Going On A Trip And Never Coming Back, Ctd

Andrew Sullivan’s readers continue an excellent discussion on the merits of 12-step based addiction recovery programs. The personal testimonies and archived debates, all accessible here, are also very much worth reading.

The Dish

Reacting to some criticism of 12-step programs, a reader writes movingly in support of AA and NA:

For both of my brothers and myself, 12-step recovery programs have literally been the difference between life and death. My younger brother had recently switched from heroin to crack cocaine by the time he entered the Fellowships of NA and AA; my entire family was quite sure that if a drug overdose didn’t kill him, some of the people to whom he owed money would see to it themselves. Eight years later, he has a wife, a lovely daughter, and a college degree, all thanks to working a 12-step program.

As for me, my drug of choice was alcohol.

I had chronic liver pains by age 26, and my hands shook so badly my mother thought I had Parkinson’s Disease. I needed at least 12 beers a day to feel normal, and a minimum…

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Going On A Trip And Never Coming Back

Andrew Sullivan, as always, has done a great job of curating the web and coming back with some of the most cogent reaction to the tragic death of actor Philip Seymour Hoffman. Not banal pronouncements from pundits and other celebrities, but a balanced look at the nature of addiction and relapse, from a variety of sources, many of them addicts themselves. Well worth a read.

The Dish

Philip Seymour Hoffman’s quick journey from long-term sobriety to relapse to death scares Seth Mnookin, who has struggled with alcohol and heroin addiction:

My first attempt at recovery came in 1991, when I was 19 years old. Almost exactly two years later, I decided to have a drink. Two years after that, I was addicted to heroin. There’s a lot we don’t know about alcoholism and drug addiction, but one thing is clear: Regardless of how much time clean you have, relapsing is always as easy as moving your hand to your mouth.

In response to Hoffman’s death, Sacha Scoblic highlights the shortcomings of twelve-step programs and wonders if another approach could have saved Hoffman:

A big part of the problem is rehab itself, which is almost universally based on twelve-step work, like Alcoholics Anonymous or Narcotics Anonymous. But AA was developed in the 1930s, in the absence of brain…

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On Addiction, Ctd. – Philip Seymour Hoffman

philip seymour hoffman

 

While the world reels from the news of actor Philip Seymour Hoffman’s death by probable heroin overdose, Damian Thompson, writing in The Telegraph, pulls back the curtain on addiction and endeavours to explain how someone with multiple years of clean or sober time such as Hoffman can appear fine (particularly to those on the periphery or observing through the media) in the run-up to a serious or fatal relapse.

Surveying the immediate reaction from friends and colleagues of the actor, Thompson writes:

“But he/she was doing so well … clean and sober for X months/years … really looking forward to their next project.”

This baffled reaction to a drugs tragedy is familiar to anyone who works with addicts. We’re hearing it from friends and fans of Philip Seymour Hoffman, who was clean for 23 years before apparently checking himself into rehab last year. To stay away from drink and drugs for nearly a quarter of a century – and then relapse? Some people will be puzzled by that.

They shouldn’t be.

Indeed they should not be puzzled. Many of the people expressing such surprise may have been friends or acquaintances of Hoffman, but very few would likely have seem him up close and observed his behaviour day-in and day-out to a sufficient degree that alarm bells would necessarily have been raised. Clearly all was not well with the actor, as he had undergone 10 days in a rehabilitation facility last year following a relapse.

Indeed, this raises another point – sometimes it is those who see an addict regularly but not continuously, at intervals well spaced apart, who are best placed to spot signs of impending trouble or emotional relapse (that stage where addictive thoughts and behaviours are creeping back in, but before the person has drunk or picked up). It will be interesting in the coming days to see whether friends and acquaintances of this type had seen a worsening or intensification of mood or using in Hoffman in these final weeks.

Even experts can sometimes be wrongfooted, as Thompson rightly observes:

In Narcotics Anonymous, however [as opposed to someone in Alcoholics Anonymous under the influence of alcohol], someone can address the room loaded up on heroin, or (if they’re careful) cocaine, or with 50mg of unprescribed Valium inside them, and they can get away with it. One or two people in the audience may guess, but they don’t want to point the finger. There are nearly always active users at meetings. Indeed, if you’re an addict looking to score in a strange city, the local NA chapter is often a good place to start.

Damian Thompson does not subscribe to the disease theory of addiction, but fully endorses the description of mind-altering substances and addiction as “cunning, baffling and powerful” – a reading from 12-step literature with which any fellowship member will quickly become familiar. And in closing, he points out the degree to which this was surely true of Hoffman:

Not only is addiction cunning, in that it hangs around for years whistling nonchalantly and leaps out just when you think you’ve turned into a “normal” person, but hiding a drug habit makes you cunning. Far too cunning for your own good.

Our prayers and sympathies must go to the family and friends of Philip Seymour Hoffman who survive him.

The following is a scene from the film 25th Hour, a favourite film of mine and one in which Hoffman plays a wonderful role in the ensemble cast:

 

May he rest in peace.

 

On Addiction

The subject of addiction gets a markedly varied treatment throughout the yearly cycle. For the first few weeks of Christmas, it is written about quite seriously. Lots of people, newspaper columnists included, are at that time emerging from the festive alcohol-induced haze wondering whether the various embarrassing or compromising predicaments in which they found themselves might be symptomatic of a larger underlying problem. The topic then gets quite a fair and sensible hearing for a few weeks, vying for equal coverage with other stories like new years resolutions, dieting, and finding love in 2014.

In a particularly good year, you might get a few slightly more scholarly articles at this time, focusing on the science, medicine and psychology behind addiction; pieces that weigh the comparative benefits and efficacy of different treatment models for addiction, or written testimonials about someone’s personal struggle.

And then, after a few weeks have passed you get the nonsense articles, the pieces ostensibly about addiction but really an exercise in self-aggrandisement, treading rhetorical water, hitting word count targets and powering through a slow news day. Lucy Mangan, writing in The Guardian, gives us one of this variety. She gave up sugar for the new year, and you’re going to hear all about it:

If you’d asked me 24 days ago if I was addicted to anything, I would have laughed in your slightly-overfamiliarly-inquiring face. I don’t smoke, I barely drink. I have one coffee a day. My entire drug consumption comprises five puffs of whatever the kids are calling marijuana these days – the last three were consecutive, after which I went cross-eyed, puked up everything I’d eaten since 1984 and fell asleep for two days. So, no, I would have said, I am a slave to nothing and to nobody, bar my toddler and my mortgage provider. Bring on the dancing girls – I have this life thing licked. That, of course, was before I decided, on 1 January, to give up sugar.

Cue revelations of a first world problem of the highest, most profound order. Waxing lyrical about her love for chocolate, Mangan writes:

When my tongue is coated in that ambrosial mixture of sugar, milk powder and vegetable fat, when the glucose hits my bloodstream, when my stomach is filling with caramel, peanut pieces, shortbread, wafer or any of the multitudinous other vehicles the ceaseless ingenuity of man has created to deliver yet more deliciously the very emptiest of calories to my Stakhanovite digestive system – that’s when I relax.

Multitudinous? Stakhanovite? Really? Lady, you just like to have yourself large quantities of chocolate every day. Dress it up with all the pretentious phraseology you like, but it basically boils down to just that. It’s quite hard to spin the simple fact of liking chocolate into a full-length column about anything at all, let alone a serious topic like addiction, not to mention rather insulting to those who suffer from more serious and potentially devastating ‘real’ addictions.

There should be a public health warning on the label.
There should be a public health warning on the label.

Mangan casually mentions these “other” addictions, which she knows all about through the educational vessel of anecdotes:

It’s been both ridiculous and terrifying to see how closely my (not even complete, remember) sugar deprivation has mimicked what we will, for reasons of limited time and space, just have to agree to call here “real” addiction – to booze, fags, drugs et al. I’m craving the stuff all the time. I can literally feel – or feel I feel – a hollow inside me that only Cadbury can fill. I can’t concentrate. I’m foul-tempered. Oh, and I totally lied before about how much I usually eat. I can’t bring myself to tell you now, but it’s much, much more than one measly bar an evening.

Yes, of course when deprived of something that the body is used to – be it sugar and caffeine or alcohol and narcotics – some of these symptoms will be experienced. The only real difference between her need for chocolate and the need of an addict for their mind-altering substance are those small details hardly worth mentioning (and indeed not mentioned) such as broken homes, physical and mental abuse, poverty and debt, criminal records, social stigmatisation, and the inexorable toll of wasted year upon wasted year of human life.

For Mangan to say that the pangs of irritability and withdrawal she has been experiencing in any way “mirror” addictions of a more serious nature is akin to her claiming empathy with the homeless because she was once caught out in a rain shower without an umbrella.

The most urgent issue of our times.
The most urgent issue of our times.

But the main thing as far as The Guardian is concerned, I am sure, is that the required column inches were filled and the word count met. Lucy Mangan’s editor was pleased with a forgettable, cookie-cutter puff piece about someone finding it hard to cut down on the old baked goods after the excesses of Christmas, and gave blessing for its publication. And so now we can all have a little giggle about how Mangan’s sweet tooth makes her just like your funny neighbourhood junkie.

In future, however, it might be better if idle newspaper columnists facing the January blues, a slow news day and writers block tried to steer clear of their love of chocolate, or biscuits, or chocolatey biscuits, when grasping for ideas thirty minutes before the filing deadline.

I, for one, would be grateful.

The Foolishness of Nick Clegg

Nick Clegg

 

He’s done it again. The latest, desperate Sun-approval-seeking initiative from our restless Deputy Prime Minister and his fellow Liberal Democrats is this – let’s make “drunk louts” pay for their A&E and jail costs.

The Daily Telegraph reports:

Mr Clegg, the Deputy Prime Minister, said he supported the idea of imposing levies on people who get “blind drunk” and end up in hospital or at a police station…

“I’ve actually got quite a lot of sympathy with the basic principle that says why should someone that goes out and gets completely blind drunk, behaves appallingly, gets themselves into trouble and a scrap – why should other people always have to pick up the tab to help them out?” Mr Clegg said.

He said it was unacceptable for the taxpayer to continue to pick up the bill for the National Health Service to treat patients whose injuries were caused as a result of excess alcohol.

Oh dear. If you are going to discuss the implementation of new policy, shouldn’t you at least make it sound as though the idea had not been concocted a mere 30 seconds before you gave it voice on national radio?

At least Nick Clegg still has that minimal level of self-awareness which allowed him to make the disclaimer (not a tremendously encouraging one for a deputy prime minister to make, though) that he hadn’t really thought the policy through very well, and that it might be quite hard to implement:

Speaking during his weekly Call Clegg programme on LBC Radio the Deputy Prime Minister admitted it would be “tricky” to implement the fines but that he has “quite a lot of sympathy with the basic principle”.

Shall we count the ways in which his latest policy idea is particularly stupid? Okay, let’s.

1. It’s quite clear – Clegg admits as much himself – that his policy is focused on what he calls “drunken louts”. But how to classify who and who is not a drunken lout without resorting to the type of class assumptions or profiling that a man of Clegg’s liberal credentials would surely abhor? I’m guessing that if I was a young man wearing a hoodie who tripped on the kerb after a few too many pints of beer of an evening, I might be a prime target for this fine. But what about a smartly dressed young barrister who tripped on her heels after a few too many glasses of port at a company dinner? Still a lout? What does one have to do, or be, to get whacked with the fine?

2. While consuming excessive levels of alcohol is clearly irresponsible, so are many other actions that humans take all the time. Extreme sports. Smoking. We all pay our taxes (well…) so who is to decide which activities will cause us to forfeit the right to the treatments and services that our taxes have paid for?

3. Some people have jobs or participate in activities that have mostly or only positive externalities. Fitness instructors, gardeners, marriage counsellors, drug caseworkers, physical therapy workers. By performing these activities they actually serve to lower the costs that the government would otherwise have to pay in a myriad of ways. Should these people get a small bonus cheque if they find themselves in the hospital? Or are we just going to punish the bad behaviour but not reward the good? Can taxes only ever go up, and not down?

4. If you engage in violent behaviour and end up in a jail cell, should it not be the case that the criminal justice system works effectively enough that if you are found guilty, you are liable for the legal and policing costs that your actions incurred? We all know that the criminal justice system  in our country is laughably broken, but is creating a separate mechanism outside of the criminal justice system to recoup costs from offenders really the way to go, Nick?

In other words, does our deputy prime minister really have nothing better to do, no more pressing matters to fill his day, than sitting in an LBC radio studio and making up demonstrably bad policy on the fly? He gets paid his ministerial salary to do this?

The next election is still two years away. I was hoping that we might be able to squeeze maybe one more year of at least aspirationally real, serious policymaking and governance into this parliament before we had to start listening to nonsense ideas like this one.