addiction

The other night we were watching an episode of "True Life"--which is, if you've never seen it, a pretty good show despite being on MTv--about oxycontin addicts. It was an old episode, from 2001, and I found myself disappointed at the end, wishing there was follow-up telling us where the people profiled were now five or six years later, who was alive and who was dead, who was still using, who was clean.

In particular, there was a young man from Maine who had started using as soon as he went away to college and over four years progressed to IV use. He seemed to be a nice kid, with a really supportive and concerned mom and sister. He went to a rehab center where they did "rapid detox" where they put you under anaesthesia and give you a drug that blocks your opiate receptors and when you wake up several hours later, you supposedly aren't physically addicted anymore. Then you go through a month of intensive counseling to work on how and why you started using and how to keep from going back, etc. At the end of the program, they showed him three months after rehab. He was working construction, not using, living at home, but basically not socializing at all because all his friends and acquaintances used drugs and he couldn't be around them. I was really rooting for him to make it. But it underscored for me what I really don't understand about addiction.

In my family there is a lot of alcoholism, on both sides. There are also--as you know, Bob--a lot of mood disorders. The two things go together, both people self-medicating their depression and anxiety with booze and the fact that the two traits are genetically linked. What we don't seem to have, though, are addictive personalities. If you know me personally, you probably know my joke about how I *know* I don't have one--I won't repeat it here. And my dad was (I guess, in rehab-speak, is) an alcoholic, though he hasn't had a drink in over thirty years. He was a very functional alcoholic; when his boss took him aside and told him his drinking was starting to affect his job, that's the day he decided to quit. And he was physically addicted. He had to go to detox and he had the hallucinations, the whole thing. But once he got out, he just never drank again. No AA, no relapsing. He even went back to his part-time second job, bar tending for my uncle for years and years, which is, I guess, a huge no-no for people "in recovery."

I could tell you other stories like that about other close family members, but it's the same point: physical addiction, can't handle alcohol on a physical level, can't drink moderately like a regular person, but no apparent addictive personality. When they wise up and realize it's a problem, they just quit and that's that. None of this relapsing and/or making their whole life about *not* drinking that seems par for the course in everything you see and hear about addicts.

So, I guess what I don't understand is this. I believe alcoholism and drug addiction are diseases. I've seen for myself that inability to physically process alcohol like normal people do. But is the psychological addiction, the addictive personality, also a disease? A separate disease or part of the same disease? Why should the young man in Maine who isn't physically addicted to opiates any more and who wants to stay clean and have a normal happy life and who has a nice family who loves him not be able to stay off the drugs?

Well, I mean, I hope he did.

xoxo