ADDICTION :THE DEEPEST PAIN, THE SECRET SHAME

“The needle tears a hole, that old familiar sting. Try to kill it all away but I remember everything” (Trent Reznor, Hurt, 1994)

MYTH

Sub­stance abusers are lazy, hedon­ist­ic, selfish lay­abouts who squander money off the state to live in a per­petu­al state of pleas­ure, avoid­ing work to bask in the explo­sion of their mind’s endorphins while oth­ers pay their taxes, take out their rub­bish bins on the right day, and gen­er­ally are law abid­ing citizens.

REAL­ITY

It is New Years Eve and I am watch­ing the fire­works go off from my bed on the eighth floor of the Roy­al Free Hos­pit­al where I have spent the last four days. I have no memory of what brought me here or the days pre­ced­ing it but my neigh­bour, who had been aler­ted that no one could get hold of me had the hor­rif­ic task of find­ing me uncon­scious on the bath­room floor. Appar­ently I had taken a large over­dose involving heroin, crack, diazepam, clonazepam, meth­adone, and lith­i­um. Addic­tion is so power­fully over­whelm­ing that it bypasses even the fear of death.

MYTH

Inject­ing drug users beg, steal, and sell them­selves in order to live in a state of obli­vi­on whereby the bioavail­ab­il­ity of the drug is 100% and a ‘nor­mal ‘ life with ‘nor­mal ‘ respons­ib­il­it­ies is bypassed and the dif­fi­culties that go with it. The term ‘junky ‘ came along with the life­style of inject­ing drug use, often asso­ci­ated with the Wil­li­am Bur­roughs book of the same name, a home­less, state­less place of being, ready to rob bor­row, beg, or steal. The inject­ing addict is ‘dirty’, a slave to the drug, and is riddled with blood Bourne vir­uses such as HIV or hep­at­it­is c, and is con­ta­gious even to look at, prompt­ing mem­bers of the pub­lic to cross the street, and no pos­ses­sion or money is safe with­in their reach.

REAL­ITY

Inject­ing drug use is one of the most dark, lonely and shame­ful places you can ever find your­self. Heroin is essen­tially dia­morphine. Dia­morphine is a potent paink­iller. Nobody uses it for fun. People use it for pain. Emo­tion­al and psy­cho­lo­gic­al pain. And the magic that it first deliv­ers is a moment unlike any oth­er. For the first time in my life I felt whole, I felt free. But it is a fal­lacy. A false prom­ise. Because noth­ing can stay the same. Even­tu­ally, with it comes more pain. And by then it is too late to get out. Around 8 years ago I was in this bleak cycle. Inject­ing gave me ter­rible infec­tions, cel­lu­lit­is, col­lapsed veins and absesses so ser­i­ous that I required 4 oper­a­tions because the very use of my arm was com­prom­ised. I was alone. I couldn’t tell any­one that I was in the hos­pit­al because of the shame of what I was doing. All I wanted was my mum, but I couldn’t bring myself to make that phonecall because I feared aban­don­ment so much, such was the stigma. This situ­ation invoked in me the Fam­ous line from a Neil Young song: “I’ve seen the needle and the dam­age done “. It has been 6 or 7 years since I last injec­ted but the intern­al scars remain.

This art­icle is one that is hard to write. Addic­tion has been pre­val­ent with­in me through­out my life, even since child­hood, in whatever form it was avail­able. I was troubled, unhappy, and even, I believe, clin­ic­ally depressed as a child. But I nev­er pos­sessed the lan­guage to express my unhap­pi­ness. I remem­ber my twin sis­ter telling me that when she saw me take my first drink, at the age of 13, she knew I had found my magic potion. One that unlocked me from the pris­on that was myself, the pris­on that was my body, the pris­on that was my mind. It imme­di­ately began as a means to self med­ic­ate. And right until the end, I still believed that it offered that prom­ise. But at some point it stops deliv­er­ing and starts per­petu­at­ing that pain.

It is that palp­able pain, the kind that throbs at 3am as though your body is about to tear apart: “At the bot­tom of every person’s depend­ency, there is always pain and heal­ing it is an essen­tial step in end­ing depend­ency” (Chris Pren­tiss). On think­ing of this agony, both phys­ic­al and emo­tion­al, the fol­low­ing thoughts entered my mind: Once you have lost con­trol, all that is left is a giant chasm, a big black hole. It steals your per­son­hood, it breaks your soul. Once you have been there, nev­er again will you be whole.

Dual dia­gnos­is is a term that is a crux for under­stand­ing addic­tion, yet, iron­ic­ally, is little under­stood at all. What it refers to is the comor­bid­ity of a men­tal health con­di­tion, with a con­cur­rent sub­stance abuse dis­order. One makes the oth­er a mine­field to treat, and accen­tu­ates the risk of death hugely. It is estim­ated that a huge amount of people with a dia­gnosed (or undia­gnosed) men­tal health con­di­tion also struggle with addict­ive tend­en­cies, in the many ways it may mani­fest each oth­er. This is often an attempt to self med­ic­ate when a per­son is in psy­cho­lo­gic­al pain, espe­cially when they are not receiv­ing the cor­rect treat­ment around one or both issues. It is a con­di­tion that is under recog­nised and greatly increases stigma sur­round­ing all aspects of men­tal health.

I myself have been dia­gnosed with bipolar affect­ive dis­order, along with oth­er labels hurled at me through the years. It has com­poun­ded everything, includ­ing my addic­tions. I was once abstin­ent for around 7 years. At one point my men­tal health began to be treated very badly, being giv­en the wrong dia­gnos­is. I was taken off my mood sta­bil­isers and very quickly, after such a long peri­od of time, had to self med­ic­ate with heroin, the num­ber one painkiller.

Going back to last news years eve, my staple med­ic­a­tion, lith­i­um was taken out in order to clear my sys­tem. It was meant to be put back in at its usu­al dose but nobody took respons­ib­il­ity for this. For months I was walk­ing around with my mood fall­ing as fast as my blood levels. Appar­ently this was vis­ible to those around me, and some of my work­ers were des­per­ately try­ing to rem­edy the situ­ation. As ever, I self med­ic­ated, walk­ing around like a corpse on crack, heroin, and ben­zos. Even­tu­ally the depres­sion won and in March I gave up the fight, planned my sui­cide, and acted on those plans. I told no one, I locked myself away, and waited for death to arrive. All I can remem­ber, before being found, was the deep feel­ing of anguish that goes with the belief that I was about to die alone.

As a res­ult of these actions I was sec­tioned in St Anne’s hos­pit­al, where I spent the next six weeks. Finally, the med­ic­a­tion for my men­tal health con­di­tions was altered and sta­bil­ised. The staff were amaz­ing, and I was really looked after. As time went on I began to feel more and more like my old self. My real self, whatever that may be. Maybe I just mean that I star­ted to feel com­fort­able in my own skin. As for sub­stances I was sure that I nev­er wanted them in my life. Those thoughts and feel­ings were genu­ine. My inten­tions were not for show and I had no cravings.

Unfor­tu­nately the grip of addic­tion proved too strong. Just 2 weeks later I wake up and I am sur­roun­ded by white walls. I don’t know where I am, why I am there, and I think maybe I am dream­ing. There is a nurse there and she tells me that I am in King’s col­lege hos­pit­al and I have over­dosed. I remem­ber noth­ing. I am ter­ri­fied. It is a scary feel­ing, to have hours if not days wiped from your memory. It turns out that I was with a friend and I col­lapsed at a sta­tion. They had to admin­is­ter cpr at the scene, and then put me on a drip con­tain­ing nalox­one, a drug that reverses opi­ates but that makes you very sick.

I can­not believe that this has happened so close to my dis­charge from St Ann’s hos­pit­al. I truly believed that everything would be OK after that. I am shattered. I am shattered for my fam­ily. I am shattered for my friends. I am shattered for the work­ers who have done so much for me, my care coördin­at­or, my dual dia­gnos­is nurse. I am heart­broken. Can I get up again from this fall? Or is this my final cur­tain call? For now I live in limbo, I am stuck between life and death. I can make no sense of this at all. These shitty sub­stances, and their allur­ing pull.

Music, as ever, depicts the pain of addic­tion in a way no oth­er medi­um can do. I am writ­ing this art­icle and while I do so You­Tube is play­ing on shuffle. A song comes on that I have nev­er heard and quite lit­er­ally, it takes my breath away. It is by an hip hop artist called Col­licch­ie and the song is called Drug Addic­tion. In just a few minutes it encap­su­lates everything that I would wish to say in this entire art­icle. As the neur­o­lo­gist Oliv­er Sacks states, the brain has a great­er capa­city for music than just words alone. The coin­cid­ent­al play of this song at the very time of pon­der­ing sim­il­ar exper­i­ences is one of those things that defies explanation:

“I wanna do bet­ter but I don’t know a dif­fer­ent way,

I’m a ser­vant and this heroin’s my king

I’m feel­ing like a slave, as I dangle from these pup­pet strings

I’m just a mari­on­ette, im star­in’ at death

As I am car­ry­in’ regrets, that are just tear­in’ through my flesh”

The last line in par­tic­u­lar res­on­ates right through me. I walk around with such guilt about who I am, what I have become, what I done to oth­ers around me. It invokes the line in plan b’s song The Deep­est Shame, as the key to what blocks my recov­ery. “I’ve been drag­ging myself to the low­est of low, For such a while, I just don’t know, If the path I take is some­thing I can change, But what stands in my way is the deep­est shame “. I remem­ber some­thing my mum said to me once that pen­et­rated through a very thick skin at the time. I used to think that I was only hurt­ing myself so that was ok. But she turned and said to me “everytime you hurt your­self you hurt me too “. This hit home, and hit home hard. I’ve car­ried guilt and shame for a very long time.

I’ve asked many oth­er people I know who have been chal­lenged by addic­tion dis­orders of vary­ing kinds. Almost all have an expect­a­tion that they will be hit by a moment of ‘magic’. For some, they anti­cip­ate that, for a fleet­ing moment at least, they will not have a care in the world. That all their prob­lems will melt away. And, sadly, that they will exper­i­ence even a mil­li­second of hap­pi­ness with­in the ruins that are left in place of what was once their life. In real­ity they are left with “fin­an­cial ruin”, “guilt and remorse “. Anoth­er per­son told me that he is left in chron­ic phys­ic­al pain that is not being adequately treated. The drugs, he says, are the only res­pite he gets. Layne Sta­ley from the band Alice in Chains, who died at the age of 34 from a drug over­dose, stated in one of his songs that addic­tion is a “slow sui­cide”, and is no way to go.

“Addic­tion is a mas­ter : It lives inside, and feeds off you, takes from you, and des­troys you. It is a beast that tears you apart, rips out your soul, and laughs at your weak­nesses. It is a stone wall that stands to keep you in, and the rest out. It is a shad­ow that always lurks wait­ing to strike. Addic­tion lives in everyone’s mind, sit­ting, star­ing, wait­ing.” (anon)

Just look at the legends that addic­tion has torn from the world : Jimi Hendrix, Jim Mor­ris­on, River Phoenix, Kurt Cobain, Lane. Sta­ley, Chris Cor­nell, Andrew Wood, Shan­non Hoon, Jean Michel Basquiet, Taylor Hawkins, and the list goes on and infinite.

There is a book called Neces­sary Losses, that describes the loves, illu­sions, depend­en­cies, and impossible expect­a­tions that all of us have to give up in order to grow. That is my place, my limbo, and my decision. Nobody can make it for me. My neces­sary loss is that sim­ul­tan­eously of my best friend and my fatal enemy. Where the two meet is a place I can­not define. Either way It is time to say good­bye if I want a ful­filling life. That is my neces­sary loss.