For thirty-five years, I have had patients with drug problems. Sometimes patients ask for help, sometimes they deny they have a problem, and frequently, they are unaware that they have a problem. Sometimes, I have to wait until the patients figure out for themselves that there is a problem before I can be of any help; until then, I just do my best to do what I can for their health. Frequently, I can instantly see for myself what the problem is; sometimes I am surprised by it after knowing the patient for years.
It is essential for me to understand how drugs affect the body and mind, so I categorize drugs according to their actions.
I have watched methamphetamine users die of starvation because they lacked the emotional energy to eat without their drug. We were taught in medical school that nicotine is a stimulant, but our society has unconsciously decided that tobacco is not a mind-altering substance. It was helpful to me to read Karl Jung’s opinion that some societies suffer from mental illness. In that circumstance, to be “normal” is to be ill, and the healthy person is at risk of being demonized. Sometimes drug use is so integrated into a society that “normal” people are unable to recognize that there is a drug involved: it is impossible to refer to tobacco or nicotine as a “drug” in a court of law, because the law defines these as “substances”. My children once bought home a booklet from school boldly entitled “Drugs of Abuse”, with a request for donations to the “educational program” that produced it: there was not a word in this extensive publication about tobacco. When I investigated, I found that the government funding for the program prohibited any mention of tobacco. Our military troops are issued stimulants in combat, and offered tobacco at a discount; our astronauts are issued dextroamphetamine for space sickness; our air force pilots are not allowed to fly their missions if they don’t take their “go pills”. Amphetamines were the very last category of drug to be tested for in the workplace because they are considered a production-enhancing influence. The alcoholics Anonymous and Narcotics Anonymous programs are willfully blind to nicotine addiction. Under these circumstances, when I am dealing with a patient who has a drug-abuse problem, my first challenge is frequently to deal with these societal attitudes which tend to keep the patient from even realizing that there is a problem. In an sick society, to be “normal” is to be ill, so I have to cure the patient of wanting to be “normal” before s/he can even begin to understand what the problem is.
The current definition of addiction no longer depends upon withdrawal symptoms: it is based upon the obsessive behavior and compulsive use despite adverse consequences. The easiest problem to figure out is when someone is having health problems caused by the drug use. The cigarette smoker with emphysema and heart disease, the methamphetamine user with “crank bugs”, or the cirrhotic alcoholic may be ready to admit to her/himself and to me that there is a problem. Until that point, the patient may be able to deny to her/himself that there is a problem. In fact, some people manage to consume drugs without experiencing any ill effects or addiction. I once heard Dr. David Smith, the founder of the Haight-Ashbury Free Clinic, and one of the world’s foremost authorities on drug abuse, say, “If it feels good, it may be a problem.” At the time, I found this very discouraging. Of course, he wasn’t saying it is always a problem, but, even if no drugs are involved, self-observation is an indispensable tool for self-improvement; enjoyment of an activity without any consideration of its consequences may lead to obsessive and destructive consequences. “Process addictions”, such as gambling or sex addiction, are no less addictive than drugs, and sometimes are equally destructive. I have patients who have suffered immensely from what others have done to them with supposedly good intentions: the child abused by “discipline”, the churchegoer maligned or ostracized by the congregation for “immorality”, the harmless drug user sentenced to prison. Any action can become cruel or destructive if it is performed without regard to its consequences. There is no substitute for kindness.