David Smith, MA LPC NCC

Why Is Addiction Still Considered a Personal Weakness?

The Vast Emotional and Financial Costs of America’s Killer Epidemic

When we hear about someone with a heart problem, HIV, cancer or diabetes we conclude they are ill. If we encounter people whose throats close when they eat peanuts or require epinephrine shots if they mistakenly eat shellfish, we understand there are aspects of their genetic wiring that make them susceptible. Yet when we hear about someone with a drug or alcohol problem, they are all too easily dismissed as weak, self-indulgent, indolent, sinful, narcissistic, debauched and feeble failures. Why don’t we assume that drug and alcohol addicts are ill and often seriously and chronically sick?

That’s one of the questions raised by Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, David Sheff’s new book that studiously documents his reflections on the place of addicts in America. Sheff knows whereof he writes. He documented the calamity of drugs in his previous work, Beautiful Boy, which described in horrifying detail the descent into life’s basement of his son, Nic, who took his first puff of pot at the age of 12, feasted on pills of all concoctions, later started shooting up cocaine, heroin and crystal meth and subsequently ricocheted between the streets, halfway houses and all manner of treatment centers. (Sheff, I should note, is a longtime friend).

Since the 1980s, drug-related deaths in America have doubled – partly because the potency of some drugs has doubled or tripled. (Deaths from prescription drugs quintupled between 1999 and 2007). The Centers for Disease Control estimate that every day 365 people die in the United States from drugs and around another 275 die because they have become the victims of addicts through robbery, driving accidents or murder. That’s around 250,000 deaths a year - or about five times the number of U.S. military of deaths during the entire Vietnam War or almost forty times the number of US military fatalities in Iraq and Afghanistan.

It is impossible to overestimate the consequences of drug and alcohol addiction on society, and Clean should be an eye-opener for every parent and manager who clings to old-school prejudices and believes that addiction is a matter of choice and human weakness. One in twelve Americans over age of 12 is addicted to drugs or alcohol and addiction is now a more prevalent disease than cancer, stroke, HIV or Alzheimer’s. In poorer communities, the problems are viciously accentuated. Beyond the personal tragedies, addiction places a huge hidden tax on America – on our healthcare system, juvenile detention centers, prison systems (which are poorly suited to treat addicts but groan beneath the burden of their incarceration) and, most insidiously, workplace absenteeism (of both the physical and mental variety).

Every day in America, according to Sheff, about 20,000 people over the age of 12 try drugs or alcohol for the first time. Some teens (and US teens use more than in any other country) have a sip of alcohol or a toke, dislike the taste and are strong enough to shrug off peer pressure or have a good enough relationship with their parents or teachers to seek assistance. But for the unlucky teenager, that early sip, sniff, smoke or snort provokes a mental stimulus that leads to a life of misery. Nine out of ten addicts fall into this dreadful hole because they started using before the age of 18. Lest we forget, about 40% of college students engage in binge drinking which can also lead to long-term calamity. For teenagers, whose prefrontal cortexes (the brain’s center of judgment) aren’t fully formed, those early experiences are catastrophic. This makes it nearly impossible for many teenagers to stop using. Drug and alcohol use changes the brain.

The perils of drugs and alcohol addiction are faced in every home and workplace. The addict, at least for a time, is usually adept at concealing the problem. The relative, friend, colleague or boss is often oblivious (frequently for years), sometimes woefully ignorant, often blind to the indisputable scientific evidence, all too eager to offer the benefit of the doubt, and often does not know where to turn for help or whose judgment to trust.

Sheff notes that most doctors have not been trained to recognize the traits of substance abuse – particularly in teenagers where it is most dangerous. For the disease of addiction there is no national center, association or society as there are for other illnesses such as cancer, diabetes or the heart. Almost half the pediatricians in the country fail to recognize drug problems in teenagers. Most of them simply haven’t been trained to screen properly. Every case is different yet – as with other diseases – there are warning signs such as: a familial history of addiction, attention deficit disorders, depression, stress, anxiety, poverty, trauma and broken marriages.

Clean provides an unvarnished portrait of the world of detox centers laced with charlatans and people quicker to separate patients from their money than their habits. He describes the pros and cons of inpatient and outpatient treatment, the way drugs can sometimes be used to wean addicts but, above all, stresses the importance of intervening as early as possible. For the longer an addict is hooked the more protracted and painful is the treatment.

The baffling catalogs and web listings of available treatments that greet addicts and their families range from the primitive (cutting grass with a pair of scissors) to the ethereal (solitary meditation retreats) and the physical (outdoor wilderness retreats). By contrast, the cinderblock-sized guide many teenagers consult before applying to college looks straightforward. Treatment programs, which are frequently entered when both the patient and their helpers are distraught and confused, are a complete crapshoot.

Though there are a few bright spots, America’s many battles (there has never been a purposeful war) over drugs have failed. The public admissions of Betty Ford or Kitty Dukakis are long forgotten. Nancy Reagan’s battle cry (“Just say no”) is now just a trivia question. Even the mournful memory of John Belushi’s gurney being wheeled out of the Chateau Marmont has become another milestone on our national drug trail. All these many tragedies later, we still find ourselves chuckling as the comedy shows ridicule the dependencies of celebrities like Charlie Sheen and Lindsay Lohan.

Maybe we can take some solace from the reversal of one fatal addiction: smoking. The carcinogenic consequences of cigarettes were first highlighted in 1953 and, though it has taken decades, refinements in medical education, huge public health campaigns and a hardening of public sentiment have led to a massive improvement. In the last fifty years, the prevalence of smoking in America has dropped by more than half. Doing for drug and alcohol addiction what has been done for smoking will be hard, require large amounts of money and will take several generations. But it’s a fight in which we should all enlist. Remember, addiction is not a choice; it is a gruesome disease. And – like it or not – we are all co-dependents.

by: Michael Moritz