The Many Faces of Addiction
Don’t shun the addict. Embrace the human being struggling with addiction.
I asked a group of nursing students write down the first thing that comes to their mind when they hear the word: addict.
Their responses included: loser, thief, liar, pathetic, homeless, failure, poor, disabled, hopeless, guilty, shameful.
This exercise, and the responses it elicited, reinforced my belief about the enduring stigma of addiction. Rather than provide the planned clinical lecture on addiction, I pivoted away from my prepared remarks and shared my own word associations connected with the term addict. These descriptions were based on the individuals that I worked with throughout my years of clinical work.
Successful. I spoke about Cindy,* a 40-year-old CEO of a successful company who presented to treatment after being arrested. While driving drunk, she hit a traffic barrier and because her 5-year-old daughter was in the car, her actions met criteria for felony DUI.
By societal standards she was living the dream. She had an amazing job, a beautiful home and well-behaved children. She also drank alcohol daily. Cindy knew her drinking was not ideal, but considered herself functional, given her ability to maintain a perfectly manicured outward appearance. During treatment she shared about growing up in a rigid home with very high expectations, which she always met. But she found no personal sense of accomplishment despite these successes. Until she began drinking. Drinking allowed her to feel as if she achieved despite being handicapped. Her drinking made her feel successful both outwardly and emotionally. Cindy was addicted to alcohol.
Traumatized. I shared the story of Jeffery, who had the most horrific childhood. Aside from the physical abuse he endured at the hands of his mother, he also lived with his alcoholic father whose emotional abuse rivaled the physical scars Jeffery received from his mother. Jeffery ran away from home at 15, lived on the couches of various friends until 18, joined the military and watched his friend die when his Humvee ran over an IED while fighting overseas. Jeffery was physically injured in the attack and was prescribed an opiate to help manage the pain. In addition to alleviating his physical pain, he noticed how it also helped him black out the memories of the past and allowed him to rest his always vigilant mind.
When his prescription ran out, Jeffery began buying pills on the street. Because the cost was exorbitant, he decided to try a cheaper alternative to pills: heroin. Jefferey was addicted to opiates.
Valedictorian. Monique was raised by her parents who were both physically and emotionally available. Her family was upper middle-class and she lived in a tree-lined suburban neighborhood. Monique enjoyed dance and was a part of her local dance troupe. In school she was liked by teachers and popular among her peers. She found academics to be easy and thrived in her classes. She began to struggle in tenth grade when she found math to be challenging. Always used to excellence, this “ordinary” challenge elicited a great deal of stress. She confided in a friend who offered Monique one of her Adderall pills, which the friend was prescribed for treatment of her ADHD.
The Adderall proved a “game changer” and Monique, taking Adderall when studying for all her future exams, eventually was appointed Valedictorian of her high school class. Her unprescribed use of Adderall escalated in college and resulted in Monique self-referring to a neuropsychologist with the hopes of attaining an ADHD diagnosis of her own so that she might get her own ADHD prescription. When this plan failed, she began buying pills on campus and was eventually caught buying from an undercover officer. Monique was addicted to stimulants.
Lonely. Dave never felt like he belonged. Throughout grade school he never fit in. If there was a party, he wasn’t invited. If kids were hanging out in the park, he was sitting in his room at home, all alone. He reluctantly began 9th grade assuming he was destined to four more years of a similar unsocial existence. Until he met Steven who, on the first day of school, invited Dave to sit with him at lunch. They hit it off and is was not long before Dave and Steven were hanging out after school.
One evening, while watching videos on Steven’s laptop, he pulled out a joint. He lit up and offered Dave a hit. At first Dave was taken aback. He had never seen anyone smoke weed. But Steven was his friend, he didn’t want to jeopardize his relationship, and if Steven was doing it so flippantly, maybe it was okay. This was the first time Dave smoked marijuana, but his use escalated quickly. He started smoking only with Steven, but then transitioned to smoking every night in his room. He left his window open and his parents were never the wiser.
Until the school did a random drug test on all of the 9th graders in April and Dave tested positive. Dave was addicted to marijuana.
I spoke about the countless numbers of fathers, mothers, daughters, sons, husbands, and wives who I have treated over my years in practice. Each person with their own intricate life story. Each human being whose life was made more difficult because of their addiction. Each member of an extended family who was suffering from their inability to break free from the clutches of their addiction.
In order to adequately assist an individual struggling with addiction, it is important to approach them from a place of caring and concern. Viewing them in a denigrating manner is not only erroneous, but creates a shaky foundation for help that is unlikely to be successful.
Noted addiction psychiatrist Dr. Gabor Maté explains this point beautifully: “In relegating the addict to the bottom of the social and moral skills and in our contemptuous rejection of him as a person, we have created the exact circumstances that are most likely to keep him trapped in pathological dependence on drugs. There is no island of relief, only oceanic despair.” (In the Realm of Hungry Ghosts, p. 319).
I left the nursing students with the following thought: “As you each go out into the clinical world you will undoubtedly encounter addicts. They are often the most difficult cases to treat. Your task is to not think of the person in front of you as an addict. If you identify them with that label, the description you wrote on your index card, then you are likely to provide suboptimal or possibly detrimental care.
“Rather, think of them as someone’s family member who could use your care and support, a human being in dire need of your help.”
While my presentation was targeted at nursing students, it is just as relevant to those not in the health profession. According to the 2019 National Survey on Drug Use and Health in the United States the incidence of substance use disorders for individuals 12-years-old and older is 7.4%. For those between the ages of 18 and 25 the rate is over 14%.
How a person believes they will be perceived plays a role in their willingness to seek assistance. Your friend, spouse, sister, brother, child, or co-worker may be dealing with addiction and suffering in silence in fear of how they might be judged. This may even be true of you, yourself.
Seeing the person behind the behavior makes caring easier. It dismantles the stigma around addiction and paves the way for one to seek help for themselves and provide support to those who may need. Choose to relate to the human not the addict. After all, they are one and the same.
*All names and potentially identifying details have been altered to protect the privacy of the individuals mentioned above.