by melanie sheckels
With addiction being a prominent issue in the news lately, I wanted to share my perspective as it is something that I encounter a lot working at the hospital. I have detoxed people who came to the emergency room as a last-ditch effort to get clean. One man in particular seemed to have one coherent and driving thought. Every day he asked that we call his mom and tell her that he was finally finished with drinking for good. We detoxed him, only to send him home more than likely ill equipped to maintain his sobriety due to lack of community resources and family support. I have provided end of life care to people dying of complications related to long term drug and alcohol use, and I have consoled their families. I’ve cared for people who have overdosed and survived by the skin of their teeth. I’ve cared for “drug seekers,” and I have rolled my eyes as I brought them dose after dose of IV Dilaudid because they said they were allergic to everything else. In my personal life, I have loved people who were steeped in their addiction. When I was hurt, I blamed them for choosing to use over me. I have cut someone I love out of my life in the interest of self-preservation. I have mistaken addiction for a choice and a moral failing. I have participated in the stigma surrounding addiction.
Recently, an old friend died of liver failure after an alcohol binge. Naturally, this was upsetting to me. Through working as a nurse and volunteering with hospice, I’ve become pretty familiar with death. What I was feeling was different than the typical sadness associated with grief. I was hurt and angry, and most of these feelings were directed at me and my friend. I was mad at myself for not advocating for him. I was mad at him for “choosing” his addiction. He was beautiful, brilliant, and hilariously funny. The world needed him in it. He had always been so private about his health, though I knew he drank heavily. I had previously experienced first-hand the turmoil of being close to someone who struggled with addiction. Because of this, I assumed his odds of seeking treatment or achieving recovery were pretty slim. For the last few years of his life, I had held my friend at arm’s length. I was afraid of watching him slowly die and being powerless to help him. I learned in school that addiction was a disease, but upon my friend’s death I realized that I did not believe it one bit.
When someone you love is an addict, you are likely opening yourself up to a world of hurt. Their brain chemistry has been rewired with intense memories of drug-induced pleasure and an inhibition of complex, organized thought and planning. As the disease progresses, the addict becomes consumed with recreating that memory, frequently at the expense of everyone and everything that is important to them. Their ability to make choices, to love you, or to respect your boundaries is severely impaired. Culturally, we are taught that addicts are selfish, and our only choices are to enable their addiction or cut them out of our lives. I do not believe that anyone would choose the type of end that most addicts meet. I can't think of any other disease short of leprosy in which it is an acceptable practice to ostracize the sick. These beliefs are harmful to everyone involved.
I don’t intend to dismiss the role of choice in an addict’s initial encounters with a substance. They choose it right up until it chooses them. Substance use becomes addiction after a pattern of behavior develops over time. This is why it is crucial to teach safe use and moderation before people begin developing habits with substances.
Addiction doesn’t leave a physical mark on your body. It is often mistaken for a moral weakness rather than a disease. Addiction cannot be willed, wished, or prayed away and has been well documented as a complex, neurochemical process. Like diabetes or heart disease, we have tools that effectively identify those at risk. Though addiction treatment is highly complex, it can be managed as well or as poorly as any other disease. Despite this, we tend to view it as a moral failing on the part of addicts and any loved ones that stick by their side. This stigmatizes the disease, the sick, and their family. This creates massive barriers to addiction treatment. Ninety percent of people entering treatment programs in the U.S. don’t receive evidence-based treatment. Most addicts don’t receive any treatment at all.
Whether you know it or not, someone around you is struggling with addiction or using substances in a way that is risky to their health and well-being. The way that we think and talk about addiction can either make getting help easier or drive someone who is vulnerable further into isolation. Addiction requires our attention. Until we begin to understand addiction as a complex disease process rather than simply a series of selfish choices it is a problem that will continue to affect us all. Those suffering from it need our empathy, our support, and a system within which they have a hope for recovery.