Archives for posts with tag: addiction

There is an episode on the podcast Crackdown that posits that, despite less effective results, doctors will still push Suboxone over Methadone when prescribing opiate replacement therapy. In theory, Suboxone is supposed to be safer because it has Naloxone chemically baked into the compound which prevents additional opiates from connecting to their neurological receptors. In short, it prevents you from getting high. Methadone, just being another opiate, allows additional opiates to be used on top of it if the prescription isn’t strong enough to prevent withdrawal. The podcast describes the social rewards of appeasing the medical professionals and being one of the “good” recovering addicts, despite the additional challenges that recovering on Suboxone has over Methadone, and the bitter disappointment of the failure that can come along with that. Ultimately, the podcast concludes that Suboxone is preferred by healthcare workers because it discourages the euphoria that is associated with opiate use on a molecular level.

This was literally the first image on my Google search for, “Doctor Knows Best.” I thought, why not, let’s sex-up this blog a bit.

To be upfront, I struggled with this on a personal level. I have worked with drug users for years, and I always went along with what the doctors and nurses suggested when it comes to opiate replacement therapy because they allegedly know “what’s best” when it comes to prescribing medication. I was told Suboxone is better because it prevents overdose, and who cares what the drug users themselves think, because if they want recovery and no longer want to get high, then why do they want to get high? I didn’t know better, and I didn’t have anyone offering any counterpoints, so it just became an assumed truth: Suboxone is better than Methadone.

Of course, when Mary Poppins says that a spoonful of sugar helps the medicine go down, we just blindly accept that firing the dopamine receptors in the brain is an easy way to make adhering to a pharmaceutical regimen more palatable. Heaven forbid you need a pharmaceutical regimen to overcome addiction, however. Then it’s no sugar for you!

The deepfake you didn’t know you needed

Why do we care if those seeking a less life-threatening way of living their lives happen to have a bit of pleasure within it? While I certainly can’t speak for everyone, I bet that it likely has something to do with the emotional reaction to drug use as a fundamentally hedonic lifestyle. We see the panhandler begging for change, decrepit and not having showered in months, and we think, that’s just the consequences of a lifetime of seeking pleasure right there, and so sad that they still haven’t learned that this is where euphoria leads you. Its cure must therefore involve the complete annihilation of any synthetic joy because only real, pure happiness is socially acceptable.

It doesn’t matter that addiction is the learned coping mechanism developed in response to trauma. No one cares about that. As much as people talk about the opioid crisis being a health crisis, no one seems to do anything about it which would be strange if, as a culture, we accepted addiction as what it actually is. Opiates have killed well over a thousand more people in British Columbia than have died from Covid-19 since Covid-19 became a thing, and the response to Covid-19 has been to shut down the world. We don’t care: drug deaths are the tragic but earned result of insatiably seeking an impure pleasure.

Even if we did offer solutions, drug users would still choose to slowly kill themselves, so what’s the point? I understand addiction.

Moral foundations theory is the belief that our morals are determined by the core emotional responses we have to certain situations. We respond with compassion to instances of harm, with indignation to cheating, with disgust to degradation, and so on, and thus are born the moral guidelines of care, fairness, sanctity, etc. Looking at the lives of a drug user, we might be moved to compassion, sure, but the judgier among us are likely to react with disgust. This creates the blueprint for moral blame toward those who indulge in profane pleasure, and thus it becomes that much easier to avoid caring about how many people who use drugs are dying.

If there is a profane pleasure, then surely there must be sacred pleasure, right? What would that be? It certainly isn’t sex, and the social categorization of sex workers would likely fall well within the scope of my thesis here. In Christianity, heaven is described as hanging out with God – being close to God is the sacred pleasure. Within Islam, heaven is a nice garden. Epicurus, the philosopher of socially appropriate hedonism, recommends just having some nice cheese as a sacred pleasure one might indulge in. The thing is though, these all seem kind of… incredibly lame and boring. Don’t get me wrong: cheese is fine, spiritual contemplation can be relaxing, and gardens are quite pretty, but is this really what we want for our sacred pleasure? It seems like the sacred euphoria is to not really have all that much pleasure in your life at all. And that’s the point: all pleasure is inherently profane. The sacred life is about restraining yourself from pleasure because pleasure is dirty.

I wonder what the perfect symbol for the maxim, “The less pleasure you have in your life, the more sacred you become,” would be? It’s on the tip of my tongue…

We’re all susceptible to this. The thing about moral foundation theory is that we all have emotions, and while some emotions may hit us individually harder than others, we can’t escape them. I myself am guilty of this, as I was describing my own thought process above. But remember, addiction is miserable. It’s an endless cycle of desperately trying to escape overwhelming pain. It is patently false to describe addiction as hedonic excess because the euphoria from any drug, let alone the banality of methadone, pales in comparison to the suffering of addiction itself. If the maxim about suffering being the road to sanctity were true, there would be none more sacred than the drug addict.

As bizarre as the moral condemnation of all pleasure is, it is completely irrelevant to the discussion at hand. It’s a trap constructed by the likes of Nancy Reagan, anti-drug campaigns, and ultimately, the racist origins of the drug laws themselves. They used to give opiates to children to calm them down, and even gave it the kind of kitschy name you’d expect for such a product, Mrs. Winslow’s Soothing Syrup. Not that this was particularly healthy for the kids, but it gives you an idea as to the benign perception of narcotics prior to their criminality. Unfortunately, racism needed a way to control immigrant communities, drug use was thus linked to those communities, and drug laws were born to prevent Asian men from boning white women. The disgust associated with drugs was created and perpetuated outside their capacity to induce pleasure (excluding the ecstasy of interracial sexy-times), and so it makes sense that the lived experiences of drug users are irrelevant to our moral condemnation today.

Oh yeah, this is definitely a lifestyle that has far too many happy outcomes in it

I am writing this piece as a means of organizing my thoughts. I did not have a conclusion in mind when I started, and so it’s actually been a longer process than it normally would be for me to write one of these things. I have to come to grips with my own biases and take the time to reflect on what they are and where they come from. The debate about the comparable benefits between Methadone versus Suboxone is pretty niche, but I knew going into this that the exploration of this topic was going to touch on more than just that. The social attitude toward drugs and the moral condemnation toward their users is ubiquitous, and no one is exempt. Even drug users will hold themselves to a higher moral standard than other drug users citing the arbitrary standard of, “Well, I would never do such and such!” as a means of separating themselves from the impure. Sometimes they end up getting to the point where they do that thing, and this is often brought up in 12-step meetings as the time they knew they had lost control. Sometimes, a new bar will be set, “I may have done such and such, but I would never do such and such!”, and the desire to maintain moral purity remains.

In all honesty, Suboxone does work for some people. It’s good to have as an option for those who might genuinely want it. The point is that we shouldn’t use moral condemnation borne out of historical racism to coerce people into a recovery that doesn’t work for them. Addiction is hard enough as it is.

I am a drug and alcohol counselor. I am at least okay at my job; clients will occasionally tell me they feel better after having spoken to me, which is as good a metric as any, and the odd client might even stop using drugs and/or alcohol if the stars are aligned just so. It’s a complicated career in which the measures of success are vague, yet regardless of whether or not I’m successful (whatever that means), a new client will always come in. This new client with their new idiosyncrasies are, more often than not, fundamentally similar to the old one. The tide comes in, the tide comes out, then, as per the pull of the moon, the tide comes back in again.

There will always be drug addicts, right? One must imagine Sisyphus happy in order to avoid the soul-crushing burnout of facing off against the boulder of the opioid crisis. And yet, even in the name, its immutability is questioned. It is called the opioid ‘crisis’, not the opioid ‘way of life’. A crisis is temporary. Solutions are possible. Causes can be identified.

Of course, a crisis can simply be an act of God or a natural disaster. There might be those who argue that nothing can be done about this crisis since its causes are out of our hands. Fentanyl is a thing now, so people will just die more because of it. There is some merit to this argument: Fentanyl is certainly deadly and more prevalent which is going to inevitably lead to more deaths. As any consumer advocate would tell you, the solution to a deadly product is of course a well-regulated market, but this ignores why people might seek out Fentanyl in the first place. Even if people take healthy doses of untainted heroin (or meth, or crack, or all the other drugs now laced with Fentanyl), this still doesn’t change the tide.

There are several theories about the causes of addiction. Trauma is a big one, and yet trauma is not preordained. The trauma of neglect is often predicated on poverty which can be alleviated through wealth redistribution (consider that there is more than enough housing for everyone, despite large numbers of homelessness. Similarly, we have enough food to feed the planet. Supply is not the issue, distribution is), livable minimum work standards (since many of those in poverty do indeed work), and so on. Trauma based on domestic abuse can also be curtailed if we shift masculine culture away from domination and violence.

There is also the lack of connection that drives addictive behaviour. This connection has been driven out of society by the cultural forces of individualism and competitiveness, and can just as easily be reduced by the imposition of their opposites. Solidarity with coworkers and neighbours, an emphasis on community values, respect for nature, and a reignition of hope; these too will reduce the need for the synthetic connections induced by narcotics.

Of course, there is also simple education. Not the education that tells us that drugs are bad. Drugs are actually amazing. Drugs offer solutions to problems when nothing else seems to have worked before. An individual, often having gone through trauma or who is suffering from mental illness, does not know how to cope with that trauma or illness. Along comes drugs, and all of a sudden the baggage associated with those things don’t seem so awful now! What needs to be taught are healthy coping skills as well as information on mental health that will help identify and then deal with these developmental dangers before addictive alternatives become the norm.

You may note that none of these things involve cognitive behavioural therapy, nor harm reduction, not even admitting you are powerless over your addiction and that your life has become unmanageable! The methods of dealing with those in addiction (with their varying degrees of effect) are only ever reactive, and ignore the systemic issues that produce drug addiction in the first place. Social fixes ought to attack the root of the problem rather than focus on managing its aftermath.

One of the stories I tell myself to endure the Sisyphean drudgery of endless addiction is the story of the curmudgeonly old man and the beach full of starfish:

Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.

Off in the distance, the old man noticed a small boy approaching.  As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea.  The boy came closer still and the man called out, “Good morning!  May I ask what it is that you are doing?”

The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”

The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”

The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”

This metaphor does help me feel better about the work I do, because ultimately helping one person live a better life is a worthwhile goal. It matters. However, the metaphor fails because a tide is by definition unstoppable, and drug addiction is not. The starfish have not been washed up onto the beach by some immutable fact of nature, they have been pushed by cultural ideologies, economic oppression, and brutish stigma.

Why bother with drug counselling? It does help, but it will never stop the tide.

In my life I have worked with those who suffer from addiction, and I have also worked in retail. From these experiences, I have noticed something about the way these two demographics, addicts and customers, interact with those paid to deal with them. Anyone who has worked in retail can tell you that customers are the absolute worst, and addicts notoriously bear the not entirely unearned stigma of being untrustworthy and catastrophically self-centred. There are always outliers and exceptions, but working within the generalities for now will help identify the trend that I’m hoping to produce here, so bear with me.

Addicts lie. Not just to people who work with them, obviously, but to family members, friends, anyone. The fundamental motive behind these lies is shame. The addict is fully aware of their behaviour and lifestyle, and the guilt and shame is often overwhelming. They know stealing from their parents is wrong; they lie because they can’t bear being judged for it. They know that leaving a detox facility to go use defeats their deep, powerful desire for sobriety and normalcy, but they lie about their ultimate destination because they’re ashamed of their weakness. The reason that the Anonymous program demands honesty is so that the addict can uncover their shame, lay it bare, and witness a community that accepts them regardless. This is the process of recovery.

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Just say no

The addict lies because they fear the human capacity for judgement. Even the more malicious lies, such as the ones for personal gain, recognize the victim’s critical thinking skills that need to be overcome. Every lie, every betrayal, the mask of the addict, is made entirely in reaction to the human.

Contrast this behaviour to the untruths of the customer. The customer doesn’t necessarily lie, but the traditional pleasantries of, “I’m fine; how are you?” “Have a good day!” are the superficial banalities that reveal nothing of authentic value. Hence, an untruth. These untruths do not exist as a recognition of the human, but as an attempt to supersede it. They gloss over the human to expedite the exchange of the product. The honest addict reveals their shame; the honest customer makes curt demands and doesn’t bother to look you in the eye. The consumer’s untruths are made in reaction to the employee as only a facet of the product being sold.

Participation within capitalism, the act of consumerism, requires a dullness in our humanity unseen in any other form of addiction. The dealers and corporate pimps of the consumer marketplace have a greater understanding of predation than those in the Downtown Eastside. Addicts are looking to fill a void, and filling that void with honest, human recovery might alleviate the drive to consume. Customer service must therefore be performed with a plastic sincerity lest the consumer have a genuine interaction that makes them realize their purchase gives them nothing of real worth.

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It is not even the product that delivers the endorphins, but the act of purchasing itself. At that point we are still blind to its irrelevance to our lives

The customer, driven by advertising that manufactures an internal void and delivers only an empty promise to fill it back up again, has no time anyway for things beyond pleasantries. They must commute, work, consume, and then obliterate anything else that remains with distractions. Busyness is a virtue. Distractions are our culture. Humanity is evaporating from one blowout sale to the next, and there is no time to even notice. It’s myopic self-destruction on a global scale, and all that is left to do is wait anxiously for the overdose.

I guess that’s why I’m happier being lied to by drug addicts.