Blood Sugar - conclusion text
Unlike Alice, A____ doesn’t get to simply wake up to a safe, rational and comfortable world as though the ominous, inverted, looking-glass world were just a dream. There is no space outside the mirror for A____.
The last time I saw her she was on Methadone again.
She couldn’t even remember how many times she had tried methadone detox. There was always trouble with the dose -- too light, or stepped down too quickly for her. Methadone wouldn’t keep her from wanting to get high, but if they got the dose right at least she wouldn’t get drug sick. The free clinics and public assistance programs she has access to are set up for short-term methadone maintenance – a stop-gap measure between detox and abstinence that starts with a dose that is high enough to act as a substitute and steps down to nothing in a period of 21 – 60 days, depending on the program. Often as her dose decreased she would resort to “chipping” and get caught with traces of heroin in her urine. She had lost her “place” in many programs this way. And since methadone partially blocks the effect of heroin she would need a much bigger hit than normal if she wanted to get high. Sometimes it was just too hard to get to the clinic every morning before 6 am, and she would miss a dose. But heroin was available on the street around the clock. When she had adequate methadone long-term she stopped using heroin. When she stopped using Methadone she very soon found herself using heroin again.
It is hard to reconcile the paradox that relapse is actually a part of recovery. Recovery is part illusion and part contradiction. The addict may be able to see where she wants to go but the path is a corkscrew helix – an asymmetrical curve – and the direction of its spiral can be difficult to read. She can end up, like Alice outside the looking glass house, repeatedly bumping into the very thing she is trying to walk away from.
A____ said, “Maybe my body just won’t let me live without drugs. Maybe I would be able to really give up Heroin for good if I could stay on Methadone for the rest of my life. I think I could do that. If I could just get the right dose and stay on Methadone I could stop smoking rock and get my brain together. But I always have to step-down and then they take me off. Why can’t Methadone be like my Insulin? Why do I have to get to the point where I can live without it?”
Why indeed? While the symptoms present as asocial behavior, we know that addiction is a chronic, relapsing brain disease. Until we learn to treat the disease as a disease and not as a failure of will – the ill will go on being ill. Why should total abstinence from any drug at all be the goal of treatment for addiction? Most of us would consider it both unethical and absurd to suggest that diabetes, or cancer, or AIDS could be resisted by will power alone. And what is will power but just another manifestation of nerve cell activity and the brain’s own drugs?
Like other chronic diseases addiction can be managed. There is research. There are new treatments. And if the addict does not want to stop, the harm the needle and the drug will inevitably do -- to her, and to anyone close to her -- can be reduced.
It may be difficult to accept that addiction is a disease and forget the blame. It may be impossible to account for the addict’s simultaneous detachment and desperation. It may be hard to credit the fact that the addict’s brain chemistry is altered to the point that her capacity for normal emotions is impaired at the neurological level. But anyone who has tried to live with an addict will tell you – they will tell you that tolerance and dependence can have many meanings. They can tell you about betrayal. They know that things can get broken that can’t be fixed.
What addicts have to tell can be difficult to hear. We may not want to look at the world on the other side of the glass. But, If the decaying body of the homeless, mentally ill junkie selling sex or collecting bottles on the street becomes an accepted part of our social landscape that we ignore with impunity – or out of fear – if our government can wage war against the poor and diseased and incarcerate them by the millions under the guise of justice – perhaps we are already on the other side and some things may be broken that need to be fixed.
We are all living with addiction. How can we fix it?
The last time I saw her she was on Methadone again.
She couldn’t even remember how many times she had tried methadone detox. There was always trouble with the dose -- too light, or stepped down too quickly for her. Methadone wouldn’t keep her from wanting to get high, but if they got the dose right at least she wouldn’t get drug sick. The free clinics and public assistance programs she has access to are set up for short-term methadone maintenance – a stop-gap measure between detox and abstinence that starts with a dose that is high enough to act as a substitute and steps down to nothing in a period of 21 – 60 days, depending on the program. Often as her dose decreased she would resort to “chipping” and get caught with traces of heroin in her urine. She had lost her “place” in many programs this way. And since methadone partially blocks the effect of heroin she would need a much bigger hit than normal if she wanted to get high. Sometimes it was just too hard to get to the clinic every morning before 6 am, and she would miss a dose. But heroin was available on the street around the clock. When she had adequate methadone long-term she stopped using heroin. When she stopped using Methadone she very soon found herself using heroin again.
It is hard to reconcile the paradox that relapse is actually a part of recovery. Recovery is part illusion and part contradiction. The addict may be able to see where she wants to go but the path is a corkscrew helix – an asymmetrical curve – and the direction of its spiral can be difficult to read. She can end up, like Alice outside the looking glass house, repeatedly bumping into the very thing she is trying to walk away from.
A____ said, “Maybe my body just won’t let me live without drugs. Maybe I would be able to really give up Heroin for good if I could stay on Methadone for the rest of my life. I think I could do that. If I could just get the right dose and stay on Methadone I could stop smoking rock and get my brain together. But I always have to step-down and then they take me off. Why can’t Methadone be like my Insulin? Why do I have to get to the point where I can live without it?”
Why indeed? While the symptoms present as asocial behavior, we know that addiction is a chronic, relapsing brain disease. Until we learn to treat the disease as a disease and not as a failure of will – the ill will go on being ill. Why should total abstinence from any drug at all be the goal of treatment for addiction? Most of us would consider it both unethical and absurd to suggest that diabetes, or cancer, or AIDS could be resisted by will power alone. And what is will power but just another manifestation of nerve cell activity and the brain’s own drugs?
Like other chronic diseases addiction can be managed. There is research. There are new treatments. And if the addict does not want to stop, the harm the needle and the drug will inevitably do -- to her, and to anyone close to her -- can be reduced.
It may be difficult to accept that addiction is a disease and forget the blame. It may be impossible to account for the addict’s simultaneous detachment and desperation. It may be hard to credit the fact that the addict’s brain chemistry is altered to the point that her capacity for normal emotions is impaired at the neurological level. But anyone who has tried to live with an addict will tell you – they will tell you that tolerance and dependence can have many meanings. They can tell you about betrayal. They know that things can get broken that can’t be fixed.
What addicts have to tell can be difficult to hear. We may not want to look at the world on the other side of the glass. But, If the decaying body of the homeless, mentally ill junkie selling sex or collecting bottles on the street becomes an accepted part of our social landscape that we ignore with impunity – or out of fear – if our government can wage war against the poor and diseased and incarcerate them by the millions under the guise of justice – perhaps we are already on the other side and some things may be broken that need to be fixed.
We are all living with addiction. How can we fix it?
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