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Imagine you’ve been buried alive. Let’s say you know you’re in a coffin, but you know you’re not dead. You don’t know how to open your coffin and push up the enormous weight of dirt above. You think of giving up and waiting for death. But you also think of banging on the coffin so that maybe you will unsettle the ground above, and then maybe, just maybe, someone will notice and start digging the way down to you.
This is what it’s like to find yourself at the lowest point of a drug addiction. You know you need help, you know you can’t do it completely on your own, but you don’t know how to get help. In reality, there are people who can help you standing nearby your grave. But you don’t know that. You think you’re going to die there.
Usually, though, people don’t think of death when they’re habitually using drugs. In order to feed an addiction, you have to be good at repressing the fear of death. I often ask clients, “Did it ever cross your mind before you used that you might overdose?” They have always answered in the negative. Some will answer, “I just inhale, I don’t shoot.” As if there haven’t been millions of deaths from drug inhalation. Others will answer, “I know my tolerance level, so I wouldn’t o.d.” As if they know exactly how pure their dealer’s supply is.
Another revealing moment comes when I ask clients to list the positives and negatives of their drug use. This is a common exercise in a treatment approach called motivational interviewing. Clients gain motivation for recovery when they realize that the positives (e.g. “drugs make me comfortable around people”) are outweighed by the negatives. But the risk of death is one negative that none of my clients has ever listed. Once I asked a group why no one listed this as a negative, and one person said, “Why would we think of that? That would ruin the high!” Her response reminds me of a joke I once heard made by the comedian Sam Kinison, who struggled with alcohol and other drug abuse. He said of drunk driving: “What is the big deal? How are we supposed to get the car back to the house?” He’s beyond worrying about death; he’s got something more important to concern himself with. I wonder if the drunk driver who eventually killed Kinison had ever heard the joke.
One of my clients did briefly consider the danger after his doctor warned him about his high blood pressure. So he found a way to minimize the problem. He did some coke while checking his blood pressure. I imagine he thought to himself, “Okay, I’m not dead yet. My blood pressure hasn’t gone up that much. Let me try doing another line.” Sounds like some high. Now he’s decided that he can keep using and not worry about his blood pressure. Especially now that he’s started eating salads. I cannot say whether or not he’s buying organic.
Death is just one matter obscured by addiction. I want to focus in this book on the many ways that addiction deceives us. I want to write about what we don’t know about when it comes to addiction, or what we fear to learn, or what we learn about only belatedly. I’m new to this field, but I’m not sure anyone’s an expert. There are many matters relevant to alcohol and other drug abuse that my clients and I, as well as society as a whole, struggle to see. People with addictions often achieve sobriety and experience many moments of happiness, but only if they are able to stumble fearfully through a fog of ignorance, uncertainty, and doubt.
In one way or another, death has already led clients to the clinic, whether or not they are aware of it. Sometimes it is the immediate cause of their entry, as in the case of Marcus. He had been shooting heroin in a graveyard. You have to be very intent upon getting your next fix if you use in a graveyard, since it’s hard not to think there about where that fix can lead you. As soon as Marcus began injecting, he felt himself descending into a dark pit, although he felt more like he was entering a warm cozy womb than a cold grave. He felt better than he had ever felt in his life, but he knew that he needed to get out of this pit. A stranger shooting drugs nearby ran over to him and pulled the needle out of his arm before he could squeeze the last drops into his arm.
Some people with addictions, when in the position of this stranger, would be turned on by the sight of Marcus keeling over, and they would then proceed to inject the remaining drops into their own arm in the hope of getting the most mind-blowing high of their lives. Dying is for other people. Not for them. But in this case, the stranger pulled the needle out of Marcus’s arm and somehow got help.
Marcus was dead, but he forgot to die. After passing out, he next remembers hearing people clap for him. Their claps sounded in super-slow motion in his ears, like the dramatic moments of so many movies. When he was able to open his eyes, he found he was in a hospital bed, and friends and family were gathered around. His after-life was on earth. So he came to my clinic shortly after.
And then there are people like Chris, where the fear of death was a major reason they seek the oblivion of drug use in the first place. Once, when he was a child, his father fired gunshots over his head to teach him not to be a bad boy. Another time his mother slammed a skillet against his head and, yet another time, his father hanged him upside down from a tree. These corrective measures and others did not stop him from being a bad boy, but they did succeed in making him a depressed and anxious boy who could not stop replaying the memory of these events. He eventually learned that drugs blocked out his fears.
And then there are clients like Tanya, where drugs block out the anxiety caused by someone else’s death. As a small child, Tanya killed her mother by injecting her with heroin. Her mother suffered from both an addiction and cancer, though Tanya knew only of the latter, so she injected her mother with “medication” when she saw suffering. A few years later, she tried injecting herself with heroin out of curiosity over her mother’s habit. And then she learned that drugs helped her temporarily stop memories of her mother from coming into her mind. A few years after that, she came to the clinic.
Long before Tony started abusing drugs, he had been raised to believe he had a gift from God to heal people. As a child, Tony laid his hand on his sickly grandmother, and she quickly regained health. Later, nuns, priests, and doctors would take Tony to hospitals to heal other people. But as a young adult, when he got to Vietnam, he saw many people he couldn’t heal. That’s when he began abusing drugs.
But wait, you may say. What about bad trips from marijuana and LSD? It’s true that bad trips from these drugs can reactivate their fears. This was apparent in a recent 911 call made by a police officer who had just eaten marijuana brownies:
SANCHEZ: I think I'm having an overdose, and so is my wife.
DISPATCH: Okay, and your wife?
SANCHEZ: Yes.
DISPATCH: Overdose of what?
SANCHEZ: Marijuana. I don't know if it had something in it.
DISPATCH: Okay
SANCHEZ: Can you please send rescue?
DISPATCH: Did you guys have a fever or anything?
SANCHEZ: No. I'm just... I think we're dying.
DISPATCH: Ok, how much did you guys have?
SANCHEZ: Uh, I don't know. We made brownies and I think we're dead. I really do.
DISPATCH: Is she breathing?
SANCHEZ: She's barely breathing.
DISPATCH: Is she awake?
SANCHEZ: I think so. Yes.
DISPATCH: Can you look?
SANCHEZ: Pardon?
DISPATCH: Can you look?
SANCHEZ: Yeah I can feel her. She's laying down right in front of me. Time is going by really, really, really, really slow. What's the score on the Red Wings game?
DISPATCH: What?
SANCHEZ: What's the score on the Red Wings game?
DISPATCH: I've got no clue. I don't watch the Red Wings.
SANCHEZ: Okay, I just wanted to make sure this isn't some type of like hallucination that I'm having.
DISPATCH: Why? What does the score say?
SANCHEZ: Three to three.
But people with addictions are much wiser about drugs than this police officer. They know that marijuana can reproduce their fears. That’s why many of them take something like heroin or Xanax with marijuana to bring themselves “down” and ward off panic attacks.
There’s something particularly American about my clients. This is a country known for its worship of youth and marginalization of the old. We don’t even like to describe people as old. They are mature. They are elderly. They are in their golden years. That is because death is un-American. While there are of course people with addictions all over the world, only in America does their denial of death fit in so well with the country’s ethos. But the route to life and liberty includes the pursuit of sadness.
Often clients first start dealing with death in their dreams. There’s my client Mario, for example, who sobers up for the first month of his adult life and then has a dream that he reports in a group counseling session. Being able to remember a dream is one sign that his mind is becoming healthier, for now the mind is consciously focusing on the painful kind of stuff we think of when asleep. In his dream, he was being chased by some guys. He kept running until he found himself standing over a grave. Now in group, he says that he can’t figure out what the dream is about. He and the other members want to know whose grave he saw.
One client says, “Try to have the dream again, and next time look to see who’s in the grave.”
Another says, “Get one of those books that tells you what dreams mean.”
It seems as if every time someone in group reports a dream, another member refers him to one of these books that provides a cookie cutter approach to interpreting your dreams. But the person who has the dream is the best person to decode the dream. A poppy appearing in a dream can mean one thing to someone with an opiate addiction, and can mean another thing to paleontologist, and can mean another thing to a British war veteran. A poppy is not a poppy is not a poppy. But in my substance abuse groups, clients are usually reluctant to figure out what the symbols in their dreams mean to them. It’s as if the they’re so used to being betrayed by their own addicted brain, as they suffer one agonizing relapse after another, that they no longer trust themselves to figure out what is going on in their mind.
I say to the group, “Let’s let Mario work on what the dream means. The people who write these dream books don’t know him. Mario, is there anyone you know who has been in danger of dying?”
Mario pauses and looks uncertain. Then another client starts reporting her dream. Then two more clients start having a side conversation. Rarely do groups the way they’re supposed to with everyone waiting for his or her turn.
So I’m forced to give up on my attempt to have Mario understand the dream without assistance. I say, “Mario, could it be that the grave is yours, not someone else’s?
The cross-talk stops.
“Maybe. Yeah.”
“And the people chasing you are drug dealers? Or maybe the addiction itself is chasing you.”
Mario’s slit-like eyes, normally imperceptible from the other side of the room, become visible for the first time. “You may be right,” he says.
Another client says, “So are you saying he’s about to die?”
“I’m saying that maybe Mario is starting to appreciate that his drug use was leading him to the grave.”
The typically impassive Mario looks almost scared.
One of my clients proves to me that her recovery is going well when she takes a step to deal with the fear of death. Martha saw death often when she used to work in the medical field. And once she had a violent husband who used to beat her to within an inch of her life. She initially dealt with that abuse by stealing medications from her job, which soon got her hooked. She left that husband, and now she has achieved several years of sobriety. But one day the abuser boards the bus she is taking to our counseling appointment. At first she finds herself wishing she had an oxycontin with her, but then she thinks, “I’ve got to get off this bus! He could kill me here!”
So Martha gets off at the next stop and boards the next bus to our counseling appointment.
Another of my clients first reaches a stage of acceptance when she recalls a dream about her stillborn daughter. She sees her baby alive, up in the heavens somewhere. She wants her baby to be with her, but then the baby tells her that she is okay. My client takes this as a sign that it is okay for her to stop feeling pinned down by her sadness. In effect, she’s giving herself permission to be happy again, an important step in dealing with a loss. I can see that my client’s five years of sobriety have given her the ability to deal during her waking life with painful experiences.