Why Talk About It?
“Fuck medical school,
I will just be a junkie for the rest of my life.”
- Me (In one of the most stupid and profound moments in my life)
At one point in 2005, I was sitting in my car, under a bypass in Irvington, NJ. My boyfriend and I had just copped some much needed dope. I had just pulled my dull ass needle out of my arm, dropped my head back into the seat and uttered the stupidest and most profound statement of my life: “Fuck medical school. I am just going to be a junkie for the rest of my life.” This uncharacteristic sentiment tumbled out of me because the heroin just relieved the hours of horrific pain and withdrawal that came with not having it. It was like the moment a fan turns off, and the room is suddenly blissfully silent, but you didn’t even realize the noise was making you tense. Not a crazy rush of pleasure, or euphoria. Not anymore. Not this far along. It was just relief. That relief was so all encompassing, so welcome, that I was willing to forgo a lifetime of ambition and hard work just to stay in that moment. There was no acknowledgment that the drug use had created the problem, only that it removed it. Temporarily. Now I could think straight. Now I would use my clear(er) head for the real work, the important work: finding a way to make sure we had enough money and dope to not have to feel that again. Withdrawal from opiates is like the worst flu of your life. There is nausea, vomiting, and diarrhea that seem like they are completely out of your control. Muscle aches that make even the strongest among us feel weak and helpless. There is this crippling pain, like someone scraping your bones with butter knives over and over. So yeah, finding a way to not have to feel it again was top priority. What I didn’t realize in that moment, though, was that this day and that statement would signal the beginning of the end of my active addiction.
People are dying. People are dying of a disease that is preventable and treatable. But we can’t prevent it if we don’t know what it is. We can’t treat it if we don’t understand it. We won’t seek to know or understand it if we can’t eliminate the stigma. The stigma that says it’s all about bad people making bad choices. The stigma that says only a certain type of person, from a certain type of home or neighborhood could be afflicted. The stigma that implies, in a deadly misperception, that it can’t happen to me or you or us.
Addiction is a plague. It touches nearly everyone. It does not discriminate. It doesn’t care if you are poor or wealthy, employed or unemployed. It doesn’t care what race or ethnicity or religion you are. It affects atheists and zealots alike. It affects the young as frequently as the old. Parents and children and siblings and spouses are not exempt. It affects employees and employers, bricklayers and politicians. Police officers and judges and nurses and secretaries fall ill with addiction. It will infect stay at home moms, CEOs and bus drivers. And it most certainly gets its deadly claws into medical school students from good homes.
I am talking about addiction and the disease process of addiction for several different reasons. Aside from my own history with it. One of the reasons that irritates me both personally and professionally is this idea that people call addiction a disease, but really have no idea why. Some people (corporations, pharmaceutical companies, healthcare industries) call it a disease because there is some, though not much, money to be made. But if you ask many of those entities to explain what the actual disease is: Crickets.
There are some that will call it a disease because, bless their bleeding hearts, they need to believe that the addict has no choice in their fuckery and tomfoolery. Still there are others who have some inkling of an idea that maybe biologically there is something going on that is more than just terrible people making terrible choices.
For the most part, what I have realized throughout my career is that when I am asked to speak about a specific topic related to addiction, the questions that I am asked following the lecture are really indicative of the fact that people just don’t get it.
Another reason I choose to talk about this is that I believe addicts need to understand what is going on within themselves. As much as we love to condemn an addict, no one, and I mean NO one is better at condemning them than they are. Addicts will beat themselves up, but then keep doing the same thing, and not know why. I want them to have love and forgiveness for themselves. I want family members to stop taking everything their addict does so personally. I think talking about the disease may give them a way to do that. Addiction is a conformational change in the brain that renders the individual unable to stop using substances without help. The symptoms of the disease range all the way from neurological underactivity to overt behaviors. The change does not occur in everyone that uses substances, but for those that do experience this biological rewiring, it can be devastating.
The stigma around addiction in society is nearly insurmountable. This negative portrayal of addicts in need of treatment and understanding ultimately limits access to services and the ability for addicts to thrive in recovery. It starts with our words and how we talk about addiction.
We are saying addiction is a disease, but when people begin comparing it to other disease processes like cancer or diabetes, it becomes a pissing match over which diseases are more important or deserve more attention. Because there are so many choice elements to it, it becomes harder to have compassion for the behaviors we see with addiction. I do not think I have ever witnessed someone say “I have multiple sclerosis” followed by a handful of people rolling their eyes, someone else walking out of the room, while another person announced, “My mom has cancer and she is a good person. Now THAT is a disease.” Additionally, every time a diabetic dies from a seizure, ketoacidosis, or kidney failure because of how they chose to eat, there is nobody talking about how their kids are better off without them. Every time that I have been present when it is announced that an addict dies of an overdose, there is someone with an opinion about how their kids are better off. We only selectively show sympathy for the family members and loved ones of someone who dies from addiction because we only semi buy into the idea that addiction is in fact a disease.