real. They are documented in thousands of peer-reviewed studies. And critically with the right treatment, many of these changes are reversible.
The Scale of the Crisis in Nigeria
The numbers are not easy to read. But they are necessary.
The 2019 National Drug Survey conducted by the United Nations Office on Drugs and Crime (UNODC) and the National Bureau of Statistics found that approximately 14.3 million Nigerians representing roughly 14.4% of the population aged 15 to 64 reported using a psychoactive substance in the previous year. By 2022, the National Drug Law Enforcement Agency (NDLEA) placed the figure at 29.4 million.
Cannabis remains the most widely used illicit substance, used by an estimated 10.6 million Nigerians. But the crisis that has escalated most alarmingly in recent years is the non-medical use of opioids primarily tramadol and codeine-containing cough syrups particularly among young people aged 15 to 35.
Tramadol is a prescription opioid pain medication. In Nigeria, it has become one of the most widely misused substances among young people. Street-level tablets are often adulterated with other substances and sold at doses far exceeding safe clinical limits.
A single tablet misused recreationally may contain 200–250mg of tramadol; a dose that would be considered dangerous even in a
clinical pain management context.
Unfortunately, some individuals are victims of unqualified professionals owning chemists. A very long time ago as an undergraduate student,
I remember a chemist prescribed me Tramadol for headache. I puked all night, could not sleep, was very restless, my mind was blank, my head appeared to be empty, couldn't walk and it was like my body was disconnected from "me". That was the first and last time, I trashed it.
The NDLEA reports that tramadol seizures in Nigeria increased by over 400% between 2015 and 2022. It is available in open markets, motor parks, and on university campuses. Young people describe it as giving them energy, reducing anxiety, making them feel invincible. What it is actually doing is disrupting their developing brains in ways that will take years to fully understand.
The scale of this crisis is not an abstraction. In every secondary school, in every university hostel, in every construction site and commercial kitchen, in every office where people are under impossible pressure — people are self-medicating. They are using substances to manage pain, stress, trauma, exhaustion, and hopelessness that they have no other tools to address.
The Substances Driving the Crisis in Nigeria
Understanding what people are using and why is essential for appropriate intervention. Different substances produce different effects, carry different physical risks, and require different treatment approaches.
Tramadol
Non-medical use has exploded among Nigerian youth. Produces euphoria, reduces anxiety, and suppresses pain. Highly addictive with physical dependence developing rapidly. Withdrawal is extremely uncomfortable and requires medical management. Common in construction workers, sex workers, students under academic pressure, and young men seeking to enhance physical or sexual performance.
Codeine-Based Cough Syrups
Sold legally as cough suppressants but widely misused for their euphoric and sedating effects. Often mixed with carbonated drinks and sweets; a combination known as “lean” or “syrup.” Particularly prevalent among teenage girls and young women, often introduced in social settings. Physical dependence develops over weeks. Nigeria's government banned high-dose codeine syrups in 2018, but availability persists through informal channels.
Cannabis (Indian Hemp / “Igbo”)
The most widely used illicit substance in Nigeria. While cannabis is often perceived as harmless, regular use particularly by adolescents whose brains are still developing is associated with increased risk of psychosis, anxiety disorders, and cognitive impairment. High-potency modern cannabis strains carry significantly higher psychiatric risk than older varieties. Daily use in adolescence roughly doubles the risk of developing schizophrenia.
Alcohol
Alcohol use disorder is under-recognised in Nigeria because alcohol consumption is socially normalised, particularly among men. The UNODC survey found alcohol to be the most commonly used psychoactive substance overall. Chronic heavy use causes liver disease, heart disease, neurological damage, and significantly increases the risk of depression, anxiety, and suicide. Alcohol withdrawal can be medically life-threatening and must be managed clinically.
Methamphetamine (“Mkpuru Mmiri”)
Crystal methamphetamine use, known colloquially as “mkpuru mmiri” (meaning “grains of water” in Igbo), has escalated dramatically in southeastern Nigeria and is spreading to other regions. NDLEA has documented a significant rise in seizures and addiction cases. Methamphetamine produces intense euphoria followed by severe crashes, paranoia, psychosis, and cardiovascular damage. It is among the most destructive substances in terms of speed of physical and psychological deterioration.
Solvents & Inhalants
Often overlooked but particularly prevalent among street-connected children and adolescents from very low-income backgrounds. Cheap and easily accessible. Glue, petrol, paint thinner, and correction fluid are sniffed or inhaled for their intoxicating effects. Even a single use carries the risk of sudden death from cardiac arrhythmia (“sudden sniffing death syndrome”). Chronic use causes permanent brain damage and cognitive impairment.
How It Starts — Every Single Time
I have sat with a lot of people in addiction recovery. I have never met a single person who planned to become addicted. Not one. Every story begins somewhere recognisable, somewhere human.
The First Encounter
Usually in a social context — a party, a peer group, a workplace, a romantic relationship. Often framed as “just once,” “everyone does it,” or “it will help you relax.” Sometimes it is not voluntary; a child given a substance by an adult, a person whose drink is spiked, a patient given a pain medication and told nothing of its addictive potential. The first experience of a substance that the brain finds pleasurable creates a memory that the brain will spend years trying to recreate.
The Honeymoon Phase
The substance works. It reduces anxiety, lifts mood, provides energy, dulls pain, creates connection. The person feels better and sometimes dramatically better than they have felt in a long time. This phase is often where the underlying pain becomes visible: the person was using the substance to treat something — undiagnosed depression, parental separation, childhood trauma, social anxiety, the unbearable pressure of being a firstborn child in a struggling family. For a brief period, the substance solves the problem. This is precisely why it is so dangerous.
Escalation and Tolerance
The brain adapts. The same dose no longer produces the same effect. More is needed to achieve the same result. The person begins using more frequently, in larger quantities, in more situations. They begin organising their day around the substance. Missing a dose begins to produce discomfort, irritability, anxiety, physical symptoms. At this point, the person is no longer using to feel good; they are using to feel normal.
Dependence
Physical and psychological dependence has developed. The person experiences withdrawal symptoms when they stop or reduce use. For opioids and alcohol, withdrawal can be physically dangerous involving seizures, severe vomiting, cardiovascular instability. For stimulants and cannabis, withdrawal is primarily psychological but deeply uncomfortable, involving profound depression, anxiety, and insomnia. The person is now trapped in a cycle they did not choose to enter and cannot easily exit.
The Consequences Begin Accumulating
Relationships fracture. Academic or professional performance collapses. Financial problems mount as the cost of maintaining the addiction escalates. Health deteriorates. The person begins lying to themselves first, then to everyone around them because the alternative is facing a reality that feels unbearable. The family sees this phase and calls it “character.” It is not character. It is a brain in crisis trying to survive.
Warning Signs to Watch For
These are the signs that family members, spouses, friends, teachers, and employers consistently describe noticing — often weeks or months before they were willing to name what they were seeing.
- Unexplained and persistent secrecy: locking phone, disappearing for long periods, being vague about whereabouts
- Sudden, dramatic personality changes: especially extreme mood swings, aggression, or unusual elation followed by deep withdrawal
- Unexplained financial problems: money disappearing, borrowing without explanation, selling personal belongings
- Rapid decline in academic or professional performance: missed deadlines, absenteeism, declining quality of work
- Physical signs: bloodshot eyes, sudden weight loss or gain, changes in smell, tremors, poor hygiene, disrupted sleep patterns
- Withdrawal from family, long-standing friends, faith community, and activities that previously gave pleasure
- New peer group that the person is defensive about and reluctant to introduce to family
- Persistent lying: including about things that seem trivial, creating a general climate of distrust in the household
- Odours: smell of alcohol on breath at unusual times, smell of cannabis on clothing or in their room, unusual chemical smells
- Defensive or explosive reaction when the topic of substance use is raised: disproportionate anger to a simple question
Finding substance use paraphernalia like syringes, small plastic bags, unusual pills, burnt spoons, empty cough syrup bottles is a serious finding that warrants immediate professional consultation, not confrontation. Your first response sets the tone for everything that follows. A reactive confrontation typically pushes the person deeper into denial and further from help.
The Myths That Keep People Stuck
At BELWET Mind Clinic, in our clinical practice across Nigeria and the diaspora, these are the beliefs we encounter most consistently — in families, in communities, in the person struggling with addiction themselves. Every one of them is contradicted by evidence. And every one of them causes harm by delaying or distorting the response to addiction.
| What People Believe | What the Evidence Shows |
|---|---|
| “They can stop if they really want to. It is a choice.” | Addiction involves measurable changes in the brain's prefrontal cortex, this is the region governing willpower and decision-making. The capacity for free choice is neurologically compromised. Recovery requires clinical support, not just willpower. |
| “It is a spiritual problem. More prayer, fasting, and deliverance will fix it.” | Faith is a powerful resource in recovery and should absolutely be part of the journey. But addiction is also a brain disorder with specific neurological and psychological mechanisms that require clinical intervention. Spiritual care and clinical treatment are not mutually exclusive and the most effective recoveries often integrate both. |
| “They need to hit rock bottom before they can get better.” | This dangerous myth has cost countless lives. Early intervention produces significantly better outcomes than waiting for catastrophic consequences. “Rock bottom” for many people means death, permanent disability, or incarceration. Families and loved ones can and should intervene early and often. |
| “If they relapse, the treatment failed and they are hopeless.” | Relapse is a clinical event in the course of a chronic condition, not a moral failure and not evidence that recovery is impossible. Relapse rates for addiction are comparable to those for other chronic conditions like hypertension and asthma (40–60%). A relapse means the treatment plan needs adjustment, not abandonment. |
| “Only a certain type of person becomes an addict; the uneducated, the immoral, the poor.” | Addiction affects people across all educational, economic, social, and religious categories. Vulnerability to addiction is biological, psychological, and social. Background and achievement provide no immunity. |
| “Talking about it or asking direct questions will make it worse or put ideas in their head.” | This fear prevents early intervention. Research consistently shows that open, non-judgmental conversations about substance use reduce harm and increase help-seeking behaviour. Not talking about it does not protect anyone, it leaves the person feeling alone and unseen. |
What Addiction Does to the Brain
This section is specifically for those who want to understand the science well enough to explain it to others, to stop blaming themselves or their loved one for something that is fundamentally neurological.
The dopamine system
Every psychoactive substance that causes addiction works in different ways and to different degrees by flooding the brain's dopamine system. Dopamine is the brain's “signal of reward” the chemical that says “this was important, remember it, do it again.” Natural rewards like eating a good meal, achieving a goal, connecting with someone you love produces modest dopamine releases. Many addictive substances produce dopamine surges that are five to ten times greater than any natural reward. The brain, designed to learn and repeat pleasurable experiences, registers this as extraordinarily important.
Tolerance: the brain defending itself
The brain is not passive. When it is repeatedly overwhelmed by dopamine surges, it adapts by reducing its own dopamine production and sensitivity, essentially turning down the volume to protect itself. This is tolerance. The person now needs more of the substance to achieve the same effect. And without the substance, they feel far below their baseline like less pleasure from everything, persistent low mood, and emotional flatness, among others. The substance has become necessary just to feel normal.
The prefrontal cortex: what addiction steals
Chronic substance use damages the prefrontal cortex — the brain's executive control centre, responsible for impulse control, long-term planning, decision-making, and the capacity to weigh consequences. This is why a person in active addiction makes decisions that seem incomprehensible to people who love them. They are not being irrational. Their capacity for rational decision-making has been neurologically compromised. This is also why “just use willpower” is not a clinically meaningful instruction and willpower lives in the prefrontal cortex, and that is the region that addiction targets.
“Addiction is not a disease of moral failure. It is a disease of the reward, memory, and motivation circuits of the brain. Once you understand that, everything about how a family should respond changes fundamentally.”
What Families Are Getting Wrong
Most families in Nigeria are not absent when a loved one develops addiction. They are present, desperately present; praying, pleading, punishing, rescuing, exhausting themselves. The problem is that many of the most natural and loving responses to addiction inadvertently sustain it.
Enabling disguised as love
Enabling means doing things that protect the person from experiencing the consequences of their addiction like paying their debts repeatedly, calling in sick on their behalf, covering their lies, providing money that you know is funding their use. Every time we remove consequences, we reduce the person's motivation to change. This is one of the most painful realities in addiction: sometimes the most loving thing a family can do is allow the natural consequences of the behaviour to occur, while maintaining emotional connection and keeping the door to help open.
Ultimatums that are not enforced
“If you do this again, I will leave.” “If this continues, I will stop paying your school fees.” These ultimatums, when stated and then not followed through, teach the person with addiction that consequences are negotiable. Over time they provide no deterrent at all. If you set a boundary, it must be one you are genuinely prepared to maintain. The purpose of boundaries in this context is not punishment, it is creating a structure within which change becomes more likely than comfortable continuation.
Shame-based confrontation
In Nigerian family contexts, confrontations about addiction often involve the gathering of extended family, public shaming, threats of disownment, or comparisons with siblings and peers. The research on this is unambiguous: shame increases the risk of continued and escalating substance use. It does not motivate recovery. It deepens the pain that the substance was originally providing relief from. An effective intervention requires empathy, specificity, and a clear offer of help alongside clear consequences, not a tribunal.
Waiting too long out of fear of stigma
At BELWET Mind Clinic, we have met mothers who knew for two years that their child had a problem and said nothing to anyone out of fear of what would people say, what the neighbours would think, what it meant about them as a parent. Those two years cost irreversibly. Stigma is real and it is painful. But silence in the face of addiction is a choice with consequences that are more painful than any judgment a community could offer.
What Evidence-Based Treatment Actually Looks Like
Effective addiction treatment in Nigeria is not a prayer house, a rehabilitation centre that functions as a detention facility, or herbal treatment advertised on roadside billboards. It is a clinically structured process tailored to the individual, addressing not just the substance use but the underlying psychological drivers.
Step 1: Comprehensive Assessment
Before any treatment begins, a trained clinician must conduct a thorough assessment covering: the specific substance(s) involved and the severity of use; the presence of co-occurring mental health conditions (depression, PTSD, anxiety, and bipolar disorder are extremely common in people with addiction and must be treated simultaneously); the person's history of previous treatment attempts; their current social support system; their stage of change (are they willing? ambivalent? resistant?); and any immediate safety concerns.
Skipping this step and jumping straight to “treatment” without a proper assessment is why many first treatment attempts fail. Without knowing what you are actually treating, you cannot treat it effectively.
Step 2: Medical Detoxification Where Necessary
For opioid dependence (tramadol, codeine, heroin) and alcohol dependence, medically supervised detoxification is essential. Opioid withdrawal, while rarely fatal, produces extreme physical discomfort severe enough that most people relapse purely to stop feeling it, not because they have changed their mind about wanting to recover. Alcohol withdrawal can be medically life-threatening. The right medical environment, with appropriate pharmacological support, makes this process safe and significantly increases the chance of completing detoxification successfully.
Do not attempt home detoxification from alcohol, opioids, or benzodiazepines without medical supervision. Alcohol withdrawal in a dependent person can cause seizures and death. Opioid withdrawal, while not typically fatal, can cause severe dehydration, cardiovascular stress, and is associated with extremely high relapse rates without medical support. If you are unsure whether medical detox is needed, always err on the side of clinical consultation first.
Step 3: Motivational Enhancement Therapy (MET)
MET is a brief, evidence-based therapy developed specifically for people who are ambivalent about change which describes the majority of people with active addiction. It works with the person's own values, goals, and ambivalence rather than against them, helping to resolve internal conflict and build intrinsic motivation for change. MET is non-confrontational, respectful, and has strong evidence across multiple substance types and cultural contexts. It is one of the cornerstones of our addiction treatment approach at BELWET Mind Clinic.
Step 4: Cognitive Behavioural Therapy (CBT) for Addiction
CBT helps the person identify the specific thoughts, feelings, situations, and relationship patterns that trigger substance use. It builds concrete coping skills — specific alternatives to using when cravings arise, strategies for handling high-risk situations, tools for managing the emotional pain that the substance was originally addressing. CBT has one of the strongest evidence bases in addiction treatment and has been shown to be effective across all major substance categories.
Step 5: Trauma-Informed Care
A very significant proportion of people with Substance Use Disorder research suggests as many as 70–80% in clinical samples have a history of trauma, including adverse childhood experiences (ACEs) such as abuse, neglect, domestic violence, and household dysfunction. Trauma is often the original wound that substance use was attempting to treat. If the trauma is not addressed, recovery is extremely difficult to sustain. Trauma-Informed Care means ensuring that every aspect of treatment from the first session to the last acknowledges the role of trauma and avoids retraumatisation.
Step 6: Relapse Prevention Planning
Relapse is not an afterthought in addiction treatment, it is a central clinical focus. A comprehensive relapse prevention plan identifies the person's specific high-risk situations, early warning signs, triggers, coping strategies, and support network. It also prepares the person for what to do if a relapse occurs; how to interrupt it quickly, who to call, how to return to treatment without shame or self-destruction. A relapse that is caught early and responded to clinically is not a crisis; it is a piece of clinical information that improves the treatment plan.
What Recovery Actually Looks Like
Recovery is not a single moment. It is not the day someone stops using. It is not a linear journey from darkness to light. It is a process, sometimes gradual, sometimes with setbacks of rebuilding a life in which the substance is no longer necessary.
I want to describe what real recovery looks like because I think the gap between what people imagine and what is actually possible is enormous and this gap keeps people from believing recovery is worth trying.
In recovery, people rebuild their relationship with pleasure; learning to experience joy, connection, achievement, and rest without a substance. This takes time because the brain's natural reward system, depressed by long-term substance use, needs time to recalibrate. The first weeks and months of recovery are often characterised by a flatness and joylessness; what clinicians call post-acute withdrawal syndrome (PAWS) that many people misinterpret as proof that they cannot be happy without the substance. This phase passes. With support and clinical care, it passes.
People in recovery often describe it as learning to live in their own skin for the first time. Learning to sit with difficult feelings rather than immediately escaping them. Learning that they are capable of things they had stopped believing were possible. The person who emerges from sustained recovery is, in many ways, more self-aware, more emotionally resilient, and more connected to others than they were before addiction, and that is because recovery demands a level of honest self-examination that most people never undertake.
“At BELWET Mind Clinic, we have watched people walk out of addiction into extraordinary lives. People who had lost careers, marriages, children, health. Recovery is not a consolation prize. For many people we have worked with, it is where their real life finally began.”
When to Act And What to Do First
If you are reading this and recognising someone you love, or recognising yourself, the answer is the same: now. Not when things get worse. Not after the next consequence. Not after one more conversation. Now.
- You or someone you love is using a substance regularly and finds it difficult or impossible to reduce or stop despite wanting to
- Substance use is causing noticeable problems at work, school, in relationships, or with health and is continuing despite those problems
- The person becomes anxious, agitated, or physically unwell when they cannot access the substance
- You have found substances, paraphernalia, or evidence of use that the person denied or became aggressive about when confronted
- Previous attempts to stop — alone or through prayer, family pressure, or willpower and have not worked or have produced short-term improvement followed by relapse
- There are signs of co-occurring mental health problems like depression, anxiety, paranoia, psychosis alongside substance use
- You are a family member who has been adjusting your own life around someone else's addiction for months or years — this is a sign that professional support is overdue for you as well as for them
If you or someone you know is in immediate physical danger from substance use, unconscious, having a seizure, or showing signs of overdose; call emergency services immediately.
If the situation is urgent but not immediately life-threatening, contact us on WhatsApp at +234 815 730 2663 for a same-day clinical consultation. You can also give us a direct call on 07015736171.
Addiction Is Treatable. Help Is Available. Now Is the Right Time.
At BELWET Mind Clinic, our addiction treatment programme integrates Motivational Enhancement Therapy (MET), Cognitive Behavioural Therapy (CBT), Trauma-Informed Care, and comprehensive relapse prevention delivered by certified and licensed clinical psychologists and psychiatric doctors. Confidential. Afrocentric. Evidence-based. From ₦50,000 / $50 per session.
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