Author’s Debut is a Tough, Lyrical Addiction Memoir

"If we don't change direction soon, we'll end up where we're going."

 –Prof. Irwin Corey

I’ve never made a secret of the fact that I don’t really like addiction memoirs—with notable literary exceptions, from Thomas de Quincey to William S. Burroughs, including worthy modern efforts from James Brown, Jerry Stahl, Sacha Z. Scoblic, and others. Writing well about addiction is a rare gift, and newcomer Jessica Hendry Nelson, in If Only You People Could Follow Directions: A Memoir, comes at the problem elliptically, in some cases deliberately pruned of strong emotion. This works in her favor, as she eschews over-the-top bravado for the facts of life. The book is, heartbreakingly, a book about family—about the power of substance abuse, self-destruction, grief, and remorse to tear away at every connection human beings share.

Childhood: We found his battered truck in a Shop Rite parking lot, the smashed headlights still pulsing lazily into the mist like two dying fireflies. The parking lot was empty except for the truck, a few wayward shopping carts, and the streetlight that had blocked my father’s passage. I wasn’t yet able to distinguish my waking life from my dream life, and so it all felt like fantastic fun.

Childhood’s End:  There were a couple sober years, when Eric and I were in early elementary school. Since then, he’s had at least two DUIs a year, and cycles from jail to rehab to halfway house and back again. Occasionally, he’ll manage a few sober months in a halfway house and occasionally he’ll stay with his mother in anticipation of getting his own place. During those months, there is lots of talk of the future, of our own bedrooms and weekends spent watching movies and skiing at the Pocono Mountains, but it never happens.

The father: Before talk therapy. Before asbestos removal jobs and wrecked cars. Nights so hot and black they burned like a solar eclipse through his insides. Before little league games and parent-teacher conferences. Before he fucked the three-hundred pound housewife next door for a couple of Klonopin. Before she killed herself with the rest.

The author is young, but as my friend James Brown, who wrote the powerful addiction memoir, This River, has put it: “Jessica Hendry Nelson knows the power of clean, sparse prose, and her keen eye for the small, most telling details of character show an insight into the human psyche well beyond her years. Her story is oftentimes a dark one, but Nelson holds strong, knowing that saving those we love may first begin, and end, with saving ourselves. A remarkable debut by a wonderfully talented writer.”

The brother: The first offense is theft, though many others will follow—a wildly colorful rap sheet—but the disease that makes him do such things is just an infant now, just an infant throwing its peas.

The mother: She is sad because Eric has taken to snorting Oxycontin in her bathroom, still lying and stealing and denying in that same fucking straight-faced way as the husband once did, until she feels she’s gone completely nuts. I know how she feels, and yet I am unable to change it.

The family: We are practiced in the art of pretend. We are able to convince ourselves that drinking and smoking are incidental, and not part of the fabric of our family, of the shared anxieties that causes us, each to varying degrees, to feel so dissatisfied with our own brain chemistry. We are trying to return to a place of innocence, to the time before, when Mother could still keep us safe. We keep trying, but morning light is unforgiving.

The book reads like the product of an older, more experienced writer. It's impressive, if somewhat digressive, but Nelson is undeniably talented, working in a terse, slightly distanced style, as if the truth of it all required some detachment for her own sake. Impressionistic, episodic, the book is composed of scenes weaving in and out of chronological time. We don’t get it all put together until the end, but when we do, we see an unbroken spirit standing in front of a long and dismal line of hospitals, police stations, institutions, and halfway houses.

The treatments: My mother picks Eric up from the halfway house in North- east Philly where he’s been staying. It is ten a.m. The halfway house is the right side of a narrow duplex. Houses brick and broken. Next to the halfway house is the crack house. Next to the crack house is the whorehouse. Next to the whorehouse is a family with two adorable little girls.

The cycle: That’s the disease talking, they say, and I try to believe that too. For years, I believed, but all I see, finally, is my brother’s hard familiar face and the illness that my mother continues to try and kiss away with love and money and blunt maternal strength until she, we, are all as sick as Eric—the dead father’s legacy, this disease.....

We bring the bottle. We have learned to just bring the bottle.....

Give it up, let it go, take it back, take control. Say yes. Say no. Say no, no, no. Stick to the script. Step One through Twelve. One through Twelve. Keep coming back. It works if you work it. If only you people could follow directions.

Book Review: Addiction Noir

 
The Next Right Thing by Dan Barden

To date, I’ve only reviewed one novel here at Addiction Inbox—Steve Earle’s I’ll Never Get Out of This World Alive, featuring the ghost of Hank Williams standing in for the addictive pleasures that musicians are heir to. Now comes The Next Right Thing by Dan Barden, an exemplar of a new literary genre I am going to call addiction noir. Dial Press, the Random House imprint that published the book, is putting Barden forward as a recovering alcoholic who has grokked this scene from the inside. “Dan Barden knows firsthand the difficulties of sobriety…. The Next Right Thing is a powerful new take on the recovery narrative.”

“I’m a recovering alcoholic,” Barden said in the press release, “and I had always wanted to write something about that experience but I couldn’t find a way to tell that story that didn’t seem stupid.”

That changed one morning while Barden was reading the New York Times. “It occurred to me that I could put everything I knew about recovery into a crime story…. There are a lot of great novels about the disease of addiction itself but not so many about recovery, mostly because there’s something very oblique and mysterious about recovery.”

The elements of Barden’s novel certainly aren’t new—a knowing, seen-it-all reformed alcoholic who happens to be an ex-cop, for starters—and plenty of unsavory bad guys. Add in the requisite women, attractive and troubled, or, as our hero Randy Chalmers prefers them, “insane and beautiful.” Chalmers is looking into the suspicious heroin overdose of his AA sponsor, Terry, in a rundown Santa Ana motel, fifteen years sober at the time of his death. The investigation leads Chalmers, sober himself for 8 years, into a tangle of recovery houses fronting as marijuana grow sites and secret shooting sets for amateur porn videos. The crisp quips and one-liners are often focused on the world of addiction. There are nice set pieces, and Chandleresque observations:

--“Those were the days of crack pipes and precious little eating. Even after she got her bearings back, she moved with the anxious, staticky jerks of a cartoon cat. She radiated disease.”

--“I hit him without thinking… but I was surprised to be once again acting without my own consent. That’s the way people talk about taking a drink, as though it’s happening to someone else at some gauzy distance. Like your arm is lifting the glass, and your consciousness has nothing to do with it.”

--“Even with all the step work and therapy and success, people still imagine they will be okay when the are rich. Or married. Or have a baby. Life for an alcoholic is often a process of discovering all the things that don’t make any difference.”

However, the book is marred by the kind of bewildering rumination that can result when a soap opera full of characters is at full boil: “Something about the recovery house scheme didn’t sit right with me. And why was this Simon Busansky character missing in action? Why had Mutt Kelly parked outside my house? Who had made that call to Cathy? Who was the business partner who so preoccupied Terry during the birth of the child he’d always wanted?”

Nevertheless, the book reads quickly, like a noirish mystery should. For influences, Barden lists the usual suspects—Raymond Chandler, Elmore Leonard, Robert B. Parker, George Pelecanos. With decent sales, I could see this becoming a book series, with our sober ex-cop getting himself involved in helping the wrong addict, or helping acquit the right one. With the public recognition of addiction seemingly at an all-time high, and with the ranks of the recently recovered always in the process of being replenished, there just might be a market for this sort of thing.

In a press release, Barden said the book was about “people who are trying to live sober lives against all odds. And what that’s like for me and my friends is complicated and beautiful and dramatic and terrifying. What’s it like to try to do the right thing by your family and friends when many of your instincts run against that?”

Or, as Randy Chalmers puts it: “Here’s another thing you learn in A.A.: when the drunk loses the woman he loves, you know you’re not at the end of the story. You know it’s going to get much worse.”

Photo credit: http://www.danbarden.com

Book Review: Thinking Simply About Addiction

Of bicycles, swimming, and drugs.

Back when I first became interested in the science of addiction, I was fascinated by an article in Parabola magazine by Dr. Richard Sandor, a Los Angeles psychiatrist with many years of experience treating alcoholics and other drug addicts. In the article, Sandor suggested that a good deal of addictive behavior could profitably be viewed as a form of dissociation. I quoted from that article in my book about addiction, and now he has published a book of his own.

Thinking Simply About Addiction: A Handbook for Recovery, focuses on the current controversy over Alcoholics Anonymous and its 12-Step variants, and takes a reasoned, thoughtful approach to the so-called spiritual aspects of recovery.

Happily, this is not another southern California feel-good self-help tome, though the author does not shy away from tweaking the neuroscience establishment for “delving deeper and deeper into the biochemistry of the alcoholic and drug-addicted brain, endless promising a ‘cure’ and yet never quite delivering the goods.”

While acknowledging that addiction is “correctly understood as a disease,” Sandor diverges a bit from the mainstream disease theory of addiction, believing that addictions are “diseases of automaticity—automatisms—developments in the central nervous system that cannot be eliminated but can be rendered dormant.”

As examples of simple automatisms, Sandor cites bicycle riding and swimming, two behaviors it is impossible to “unlearn.” Consider swimming: If, for some reason, it became extremely dangerous for you to swim (pollution, a heart condition, sharks), the problem is that “you literally cannot choose not to swim. Your only reliable choice is to stay out of the water, to become abstinent.”

Much of the confusion over addiction, the author maintains, is that “we miss the essential quality that defines addiction as a disease: Something someone has rather than something they’re doing.”

What his addicted patients frequently tell him, Sandor writes, is that “the core experience of being addicted is powerlessness, the experience of having lost control over the use of alcohol or a drug.” As one addiction expert put it, addicts “have lost the freedom to abstain.” Like other forms of rehabilitation, says Sandor, “treatment doesn’t work or not work. The patient works. It seems obvious. If the very nature of addiction is automaticity—the loss of control—then recovery is the restoration of choice, not handing choices over to someone else.”

On controlled drinking, or a return to social drinking, Sandor writes that “studies that have followed reliably diagnosed alcoholics for long enough periods of time reveal what clinicians and AAs have known for a long time: Abstinence is necessary for recovery…. If you follow true alcoholics for years, you discover that those who continue to drink get worse and those who remain abstinent don’t. Presumably, the same is true for all other addictions.”

Problem drinkers who do return to moderate drinking “were people who had had enough problems with drinking to land in treatment but who were never physically addicted and therefore didn’t have to become abstinent in order to stop the progression of the disease.”

Where does the “Higher Power” concept fit into all this? Sandor endorses the wider view taken by many psychologists and thinkers, from Gregory Bateson to C.G. Jung. In line with his theme of keeping it simple, Sandor suggests that thinking about a Higher Power may mean coming to realize that “the body’s capacity to restore itself is part of something much larger than our operations and medications… If you like, it comes from God. If you don’t like, it comes from a Higher Power, from Nature, from five billion years of the evolution of life on Earth, from the created universe, from whatever you want to call it.”

It is the simplest of simple ideas: “We all belong to something beyond ourselves.”

Graphics Credit: www.thesecondroad.org

The Three-Headed Dragon

A symbol of need.

 Getting off drugs, or learning to stop drinking, is very often easier than staying off them. As Mark Twain remarked about tobacco, quitting was easy—he’d done it dozens of times. Relapse, the biological imperative, will have its way with most of those abstaining for the first time. Addiction is a psychological disorder with strongly cued behavioral components, whatever its dimensions as a biochemically-based disease.

The three-headed dragon is a metaphor first popularized by alternative therapists at the Haight Ashbury Free Medical Clinic in San Francisco. The first head of the dragon is physical. Addiction is a chronic illness requiring a lifetime of attention. The second head is psychological. Addiction is a disorder with mental, emotional, and behavioral components. And the third head of the dragon is spiritual. Addiction is an existential state, experienced in isolation from others.

Addicts speak of “chasing the dragon” in an effort to catch the high that they used to achieve so easily. It is also drug slang for the use of small metal pipes to catch and inhale the wisps of smoke from a pile of burning opium, crack, or speed. We can picture the dragon chasing his own tail, snapping at it with all three hungry mouths, in an endless escalation of tolerance and need.

“Because of the unique reaction that the genetically addiction-prone individual experiences to his drug of choice, he or she programs his or her belief system with the deep conviction that the substance is ‘good,’” writes Richard Seymour. “This is where self-help becomes intrinsic to recovery. Unless one deals with the third head, unless one changes the belief system and effects a turning-about in the deepest seat of consciousness, there is no recovery.” The “X” factor in recovery, for many people, turns out to be a form of inner self-awareness; something that includes the attributes of will power and determination yet transcends them through a form of surrender.

And speaking of changing one’s belief system, experience has shown that it is a spectacularly bad idea to sit around and do nothing but stare at the wall during the early phase of recovery. Psychologist Mihaly Csikszentmihalyi argues, in The Evolving Self, that when attention wanders, and goal-directed action wanes, the majority of thoughts that come to mind tend to be depressive or sad. (This does not necessarily apply to formal methods of meditation, which cannot be described as states marked by wandering attention.) The reason that the mind turns to negative thoughts under such conditions, he writes, is that such pessimism may be evolutionarily adaptive. “The mind turns to negative possibilities as a compass needle turns to the magnetic pole, because this is the best way, on the average, to anticipate dangerous situations.” In the case of recovering addicts, this anticipation of dangerous situations is known as craving. The next step is often drug-seeking behavior, followed by relapse.

For a highly motivated addict with a stable social life, a safe and effective medication to combat craving might be all that is needed. For many others, however, attention to the other two heads of the dragon is going to be necessary. An addict’s ability to experience pleasure in the normal way has been biochemically impaired. It takes time for the addict’s disordered pleasure system to begin returning to normal, just as it takes time for the physical damage of cigarette smoking to partially repair itself.

Alternative therapists are fond of referring to recovery as a process, with an emphasis on the importance of time. Medication of any disease, even if successful, does not treat the continuing need for healing. It is now well understood that mood and outlook can have an effect on healing. Positive emotional states can be beneficial to the maintenance of good health. Thoughtful physicians make the distinction between a disease and an illness. A disease is a chemically identifiable pathological process. An illness, by contrast, is the disease and all that surrounds it—the sociological environment, and the individual psychology of the patient who experiences the disease.

From The Chemical Carousel By Dirk Hanson, pp. 311-313.  © Dirk Hanson, 2008.

Graphics Credit: wwwwilliammorristile.com

The Alcoholic Rats of Dr. Li.

Excerpt from chapter 1 of The Chemical Carousel.

In the early 1990s, it was safe to say that Dr. Ting-Kai Li was in possession of the largest and most famous collection of alcoholic rats in the world.

Housed in a laboratory near Dr. Li’s office at Indiana University, the “P-line” of rodents were freely self-administering the body-weight equivalent of one bottle of whiskey a day for a 155-pound man; a blood alcohol concentration that would have gotten them arrested on any highway in America. The P-line rats were seriously addicted to ethanol, the purified form of booze known outside the laboratory as grain alcohol, or white lightning.

“It’s actually the only line that’s been well developed in the world,” Dr. Li told me at the time, with justifiable pride. “And it has been developed through genetic selection for alcohol preference.” In other words, Dr. Li did not teach these animals to drink. He didn’t have to.

Dr. Li, who was until recently the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the alcoholism wing of the National Institutes of Health (NIH), made it sound easy: “You take a stock with some genetic heterogeneity in it, and then you test it for drinking behavior, and there will be, say, two or three out of a hundred that like to drink, so you take those, and you breed them. And the ones that don’t like to drink, you breed those, and within ten generations you start to have a very good separation between drinking scores.”

Why would a rat drink alcohol, and why would anybody care? When I first spoke with Ting-Kai Li, the lack of suitable animal models of alcoholism and addiction was all too apparent. Without suitable strains of test animals, most genetic and neurobiological research would take centuries, and would involve ethical questions about human testing far stickier than the questions raised by the animal rights movement. Animal models are one of the primary pathways of discovery available to neurobiologists and other researchers.

The precisely spoken, self-effacing Dr. Li, along with neurobiology professor Dr. William McBride and their co-workers at Indiana University, were never really in the business of teaching rats to drink. They were in the business of discovering ways to make them stop.

To be like human alcoholics, the rats must also demonstrate both an increased tolerance to the effects of the drug, and the onset of physical dependence as manifested by withdrawal symptoms. And they do. The P-line rats develop tolerance, and they show acute withdrawal symptoms when researchers cut off their supply. The rats suffer tremors, seizures, and a rodent version of delirium tremens. They fall down a lot. They are also quick to avail themselves of a little “hair of the dog.” After a period of abstinence, they take alcohol again to relieve the withdrawal symptoms.

The P-line rats met every definition of alcoholism anyone could imagine, and the cause of their alcohol addiction appears to be strictly genetic. What was happening with the P-line rats was not explainable by resorting to arguments about simple learned behavior.

“How do you explain this difference?” said Dr. Li, all those years ago. “My explanation is that there are genetic differences among different individuals. You’re making the assumption that you expose them to the same environment, the same environmental influences, and yet they behave differently in terms of addiction.”

Today, we can safely say that Dr. Li’s hypothesis has proven to be true.

© Copyright 2008

Photo Credit: smh.com.au

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The Chemical Carousel

What Science Tells Us About Beating Addiction, by Dirk Hanson.


My book on addiction research is now available for purchase online at AMAZON, BOOKSURGE, ABEBOOKS, AND ALIBRIS.

FROM THE PUBLISHER:
The Chemical Carousel is an in-depth look at addiction science and medical treatments for drug dependence and alcoholism. An experienced science and business journalist, author Hanson brings a complex and widely misunderstood subject out of the shadows and into the light of understanding. In this groundbreaking and highly readable examination of addiction science and the biological, emotional, and scientific underpinnings of substance abuse, The Chemical Carousel breaks through the myths, while presenting the surprising and cutting-edge facts about addiction and its medical origins. Hanson leaves no stone unturned in this invaluable examination of why people become addicted.
ISBN-13 978-1439212998
$20.95 Trade Paperback
472 pages
Notes, selected bibliography, index

BOOKSURGE PUBLISHING www.booksurge.com

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America Anonymous—Book Review

Sex, drugs, and shoplifting.

New York Times magazine contributor Benoit Denizet-Lewis interweaves eight personal stories of addiction and obsession and ties them in with a well-researched summary of the drug treatment business in his new book, America Anonymous. Offering deft portraits of people suffering from various forms of addiction and compulsion, Denizet-Lewis brings to life much of the denial, prevarication, giddy hopes of victory, incomprehensible relapses, and endless stream of lies and broken promises with which so many active addicts string together their fractured narratives.

By design, Denizet-Lewis swings wide when it comes to defining addiction. In addition to alcoholics and drug addicts, the author, a self-confessed sex addict, includes in his case histories a woman who is a serial shoplifter, a body builder addicted to steroids, a fifty year-old compulsive eater, and a college student addicted to pornography.

“I believe in an expanded understanding of addiction, “ Denizet-Lewis writes. “That is, I believe that gambling, sex, food, spending, and work (to name a few) can, for some people be as addictive and debilitating as an addiction to drugs.”

While I am not as convinced as the author that the scientific evidence is beginning to weigh heavily on the side of accepting behavioral compulsions as classic addictions, I can only agree when he points out that, for all the heady buzz about addiction medicine and pills for alcoholism, 12 Step programs—which originated more than 50 years ago--still arguably represent the most effective approach to treating addiction that we know of. In addition, Denizet-Lewis writes, doctors and clinicians have been promising medical treatments for addiction for 200 years now, and only in the last ten years or so has there been any real progress.

Point taken. The author basically accepts that addictions are chronic diseases with genetic components, “and an onset and course that vary depending on behavior and environmental factors.” Scientific information is presented accurately and in an understandable fashion. Denizet-Lewis knows his subject, even if he uses that data to reach different conclusions than I do. I liked this book, even though I am at odds with many of its arguments.

So, what do Denizet-Lewis’s people teach us about addiction? The crucial need for honesty, to begin with. “If we’re not rigorously honest,” one addict says, “we can’t recover. It’s impossible.” This rule applies to the healers as well. The author quotes one researcher succinctly: “I would distrust anyone who says they can cure addiction.” This sentence alone, if absorbed by addicts seeking treatment, could save them considerable time, money and self-esteem. The author also quotes addiction researcher Anna Rose Childress to good effect: “Relapse is not a failure of treatment. Relapse is part of the disorder.”

What runs through all the personal sagas is the desire of the subjects to feel normal—to “feel feelings” in a normal way. The author offers compelling narratives that catch the flavor of the addicted way of life, a combination of monotony, mood swings, and fear. Denizet-Lewis is particularly adept at making us care about what happens to these people, and we read the book with a hopefulness laced with dread. We know it cannot end happily for everyone. And it does not.

In the end, the author concludes that most forms of addiction can be accounted for by the childhood trauma model. Since a good deal of sex therapy centers on this conception, perhaps the author’s conclusions in this regard are not surprising. However, trauma theories about the origin of addiction have not translated into reliable and effective treatments for addiction, either. And such theories have had a long run, starting even before Freud.

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