Experts have known it for some time. But I admit I was taken aback to learn that heroin is not addictive. Any more than crack cocaine or crystal meth is addictive. Or alcohol or Zoloft. Or jumping into bed with one sex partner after another or watching marathon episodes of House. Or dining habitually on tasty fats saturated in, well, saturated fats.
By way of illustration, we recognize compulsive gambling as an addiction. But, as Dr. Gabor Maté points out, we don't blame the addiction on a deck of cards.
Recently, I was privileged to introduce Dr. Maté at a reading of his extraordinary book, In the Realm of Hungry Ghosts: Close Encounters with Addiction. He noted in his talk that one of the "bedbrock fables" of the War on Drugs is the widespread belief that "drug taking by itself [leads] to addiction -- in other words, that the cause of addiction resides in the power of the drug over the human brain." If that were so, he concludes, millions of people who are prescribed opioids for pain relief, some for very long periods of time, and who survive their illnesses and/or recover from their injuries, would emerge as stone-cold, life-long addicts. Very few do. Indeed, as cited in Hungry Ghosts, 4.6 percent of Canadians have tried crystal meth -- today's scariest, "most addictive" drug -- yet only .05 percent had used it in the past year. As Maté points out, if we accept traditional definitions of addiction, those two numbers would be virtually the same.
I have some personal experience with the subject: a flirtation with drug addiction back in the early eighties. Originally prescribed to manage the pain of a failed kidney stone extraction, I went to work for weeks with pockets full of Percodan. At first I took the tablets because of the pain. Then I took them in expectation of pain. Finally, even after a new and improved urologist flushed the beast out of me and the pain was at long last gone, I took them because I liked how I felt under their influence.
I was a deputy chief of police at the time, and scared to death of being fingered as an addict. So, blissful as those little pills made me feel, I didn't try to renew the prescription.
In time, I came to realize that the drug had masked more than physical pain. Because of what was going on in my life I was particularly ripe for the escape it provided.
Now, some 30 years later I've developed another kidney stone, a nasty calculus causing familiar agony. This one's equally reluctant to leave of its own accord (despite weeks of Flomax and a filter). Once again, I'm popping Percodan. But there's a difference this time around.
Remember that M.A.S.H. episode where Hawkeye, recognizing he's got a drinking problem goes cold turkey? He's been dry for a spell but after a grueling day in the O.R. he joins the crowd at Rosie's and orders a cocktail. The bartender fills the glass in front of Hawkeye. Our hero stares at it. "Boy, do I need this." Suddenly, he shakes his head, stands up and walks away, saying over his shoulder, "I'll come back when I want it."
It's the opposite for me, yet it's the same principle. I'm taking pain pills not because I want them but because I need them. In fact, I can't wait to get not only the stone out of my body but the Percodan as well. I appreciate the relief and I'm grateful there's medicine out there to provide it. But when the pain leaves so will my need for the pills. That's a good feeling, and I don't take it for granted.
"Addiction" is never about the substance or the behavior. It's always about the underlying pain.
A former family physician, Dr. Maté has worked for years in Vancouver's Downtown Eastside. He's met and treated thousands of patients, people who when they're not seated across from him at the Portland Hotel are huddled in the rain, dumpster diving for food, panhandling, stealing, dealing, hooking, nursing injuries. Living from fix to fix. His descriptions of their medical conditions are graphic and heartbreaking, no less their personal histories. As he told his audience in Seattle, he's never treated a female heroin addict who had not been sexually abused as a child. The incidence of childhood physical and emotional abuse for male addicts is just as dismal.
It bears repeating. It's not about the smack, it's about the pain.
Yet, we continue to wage war on those with chemical dependencies. We persecute and prosecute them, limit or bar their access to treatment, strip them of their dignity -- in large part because of the myths surrounding addiction.
The solution? Stop the drug war. Legalize, tax, and regulate all drugs. Integrate drug policy -- abuse prevention, education, treatment -- into the field of public health. And treat addicts as human beings, their physical and psychological issues as the medical conditions they are.
January 31, 2010
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Drug Warriors: Addicted to Myths