Chapter 4: The Disease of Addiction, pt. 1

The universal nature of addictive experience
What I enjoy the most about having a presence on the internet is receiving comments from people from around the world.  The writers describe the same progression of symptoms that characterize opioid dependence, a disease that affects people from all cultures and socioeconomic groups.
I often think about how surprised most ‘normal’ people would be to learn the true extent of what can only be described as an epidemic of opioid use.  Writers, stockbrokers, artists, businessmen, doctors, lawyers, factory workers, photographers, teachers, students, IT professionals, waitresses, realtors, landlords, welders, professors, home-makers, mothers and dads… I have patients with opioid dependence from all of these occupations in my practice alone.  And in each patient, the story is the same…  the initial use, the loss of control, the assumption that the control will come back, the feeling of being ‘different’ from those ‘other people’ who get addicted, the assumption that what happens to other people won’t happen to ME, the repeated failures to control use, the repeated episodes of withdrawal, and the fear deep in the gut that maybe I really AM in trouble after all.  Each addict knows the deep shame that ‘I should have known better.’  Each addict makes a weak effort to blame someone or something else—a lie that even the addict doesn’t fully believe but that he still uses since the alternative– accepting all the blame himself– is intolerable. Each and every addict has done things that he never thought he would do—spending the family Christmas fund on pills, picking the kids up late from school because of a dope deal or from ‘nodding off’ at work, lying to friends, spouse, or children, stealing pain pills or money from family members, and eventually criminal activity and serious consequences that leave the addict thinking, ‘how did I become one of THOSE people?!’ At that point the addict often rationalizes that his constant guilt keeps him from getting clean, but that is just another excuse; he could just as easily say that being sick of hating himself is the reason he MUST get clean.
The first choice is the one that is taken, because for an addict, there is ALWAYS an excuse to use. The family is too distant… or is‘suffocatingly close.’  The weather is too horrible, or too nice.  The house is too empty or too full; my wife is too attractive and flirty, or too unattractive and boring.  There is always an excuse– which really means that there is never an excuse.  I run short on patience when addicts telling their stories get to the excuses; I have heard them all and none of them mean anything.  And yes, I have used many of the same excuses back in my own using days.
For the typical opiate addict, those first few weeks of using felt great.  He/she was stressed over a busy job and the opioids provided extra energy at home.  The spouse and kids were happy about the changes in attitude.  But after a short time the addict began to feel miserable inside (note:  even after years of sobriety I will hear addicts wonder if they can pull it off;  find a way to capture that initial euphoria without the misery that follows.  I can save them much trouble—the answer is ‘no’).  The addict retreats further and further into a world of secret thoughts.  His personality and interests grow smaller and smaller and he puts up a cocky façade, thinking he is fooling everyone. His kids might be the first to notice that something isn’t right, only because they lack the ability to ignore and repress thoughts that are too painful or frightening to acknowledge.
A parent living behind a façade is a set-up for causing borderline personality in the kids;  later when the kids talk to their own therapists they will say that everything seemed OK– there were no beatings, and dad was always happy…  but normal child development doesn’t do well with ‘fake’ personalities.  The kids internalize the growing distance from the addict (dad or mom) as somehow related to them.  To kids, everything relates to themselves… so the distance becomes part of low self esteem, mood swings, cutting, and impulsive behavior that is really borderline personality but that some shrink with 7-minute appointments will misdiagnose as ‘bipolar.’   The kid will be put on Depakote or Seroquel or Zyprexa and will gain 100 pounds, assuring a lifetime of self-consciousness.  It is hard to acknowledge, but our addictions are horrible for our children.
The good news is that sometimes the addict will get miserable enough to take action.  The bad news is that the damage will last a lifetime– not just the addict’s lifetime, but the kids’ lifetimes as well.