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Understanding Addiction (part one)

On my office wall is a piece of brilliance from Heiko Ganzer entitled, “I Am Your Disease.” This poem personifies the power of addiction and its desire to destroy. Investing five minutes in reading it will further your understanding of addiction better than researching any medical information, better than reviewing anything our government agencies produce, and better than the crap you hear in the media.

If you’ve never experienced addiction, it’s a lot to wrap your head around. In order to grasp it, you must be willing to think in completely irrational, and utterly self destructive ways. You have to table your ego – not being egotistical – your ego, the sum total of your identity. To see the world through someone else’s eyes is difficult/scary for most folks to do and yet it allows us a far deeper level of empathy and understanding. People confuse empathy with pity. One of the worst things you can do to an addict is pity them. Pity leads to enabling. Understanding leads to being more human and achieving better outcomes.

Remember the first time you took a sip of whiskey and the face you made? You had to learn to like it (if you liked it from the first sip consider that a red flag). Now imagine grinding up a tablet of Percocet (30 mg) and smoking it. The toxic mess you’re ingesting will rip your lungs to shreds. Now imagine craving that. Remember Pixie Sticks? Childhood hyperactivity in a plastic tube. Go buy one. Put a small amount in a thin vertical line. Roll up a dollar bill. Insert it in one nostril and snort that shit. There’s an excellent chance you will gag and a high likelihood you’ll puke. Now imagine craving that experience.

Christopher Robin asked Winnie the Pooh what his favorite time is? Pooh explained that there is a time when he knows he’s going to get some honey and the time just before he gets it is his favorite time. This is anticipation mixed with the expectation of immediate gratification. The brain of an addict develops very powerful and simple associations. Seeing a pill crusher, a razor blade, a needle, whatever they use to get high, causes their brain to light up like a Christmas tree. The preparation of getting high comes to release endorphins in the brain. This is why you’ll hear crazy stories of addicts shooting water into their veins – the act itself feels good even when there’s no reward.

I worked with a young man who was addicted to Percocet. He had managed to stay clean for three months but he could not get past the temptation to snort something. What he did to get past this craving is both incredible and horrible. For two weeks, every time he craved snorting Percocet, he forced himself to snort baking soda instead. This resulted in a lot of vomiting but it also cured him of craving the experience of grinding, cutting, and snorting. These simple associations are a lot to wrap your head around until you look at a brain scan of an addict when experiencing any form of anticipation. Going to such horrible lengths to be free lands right in the center of doing “whatever it takes” to be clean and sober.

Freedom of something most of us take for granted. Addicts are never free. To truly grasp this, one must understand the difference between being dependent on a drug and being addicted. Dependence is inevitable for any person who ingests addictive substances over an extended period of time. Rehabilitating from surgery often creates drug dependence. Most folks slowly titrate (wean) off their prescription meds under the supervision of a doctor and become free of dependence. Many find it difficult to cope with physical and emotional pain and are at risk of becoming addicted.

To the addicted, their drug of choice is the focal point of their life. There is nothing more important, more urgent, or more demanding. It’s not that they stop valuing their families, friends, careers, and hobbies, it’s that these things become secondary to the obsession and compulsion to get more drugs. It’s like Obsessive Compulsive Disorder (OCD) times ten with symptoms of physical withdrawal to boot. Most folks don’t understand how truly afflicting OCD is. In a nutshell, try to imagine having incredibly intrusive thoughts you don’t want coupled with feeling compelled to do them. The emotional experience is that you will cease to exist if the urge is not satisfied.

Addicts serve a master that convincingly promises relief while inflicting pain. Attaining drugs and doing drugs and getting more drugs is more than a pattern of destruction, it is life itself. Significant relief only comes through stockpiling and this is always short lived unless you have a prescription pad and/or lots of money.

We associate addiction with poverty, welfare, and criminology. While these are often the results of addiction, we continue to believe that addiction is not a middle class/upper middle class problem despite overwhelming evidence that it is. We associate addiction with “hard drugs:” like heroin, cocaine, and now prescription meds. We do not consider highly addictive drugs like Klonopin, Ativan, Xanax or Valium to be drug addiction because grandma takes them and she is prescribed them. We do not consider Adderall, Ritalin, or Vyvanse to be addictive drugs because our pediatricians give them to our children.

It’s time for us to wake up. Every addictive substance causes dependence and every dependence carries the risk of addiction and addiction destroys lives. More to come – all questions and comments welcomed at

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