Craving Relief

Why is it so hard for addicts to say “enough?”

One of the useful things that may yet come out of the much-derided DSM-5 manual of mental disorders is the addition of craving as a criterion for addiction. “Cravings,” writes Dr. Omar Manejwala, a psychiatrist and the former medical director of Hazelden, “are at the heart of all addictive and compulsive behaviors.” Unlike the previous two volumes in this monthful of addiction books, Manejwala’s book, Craving: Why We Can’t Seem To Get Enough,  focuses on a specific aspect common to all addiction syndromes, and looks at what people might do to lessen its grip.

Why do cravings matter? Because they are the engine of addiction, and can lead people to “throw away all the things that really matter to them in exchange for a short-term fix that is often over before it even starts.” When Dr. Manejwala asked a group of patients to explain what they were thinking when they relapsed, their answer was often the same: “I was so STUPID.” But the author had tested these people. “I knew their IQs.” And the best explanation these intelligent addicts could offer “was the one explanation that could not possibly be true.”

In my book, The Chemical Carousel, I quoted former National Institute on Alcohol Abuse and Alcoholism (NIAAA) director T.K. Li on the subject of craving: “We already have a perfect drug to make alcohol aversive—and that’s Antabuse. But people don’t take it. Why don’t they take it? Because they still crave. And so they stop taking it. You have to attack the other side, and hit the craving.” However, if you ask addicts about craving when they are high, or have ready access, they will often downplay its importance. It is drug access unexpectedly denied that sets up some of the fiercest cravings of all. Conversely, many addicts find that they crave less in a situation where they cannot possibly score drugs or alcohol—at a health retreat, or on vacation at a remote locale.

Why are cravings so hard to explain? One reason is that “people use the word to mean so many different things.” You don’t crave everything you want, as Manejwala points out. Cravings are not the same as wants, desires, urges, passions, or interests. They are “stickier.” The brain science behind craving starts with the downregulation of dopamine and other neurotransmitters. As the brain is artificially flooded with neurotransmitters triggered by drug use, the brain goes into conservation mode and cuts back on, say, the number of dopamine receptors in a given part of the brain. In the absence of the drug, the brain is suddenly “lopsided,” and time has to pass while neural plasticity copes with the new (old) state of affairs. In the interim, the unbalanced state of affairs is a prime ingredient in the experience of craving.

Cravings are “disturbingly intense” (Manejwala) and “incomprehensibly demoralizing” (AA). Alcohol researcher George Koob called craving a state of “spiraling distress.” Cravings are not necessarily about reward, but about anticipating relief. “The overwhelming biological process in addictive craving is really a complex set of desperate, survival-based drives to feel ‘normal,’” says Manejwala.

The late Alan Marlatt, a psychologist who studied cravings for years, proposed that apparently irrelevant decisions could trigger or prevent relapse, almost without the addict knowing it. Turning left at an intersection, toward the supermarket, or turning right, toward the liquor store, can feel arbitrary and dissociated from desire. We also know that environmental cues can trigger craving, such as the site of a crack house where an addict used to do his business. Manejwala points to research showing that “some relapses related to cues and context are mediated by a small subgroup of neurons in the medial prefrontal cortex,” and suggests that it may be possible in the future to target this area with drug therapy.

Manejwala is unabashedly pro-12 Step, and favors traditional group work as the standard therapy. For example, he points to a Cochrane analysis of 50 trials showing that group participation roughly doubles a smoker’s chance of quitting. One of the reasons AA works for some people is that AA attendance reduces “pro-drinking social ties.” Simply put, if you are sitting with your AA pals in a meeting, you’re not out with your drinking buddies at the tavern. The author admits, however that alternatives such as SMART recovery work for some people, and that “sadly, much energy has been wasted as members of these various organizations bicker with each other about which works best, and this leaves the newcomer perplexed…. Over 20 million American are in recovery from addiction to alcohol and drugs. I can tell you this much: they didn’t all do it the same way.”

And along the way, you can be sure that all of them became familiar with cravings. Manejwala offers several strategies for managing cravings, and I paraphrase a few of them here:

—Join something. Participate. Get out of your own head and become actively involved in some group, any group, doing something you are interested in.

—Hang around people who are good at recovery. Long-timers, with a solid base of sobriety. You will not only learn HOW to do it, but that it CAN be done.

—Write stuff down. This makes you pay attention to what you’re doing. Keep a cigarette log. Count calories. Know what you’re spending per month on alcohol. Educate yourself about your addiction.

—Tell someone. Tell somebody you trust, because if there is anything harder than dealing with cravings from drinking, smoking, or drugging, it’s doing it in secret.

—Be teachable. Watch out for confirmation bias. “When you think you have the answers, it’s hard to hear alternatives.”

—Empathy matters. The author notes that the Big Book insists that by gaining sobriety, “you will learn the full meaning of ‘Love thy neighbor as thyself.’” Altruism may have evolutionary, physiological, and psychological implications we haven’t worked out yet.

How to Kick Everything

Christopher Kennedy Lawford on recovery.

Christopher Kennedy Lawford’s ambitious, one-size-fits-all undertaking is titled Recover to Live: Kick Any Habit, Manage Any Addiction: Your Self-Treatment Guide to Alcohol, Drugs, Eating Disorders, Gambling, Hoarding, Smoking, Sex, and Porn. That pretty much covers the waterfront, and represents both the strengths and the weaknesses of the book.

There’s no doubting Lawford’s sincerity, or his experiential understanding of addiction, or the fact that the raw ingredients were present in his case: bad genes and a traumatic early environment. He is related to Ted Kennedy, two of his uncles were publically murdered, and he started using drugs at age 12. But this book doesn’t dwell on his personal narrative. Lawford is a tireless supporter of the addiction recovery community, and Recover to Live is meant to be a one-stop consumer handbook for dealing with, as the title makes clear, any addiction.

To his credit, Lawford starts out by accurately pegging the addiction basics: A chronic brain disorder with strong neurological underpinnings. He cites a lot of relevant studies, and some questionable ones as well, but ultimately lands on an appropriate spot: “You can’t control which genes you inherited or the circumstances of your life that contributed to your disease. But once you know that you have the disease of addiction, you are responsible for doing something about it. And if you don’t address your problem, you can’t blame society or anyone in your life for the consequences. Sorry. That’s the way it works.”

Once you know, you have to treat it. “It can turn the most loving and nurturing home into a prison of anger and fear,” Lawford writes, “because there is no easy fix for the problem, and that infuriates many people.”

 Lawford includes good interviews with the right people—Nora Volkow, Herb Kleber, and Charles O’Brien among them. And he makes a distinction frequently lost in drug debates: “Nondependent drug use is a preventable behavior, whereas addiction is a treatable disease of the brain.” Due to our penchant for jailing co-morbid addicts, “our prisons and jails are the largest mental health institution in the world.” He also knows that hidden alcoholism and multiple addictions mean “rates of remission from single substances may not accurately reflect remission when viewed broadly in terms of all substances used.”

One nice thing about Lawford’s approach is that he highlights comorbidity, the elephant in the room when it comes to addiction treatment. Addiction is so often intertwined with mental health issues of various kinds, and so frequently left out of the treatment equation. The author is correct to focus on “co-occurring disorders,” even though he prefers the term “toxic compulsions,” meaning the overlapping addictions that can often be found in the same person: the alcoholic, chain-smoking, compulsive gambler being the most obvious example.

The curious inclusion of hoarding in Lawford’s list of 7 toxic compulsions (the 7 Deadly Sins?) is best explained by viewing it as the flipside of compulsive shoplifting, a disorder which is likely to follow gambling into the list of behavioral dependencies similar to substance addictions. In sum, writes Lawford, “If we are smoking, overeating, gambling problematically, or spending inordinate amounts of time on porn, we will have a shallower recovery from our primary toxic compulsion.” Lawford sees the exorcising of childhood trauma as the essential element of recovery—a theory that has regained popularity in the wake of findings in the burgeoning field of epigenetics, where scientists have documented changes in genetic expression beyond the womb.

But in order to cover everything, using the widest possible net, Lawford is forced to conflate an overload of information about substance and behavioral dependencies, and sometimes it doesn’t work. He quotes approvingly from a doctor who tells him, “If you’re having five or more drinks—you have a problem with alcohol.” A good deal of evidence suggests that this may be true. But then the doctor continues: “If you use illicit drugs at all, you have a problem with drugs.” Well, no, not necessarily, unless by “problem” the doctor means legal troubles. There are recreational users of every addictive substance that exists—users with the right genes and developmental background to control their use of various drugs. And patients who avail themselves of medical marijuana for chronic illnesses might also beg to differ with the doctor’s opinion.

Lawford attempts to rank every addiction treatment under the sun in terms of effectiveness (“Let a thousand flowers bloom”), an operation fraught with pitfalls since no two people experience addictive drugs in exactly the same way. Is motivational enhancement better than Acamprosate for treatment of alcoholism, worse than cognitive therapy, or about as good as exercise? Lawford makes his picks, but it’s a horse race, so outcomes are uncertain. Moderation management, web-based personalized feedback, mindfulness meditation, acupuncture—it’s all here, the evidence-based and the not-so-evidence based. Whatever it is, Lawford seems to think, it can’t hurt to give it a try, and even the flimsiest treatment modalities might have a calming effect or elicit some sort of placebo response. So what could it hurt.

Lawford’s “Seven Self-Care Tools” with which to combat the Seven Toxic Compulsions vary widely in usefulness. The evidence is controversial for Tool 1, Cognitive Behavioral Therapy. Tool 2, 12-Step Programs, is controversial and not to everybody’s taste, but used as a free tool by many. Tool 3 is Mindfulness, which is basically another form of cognitive therapy, and Tool 4 is Meditation, which invokes a relaxation response and is generally recognized as safe. Tool 5, Nutrition and Exercise, is solid, but Tool 6, Body Work, is not. Treatments like acupuncture, Reichian therapy, and other forms of “body work” are not proven aids to addicts. Tool 7, Journaling, is up to you.

One of the more useful lists is NIDA director Nora Volkow’s “four biggest addiction myths."

First: “The notion that addiction is the result of a personal choice, a sign of a character flaw, or moral weakness.”

Second: “In order for treatment to be effective, a person must hit ‘rock bottom.’”

Third: “The fact that addicted individuals often and repeatedly fail in their efforts to remain abstinent for a significant period of time demonstrates that addiction treatment doesn’t work.”

Fourth: “The brain is a static, fully formed entity, at least in adults.”

Finally, Lawford puts a strong emphasis on an important but rarely emphasized treatment modality: brief intervention. Why? Because traditional, confrontational interventions don’t work. The associate director of a UCLA substance abuse program tells Lawford: “I haven’t had a drink now in 25 years, and this doctor did it without beating me over the head with a big book, without chastising me, or doing an intervention. What he did was a brief intervention. Health professionals who give clear information and feedback about risks and about possible benefits can make a huge difference. A brief intervention might not work the first time. It might take a couple of visits. But we need more doctors who know what the symptoms of alcohol dependence are and know what questions to ask.”

If your knowledge of addiction is limited, this is a reasonable, middle-of-the-road starting point for a general audience.

Addiction Books For the Beach

When 50 Shades of Grey doesn’t cut it.


The Science of Addiction: From Neurobiology to Treatment

Carlton K. Erickson
312 pages
Publisher: W. W. Norton and Company (2007)

Amazon Overview: Neuroscience is clarifying the causes of compulsive alcohol and drug use––while also shedding light on what addiction is, what it is not, and how it can best be treated––in exciting and innovative ways. Current neurobiological research complements and enhances the approaches to addiction traditionally taken in social work and psychology. However, this important research is generally not presented in a forthright, jargon-free way that clearly illustrates its relevance to addiction professionals. In The Science of Addiction, Carlton K. Erickson presents a comprehensive overview of the roles that brain function and genetics play in addiction.


The Addiction Solution: Unraveling the Mysteries of Addiction through Cutting-Edge Brain Science

David Kipper and Steven Whitney
304 pages
Publisher: Rodale Books (2010)

For decades addiction has been viewed and treated as a social and behavioral illness, afflicting people of “weak” character and “bad” moral fiber. However, recent breakthroughs in genetic technology have enabled doctors, for the first time, to correctly diagnose the disease and prove that addiction is an inherited, neuro-chemical disease originating in brain chemistry, determined by genetics, and triggered by stress. In their groundbreaking Addiction Breakthrough, David Kipper, MD, and Steven Whitney distill these exciting findings into a guide for the millions of adults who want to be free from the cycle of addiction, and for their loved ones who want to better understand it and to help.


In the Realm of Hungry Ghosts: Close Encounters with Addiction

Gabor Maté
520 pages
Publisher: North Atlantic Books (2010)

Based on Gabor Maté’s two decades of experience as a medical doctor and his groundbreaking work with the severely addicted on Vancouver’s skid row, In the Realm of Hungry Ghosts radically reenvisions this much misunderstood field by taking a holistic approach. Dr. Maté presents addiction not as a discrete phenomenon confined to an unfortunate or weak-willed few, but as a continuum that runs throughout (and perhaps underpins) our society; not a medical "condition" distinct from the lives it affects, rather the result of a complex interplay among personal history, emotional, and neurological development, brain chemistry, and the drugs (and behaviors) of addiction. Simplifying a wide array of brain and addiction research findings from around the globe, the book avoids glib self-help remedies, instead promoting a thorough and compassionate self-understanding as the first key to healing and wellness.


Memoirs of an Addicted Brain: A Neuroscientist Examines his Former Life on Drugs

Marc Lewis
336 pages
Publisher: PublicAffairs (2012)

Marc Lewis’s relationship with drugs began in a New England boarding school where, as a bullied and homesick fifteen-year-old, he made brief escapes from reality by way of cough medicine, alcohol, and marijuana. In Berkeley, California, in its hippie heyday, he found methamphetamine and LSD and heroin. He sniffed nitrous oxide in Malaysia and frequented Calcutta’s opium dens. Ultimately, though, his journey took him where it takes most addicts: into a life of addiction, desperation, deception, and crime. But unlike most addicts, Lewis recovered and became a developmental psychologist and researcher in neuroscience. In Memoirs of an Addicted Brain, he applies his professional expertise to a study of his former self, using the story of his own journey through addiction to tell the universal story of addictions of every kind.


The Chemical Carousel: What Science Tells Us About Beating Addiction

Dirk Hanson
472 pages
Publisher: BookSurge (2009)

A book for anyone concerned with the care and healing of addiction, substance abuse, and the latest advances in the area of addiction science. In The Chemical Carousel, science writer Hanson takes the reader on a voyage through the heady world of addiction science, from the lab to the clinic to the junky on the street. Hanson explains the workings of common neurotransmitters and documents the direct effect drugs and alcohol produce on the reward pathways of the brain. He shows how scientists and treatment professionals have finally given us an answer to the perennial question about addiction: Why can't those people just say no?


An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine

Howard Markel
336 pages
Publisher: Vintage (2012)

Acclaimed medical historian Howard Markel traces the careers of two brilliant young doctors--Sigmund Freud, neurologist, and William Halsted, surgeon--showing how their powerful addictions to cocaine shaped their enormous contributions to psychology and medicine. When Freud and Halsted began their experiments with cocaine in the 1880s, neither they, nor their colleagues, had any idea of the drug's potential to dominate and endanger their lives. An Anatomy of Addiction tells the tragic and heroic story of each man, accidentally struck down in his prime by an insidious malady: tragic because of the time, relationships, and health cocaine forced each to squander; heroic in the intense battle each man waged to overcome his affliction.


How to Change Your Drinking: a Harm Reduction Guide to Alcohol

Kenneth Anderson
86 pages
Publisher: CreateSpace (2010)

This book is the first comprehensive compilation of harm reduction strategies aimed specifically at people who drink alcohol. Whether your goal is safer drinking, reduced drinking, or quitting alcohol altogether, this is the book for you. It contains a large and detailed selection of harm reduction tools and strategies which you can choose from to build your own individualized alcohol harm reduction program. There are many practical exercises to help people change their behaviors, including risk-ranking worksheets, drinking charts, goal choice worksheets, and many more. There are also innumerable practical tips from folks who "have been there" and have turned their drinking habits around for the better.


Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It

William R. Miller and Kathleen M. Carroll
320 pages
Publisher: Guilford Press (2010)

While knowledge on substance abuse and addictions is expanding rapidly, clinical practice still lags behind. This state-of-the-art book brings together leading experts to describe what treatment and prevention would look like if it were based on the best science available. The volume incorporates developmental, neurobiological, genetic, behavioral, and social–environmental perspectives. Tightly edited chapters summarize current thinking on the nature and causes of alcohol and other drug problems; discuss what works at the individual, family, and societal levels; and offer robust principles for developing more effective treatments and services.

Writers On The Edge: 22 Writers Speak About Addiction and Dependency

Diana Raab and James Brown
204 pages
Publisher: Modern History Press (2012)

Writers On The Edge offers a range of essays, memoirs and poetry written by major contemporary authors who bring fresh insight into the dark world of addiction, from drugs and alcohol, to sex, gambling and food. Editors Diana M. Raab and James Brown have assembled an array of talented and courageous writers who share their stories with heartbreaking honesty as they share their obsessions as well as the awe-inspiring power of hope and redemption. Frederick & Steven Barthelme, Kera Bolonik, Margaret Bullitt-Jonas, Maud Casey, Anna David, Denise Duhamel, B.H. Fairchild, Ruth Fowler, David Huddle Perie Longo, Gregory Orr, Victoria Patterson, Molly Peacock, Scott Russell Sanders, Stephen Jay Schwartz, Linda Gray Sexton, Sue William Silverman, Chase Twichell, and Rachel Yoder

Photo Credit: http://www.readingkingdom.com/

Books By Addicts: A Collection

The Up and the Down.
 
(Click titles for full review)

Steve Earle and the Ghost of Hank Williams: I’ll Never Get Out of This World Alive

Musician Steve Earle made a solo name for himself with "Guitar Town" and "Copperhead Road" after playing in legendary country and bluegrass bands as a young prodigy. He was nominated for a Grammy, his reputations soared, he added rock and roll to his range—until 1991, when Earle put out the aptly named live album, Shut Up and Die Like An Aviator. Shortly thereafter, he was dropped by his record label for long-standing drug problems, and landed in prison with a heavy sentence for possession of heroin….






When Did I Become the Junkie Auntie Mame? Courtney Love tells her tangled tale in a new e-book.

Maer Roshan, author of Courtney Comes Clean: The High Life and Dark Depths of Music’s Most Controversial Icon, logged a dozen “exhilarating and exhausting” sessions with the widow of Nirvana’s Kurt Cobain over the course of a year, pulling together a definitive look at Love’s drug addictions and other demons. Roshan taped countless hours of interviews, and received additional written material from the “Tolstoy of texting,” as Love refers to herself. The book is highly readable, almost, one is tempted to say, addictively so. Sure, it’s tabloid stuff—let he or she who has never peeked at Gawker or Jezebel cast the first stone….





Mike Doughty Talks About The Book of Drugs: Former Soul Coughing front man on sobriety and life as a solo artist.

Over the phone, Mike Doughty doesn’t have much to say about his former band, Soul Coughing. When I mention it, he gives out a low growl as a warning. He said it all in The Book of Drugs, and it doesn’t sound like he had much fun. Although the avant-garde rock band created music that was spiky and sneaky and immensely popular, topped off by Doughty’s monotonic but strangely penetrating vocal delivery on such classics as “Super Bon Bon,” “True Dreams of Wichita,” and “Circles,” Doughty was drug-dependent and miserable….






Writers On The Edge: A compendium of tough prose and poetry about addiction

Here’s a book I’m delighted to promote unabashedly. I even wrote a jacket blurb for it. I called it an “honest, unflinching book about addiction from a tough group of talented writers. These hard-hitters know whereof they speak, and the language in which they speak can be shocking to the uninitiated—naked prose and poetry about potentially fatal cravings the flesh is heir to—drugs, booze, cutting, overeating, depression, suicide. Not everybody makes it through. Writers On The Edge is about dependency, and the toll it takes, on the guilty and the innocent alike.”






Book Review of Drunken Angel: A hipster gets his shit straight—sort of.

Addiction memoirs remain one of the most popular forms of autobiography on the shelves. But now, when considering a new addition to the genre, it’s impossible not to wonder whether the claims being made by the author are genuine. Since serious drunks often end up visiting the lower circles of hell during the course of their disease, hair-raising and improbable scenes are lamentably common—that is part of the genre’s charm, if that is the right word for it. But how are we to react now? The answer is, you can’t know, and you never really could, that bastard James Frey notwithstanding....






Addiction Fiction: Coming-of-Age Drug Novels

Call it “addiction fiction.” In the past few years we have seen a blossoming of this genre, where the private eye goes to 12-Step meetings, and one day your sponsor may just save your life by gunning down a rival in the street. Or, where the wise-beyond-their-years prep school drug addicts engage in Brett Easton Ellis-style sex and ennui….








Addiction Noir: The Next Right Thing

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….








John Berryman and the Poetry of “Irresistible Descent”: The penal colony’s prime scribe

A year before he committed suicide by jumping off a Minneapolis bridge in 1972, Pulitzer Prize-winning poet John Berryman had been in alcohol rehab three times, and had published a rambling, curious, unfinished book about his treatment experiences. Recovery is a time capsule. If you think we have little to offer addicts by way of treatment these days, consider the picture in the 60s and 70s. In Recovery, treatment consists almost entirely of Freudian group analysis, and while there is regular talk of alcoholism as a disease, AA style, there is no evidence that it was actually dealt with in this way, after detoxification....

“Addiction Fiction”

Coming-of-Age Drug Novels

Call it “addiction fiction.” In the past few years we have seen a blossoming of this genre, where the private eye goes to 12-Step meetings, and one day your sponsor may just save your life by gunning down a rival in the street. Or, where the wise-beyond-their-years prep school drug addicts engage in Brett Easton Ellis-style sex and ennui.

Fiction readers of a certain age will recall that this is not a new thing under the sun. From Junky to The Man With the Golden Arm, from Naked Lunch to Less Than Zero, drug novels have always been with us. Addiction fiction has two distinct subgenres: addicts with money, and addicts without money. For obvious reasons, the latter genre is the prevailing one—Trainspotting and Requiem for a Dream come to mind. But the wealthy end of the spectrum is not without representation. Consider The Basketball Diaries, or Bright Lights, Big City.

As an example of the first type of book, the one where the addict has no money, we have Spoonful, by first-time author Chris Mendius. As for the upscale second type, there is the recently released novel, No Alternative,  by William Dickerson, a budding film director with an MFA. I would judge both authors to be well south of the age of 40, making both of them pure examples of Generation X. 

Ah, the 90s. As time passes, it seems clear that the death of Kurt Cobain has been added to the touchstones of American youth culture, in a tradition going back to the 60s. Where were you when Kennedy died? When Lennon died? When Cobain died? This last question matters, since Nirvana and Cobain are threaded thematically through both of these new novels. As Chris Willman wrote at Stop the Presses: “April 5 is to many contemporary rock fans what November 22 is to older baby boomers: the day you can almost certainly remember where you were or what you were doing when you heard that ___ died. That's not to say that Kurt Cobain's suicide represented a loss of national innocence in the same way that JFK's assassination did. For one thing, Cobain's whole life and career already symbolized lost innocence, long before he died.”

In Generation X drug novels, lost innocence isn’t lost—there was never any innocence in the first place.

Michael, the narrator of Spoonful, is the kind of drug addict with no money. Michael is forthright, if not one to probe the philosophical ironies of his condition: “Nobody ever says, ‘When I grow up, I want to be a junkie.’” End of story. Well, the beginning, really. In this well-written junky novel, author Chris Mendius brings his tragic characters to life in a manner that calls to mind Hubert Selby, Jr.’s stark New York classics of addiction without redemption.

Set in Chicago’s Wicker Park area, young Michael and his pal Sal find their way to heroin in a hurry. They also quickly learn the flip side of the illness—the sickness of withdrawal, “like having a debilitating combination of food poisoning and the flu, with periodic muscle cramps.” No matter. “Once we made it through all that, we decided to stay off dope. A month passed with no discernible improvement in our lives and we promptly resumed getting high.”

It’s heroin he craves. Michael is no fan of cocaine: “You’re up all night, running your mouth, jaw twitching, nose burning. You might want to fuck but you can’t. All you can do is keep going. Before you know it, the birds are chirping and the garbage trucks are rolling. You’re out hundreds of dollars and for what?” And they scoff at pharmaceutical efforts at non-addictive synthetic opiates, “engineered to not let anyone feel a moment of undeserved pleasure.” One character likens kicking methadone to “getting your skin pulled off with pliers.”

The debate over freely distributing the drug naloxone as an anti-OD safety measure is referred to obliquely: “That’s the thing with smack. It’s a fine line between the time of your life and the end of your life…. More often than not, the difference between life and death was having someone there to revive you or call somebody who could.”

Mendius is good at drawing a picture of the addict’s endless grind: “Finding the ways and means to score is a twenty-four-seven gig. You might get lucky and hit it big now and then but you’re always looking ahead. Plotting. Planning. No matter how much you get or how close the scrape, you always gotta keep at it. Day in and day out.”

Michael never quits for long, and when he is off heroin, he buries himself in marijuana and booze. There is no redemptive ending. He walks off into the sunset.

From seedy Chicago to the upper reaches of Westchester, New York. Like Spoonful, No Alternative by William Dickerson features characters whose collective memory goes back no farther than the 80s. Which sucked, as we all know, and as Thomas, the narrator, never tires of telling us. Thomas and his friends are drug and alcohol abusers with money. The drugs of choice are prescription medications, not heroin or cocaine, for these products of Fordham Prep. 

It is 1994, and the grunge youth of Yonkers, the children of Vietnam vets and hippies, are rootless and confused. “There was no clear-cut path beckoning them. No modus operandi.” It was a generation, Dickerson writes, that “earned a label that was just about as vague as their sense of what to do with their lives: Generation X.” In this version, not much has changed since the crack-crazy L.A. 80s of Brett Easton Ellis. The names and the drugs have been altered, but otherwise the trappings are indistinguishable: high disposable income and excessive ennui.

Thomas supports his crazy little sister Bridget, who becomes a white rapper named Bri Da B. His sister’s drug of choice is cutting herself: “She was determined to be in control. If she was going to bleed, it was going to be a decision, it was going to be controlled, and she was going to bleed everywhere, not just from the abyss between her legs. If pain was to be a constant, might as well get used to it and build up a tolerance.”

No Alternative is readable enough, but it does not carry the campy forward motion of other rich-kid addiction books. It is more measured, dry, and there is an odd hitch in the narration, which is resolved, rather shakily, at the end, with a big Reveal that distracts the reader from the central relationships in the story.

So, two early novels, by promising young writers, about drugs and what they do to you. It will be interesting to find out what becomes of these authors, and what manner of new work they get up to in the future. The story never ends where you think it does.

Book Review: Writers On The Edge

A compendium of tough prose and poetry about addiction.

Here’s a book I’m delighted to promote unabashedly. I even wrote a jacket blurb for it. I called it an “honest, unflinching book about addiction from a tough group of talented writers. These hard-hitters know whereof they speak, and the language in which they speak can be shocking to the uninitiated—naked prose and poetry about potentially fatal cravings the flesh is heir to—drugs, booze, cutting, overeating, depression, suicide. Not everybody makes it through. Writers On The Edge is about dependency, and the toll it takes, on the guilty and the innocent alike.”

I am happy to stand by that statement, content to note that this collection of prose and poetry on the subject of addiction and dependency by 22 talented writers, with an introduction by Jerry Stahl of “Permanent Midnight” junky fame, includes a number of names familiar to me. That makes it all the easier to recommend this book—I know some of the talent. Take James Brown, a professor in the M.F.A program at Cal State San Bernardino, the book’s co-editor, who offers an excerpt from his excellent memoir, This River.  James is no stranger to the subject, having pulled out of a drug and alcohol-fueled nosedive that would have felled lesser mortals for good. “Even though you’ll always be struggling with your addiction, and may wind up back in rehab,” Brown writes, “at least for now, if only for this day, you are free of the miracle potions, powders and pills. If only for this day, you are not among the walking dead.” Or my friend Anna David, who is an editor at The Fix, an online addiction and recovery magazine to which I frequently contribute, and author of several books, including Party Girl and Falling for Me. Anna poignantly recalls “my shock over the power than booze had… it was the greatest discovery of my life.” And Ruth Fowler, another Fix contributor and author of Girl Undressed, delivers up a brilliantly detached story of her life as an addict on both coasts and just about everywhere else, which begins with the line, “I gravitated to the fucked up writers.”

Then there are the contributors I don’t know but wish I did, like co-editor Diana Raab, a registered nurse and award-winning poet, as well as co-author of Writers and Their Notebooks, who offers a poem to her grandmother: “Your ashen face and blond bob/disheveled upon white sheets/on the stretcher held by paramedics/lightly grasping each end, and tiptoeing.” Or another poet, B. H. Fairchild, author of the marvelous collection, Early Occult Memory Systems of the Lower Midwest: “When I would go into bars in those days/the hard round faces would turn/to speak something like loneliness/but deeper, the rain spilling into gutters/or the sound of a car pulling away/in a moment of sleeplessness just before dawn.”

And more: Frederick Barthelme, author of Double Down: Reflections on Gambling and Loss. Stephen Jay Schwartz, best-selling crime novelist  and former director of development for filmmaker Wolfgang Petersen. Writers Rachel Yoder, Victoria Patterson, David Huddle, and Scott Russell Sanders. Etc. This collection is a rich brew of essay, poetry, and memoir. A tough book, a brutal book, a real heartbreaker with grit. Some people get stronger and rise; some don’t. It is a thoughtful and creative compendium of addiction stories, and some of them will surprise you. All of them are solidly written, laid out with an unrelenting realism.

Here it is, these authors are saying. This is how it plays out. Unforgettable stuff.

A River of Rage and Redemption

An interview with writer James Brown.

“Who could blame a reader, after James Frey's discredited 'A Million Little Pieces,' for being skeptical of the pyrotechnic literature of addiction?” asks Susan Salter Reynolds in her review of James Brown's “This River” in the March 20 Los Angeles Times. Besides, it’s a cliché to assert that former addicts always know more about drug addiction than the so-called “experts.” But Los Angeles writer James Brown, a professor of creative writing at Cal State San Bernardino, is a special case. Brown has a sharp, restless mind, a hair-raising background, and has read just about everything worth reading on the subject of addiction. In “This River,” James Brown has come not to bury us in bullshit, but to praise the ineffable mysteries of the human condition. The author writes of the time when, battered and baffled, he clung to the notion of sheer will, of having total mastery over his own destiny—even as the devastating deconstruction of everyday life that drug addiction produces was proceeding apace all around him.

What saved him from dying of drug-related misadventures, like his brother and his sister and a shocking number of his childhood friends? “This River” is no ordinary tale of redemption, but rather a dogged, unadorned, very human description of one man’s attempts to understand his disorder, and to find some way to control it.

 I asked Brown if he would submit to a brief Q and A by email to be published here at Addiction Inbox, and he graciously agreed.

Q. Recent surveys suggest that kids who had their first drink at 12 or 13 are far more likely to experience alcohol dependence as adults. Did you have any early formative experiences with alcohol or other drugs that in hindsight seem significant to you?

James Brown: I’ve heard about this survey, along with another statistic cited in Under the Influence: A Guide to the Myths and Realities of Alcoholism by Milam and Ketcham that children born to an alcoholic mother or father have a four times greater chance of becoming alcoholic themselves than if they’d come from teetotaler parents. 

 Given both studies, if there’s truth to them, and I believe there is, I got off to a great start. I took my first hit of marijuana when I was nine, by twelve I’d begun drinking, and by fourteen I had my first taste of heroin. Alcohol and drugs were a way of life in the neighborhoods I grew up in, poor neighborhoods in poor apartment complexes, where nearly all of the kids were raised by single parents, typically mothers.  

All the kids I knew and hung out with drank and used. I lost contact with nearly all of my childhood friends over the years, but one became a heroin addict and bank robber (and a good one, if there is such a thing, with over 40 robberies before he got caught), and is currently in San Quentin; another shot one too many loads of meth and died of a heart attack in his 40’s; and a good friend, one of my best friends, is still hanging in there. He always loved his marijuana and now gets it prescribed, but he’s quit drinking.

So if I’m any example, and if my childhood friends are any example, I’d have to say, based on personal experience, that I believe there is a strong connection between addiction and getting off to an early start at it.

Q. Tom McGuane once referred to alcoholism as "the writer's black lung disease." Why do you think so many prominent writers have been addicted to alcohol or other drugs?

James Brown: The list of alcoholic writers is long: Hemingway, Kerouac, Eugene O’Neil, Dorothy Parker, Fitzgerald, Jean Rhys, Poe, Faulkner, and on and on. The only rationalization I can come up with, at least in regard to my own addiction, is spending long, long hours alone in a room, trapped in my own head, imagination, feelings, memories and thoughts, and when it’s time to resurface, to leave that room and return to the world that exists outside the sheltered perimeters of my mind, I’d want a drink to ease myself back into it. Without that drink, and the many that followed it, because not even from the beginning could I or did I want to stop after just one or two, it was stimuli overload.  Lights seemed brighter.  Noises louder. I was expected by my wife and children to just return to earth and join their lives when a big part of me was still locked up in that room.

But these are rationalizations. As the years passed, and the alcohol and drugs took greater hold of me, using and drinking was no longer about easing back into the world but eluding it altogether, where I didn’t have to feel or think.   Did booze or drugs help me creatively? No. That’s myth, a lie, this notion of the tragic artist. Outside of Kerouac’s On The Road, which he wrote on speed, and Stevenson’s Dr. Jekyll and Mr. Hyde, which he purportedly completed in 21 days spun on coke, and maybe a few other writers, maybe a dozen other exceptions, generally speaking writing under the influence typically produces work that reflects an insensible, messed-up consciousness.  That’s scribbling, not writing. Good writing requires clarity of mind and vision. 

Q. Can you describe your experience with the controversial drug Seroquel?

James Brown: For me Seroquel has been something of a miracle drug and helpful in maintaining my sobriety. As I’m sure you already know it’s categorized as an antipsychotic and classified as a “major tranquilizer,” as opposed to the “minor tranquilizers,” typically members of the benzodiazepine family. Why Seroquel has become a drug of abuse, I have no idea, because it doesn’t get you high, at least not for me, and there’s no sense of the euphoria associated with Valium and Xanax. Why there’s this big push (all the TV ads) to prescribe it for those suffering from depression, I also have no idea, other than the obvious, which is to make the pharmaceutical companies more money. Seroquel is potent stuff, and was prescribed to me for manic-depression (I prefer this term because it more aptly describes the nature of the illness than the euphemistic “bipolar”), post-traumatic stress syndrome and mild schizophrenia.

It took my nervous system about a week or better to adjust, with side effects of blurred vision and garbled speech, but once the sides passed the drug made a major difference in my ability to sleep without the nightmares that have plagued me for many, many years. Also, it made a big difference with the mania aspect of my mental illness, keeping my system at a relatively even keel, but I can only take it at night. If I use it during the day, I can’t function well, I can’t think clearly or quickly, and I have to be focused when I teach and write.  For depression, I use Wellbutrin, which is effective for me.  Again, I don’t understand, or agree, with the aggressive marketing of Seroquel.  It’s nothing to mess around with and should only be taken if absolutely necessary for ones mental stability.

Love, Loss, and Addiction

Review of “This River” by James Brown.

James Brown, author of “The L.A. Diaries,” has offered up another candid and courageous memoir in his new book, “This River.” In a series of related vignettes, the book amplifies and extends the basic story of Brown’s life as chronicled in “L.A. Diaries,”--a harrowing tale of genetic fate and social failure; a dysfunctional family riven by alcoholism and drug addiction, culminating in the suicide of the author’s brother, followed by the suicide of his  sister.

Throughout his descents into hard drug use, his ups and downs along the alcoholic’s rehab trail, Brown remains a fierce observer of his own behavior, and, heartbreakingly, its effect on those around him: “Worrying, damaging, terrorizing those closest to us, intentionally or not, is what alcoholics, addicts, and the mentally ill do best.” As was true of “The L.A. Diaries,” Brown writes in a spare, direct, unflinching style—a bracing antidote to the Stuart Smalleys of the world.  His observations on A.A., anti-craving medications, and antipsychotic drugs are those of a man unwilling to let prior prejudices and built-in excuses deter him from a search for the true nuts and bolts of his condition.

Reaching that point of understanding, and comprehending the need for action—none of it typically comes fast, cheap, or easy. Brown, who teaches in the MFA program at Cal State San Bernardino, masterfully captures the internal monologues of the addictive mind:

"Getting hooked is for weaklings, the idiots who can’t control themselves, those losers who end up broke and penniless, wandering the streets at night like zombies, like the walking dead…. For the budding addict, the supply is never enough, but your only regret, at least to date, is that you didn’t come across this miracle potion sooner."

The internal dialog eventually becomes an existential struggle: “True or not, I resist the idea that mental illness and alcoholism are somehow inborn. Accepting that premise means embracing the notion of fate, and I don’t. I prefer to believe that I’m in full control.”

As who among us does not. And although none of us are truly in full control—we are all a conflicting welter of “I”s, of shifting identities and roles—it is through the dissociations characteristic of addictive illness that the Jekyll and Hyde nature of these changes, which are somehow “in the blood,” sometimes manifest themselves most graphically.

Does the author prevail? He does, for now, and that is how we must leave it:

Things are changing deep inside you and have been for some time: hormones, genes, brain chemistry, all of it adapts to the alcohol and drugs you continually dump into your body. The cells habituate. The cells literally mutate to accommodate your cravings and now they crave too. Now your addiction has more to do with physiology than psychology. Now it’s the body that robs the mind of its power to choose, and it’s not long before you’ll wish you never came across that miracle potion, those powders and pills.

With suberb jacket reviews from the likes of Tim O’Brien, Robert Olmstead, and Duff Brenna, “This River” is a short read that will lodge itself firmly in your memory.  I read it in one sitting, and I bet you do, too.

Photo Credit: http://radaris.com/p/James/Rivers/

A (Belated) Review of "The Los Angeles Diaries"

A powerful—and true—memoir of addiction.

I’ll admit it: I don’t like drug memoirs. I didn’t like drug memoirs even before James Frey blew up the whole genre by telling a heartfelt story about addiction that turned out to be a tissue of lies.

But The Los Angeles Diaries by James Brown transcends all that. I’ve never read a better true story about addiction. It’s also one of the best modern autobiographies I have ever read, addiction notwithstanding. In addition to having been an alcoholic and a meth head, James Brown is a very talented writer, the author of four novels, and it shows.

First published in 2003, The Los Angeles Diaries is a spare, utterly harrowing account of the author’s experience in a family marked by a history of virulent alcoholism. Brown’s unvarnished truth-telling about addiction is evident early on: “I know there’s no excuse for getting drunk when you’re supposed to be home with your family and I wish knowing this would stop me from doing it. I wish that’s all it took. That I could will it to happen. But it doesn’t work that way, it never has, and in my state of mind, at this particular moment, I can’t imagine living without it.”

While offering up memorable sketches of his boyhood in Los Angeles, Brown paints a devastating picture of the “denial and rage” that characterize full-blown addiction. He deals with the suicide of family members, divorce, the neglect of his children—all of it caused by addiction—without a shred of self-justification. It is, he writes, “a constant quest for more when there can never be enough.”

Interspersed throughout are the author’s mordantly funny adventures in the screen trade, as book after book is optioned for the movies, taken apart and ultimately scrapped before reaching the screen. However, we are never far from the author’s chilling revelation: “Never underestimate the power of denial.”

I can’t improve on the review that appeared in Washington Post Book World: “It’s the balance of agony and grace, of course, that makes life so ferociously interesting. Brown has perfectly captured that balance in his unpretentious, very profound book.”

Inspiring, witty, and bleak, all at the same time, James Brown’s book will appeal to anyone with an interest in addiction—and anyone who enjoys tough, spare prose.

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