Prologue, Part One.

April 10, 2011

 Since going through my use history feels a little like reveling in it, I’m going to lay out my plan for treatment in Part I, in order to demonstrate that is my primary concern. Check out Part Two for all the gory details of my use; those of you who know me may want to skip Part Two. Said another way, I would prefer those of you who know me to skip Part Two. Our initial goal is to get me through the treacherous waters of detoxification (which, since it involves other, more powerful drugs, is probably inaptly named) as comfortably as possible, so I can get on with the business of long-term treatment.  Treatment – because this is not my first rodeo – will involve identifying and treating my various mental health issues – known in treatment colloquially as “-isms” – of which, presumably, addiction is only a symptom. I’ve asked the question whether addiction can simply be both the root and the symptom, and the answer seems to be generally no, with some qualification.      

Okay, buddy, we're going to settle this once and for all.

Substance abuse and mental illness exhibit traits of the chicken-or-the-egg dilemma. People start using drugs and alcohol for all kinds of reasons, but not everyone who ingests a potentially addictive substance becomes addicted – in fact, the vast majority do not. There are a lot of smart people who have studied this subject for a long time who cannot tell you why that is. I conducted years of field research on the subject myself (/tongue firmly placed in cheek) and I have some ideas. For one thing, I don’t believe that people start using drugs because they have a mental illness. I certainly don’t believe I fall into that category. And it is also true that anyone can develop an addiction if the duration and scope of use reaches a certain threshold (opiates, specifically, come to mind), and in the absence of mental illness altogether. Certain people do, however, appear more susceptible to becoming addicted to substances than others. And the evidence is legion that there is a link between mental illness and a predilection for addiction.

My belief about my own addiction is that I have mild to moderate clinical depression (though as a younger man, I would have sometimes described it as boredom), that my use has allowed to blossom into a crippling, severe brand of depression that on some days makes getting out of bed a minor miracle. I believe that, as my appetite for substances grew during my honeymoon phase with them, my tendency over time became to use less and less to have a good time, and more and more to cope with life. This was very subtle at first – I had a great life. But I do have a streak of melancholy even under the best of circumstances, and as I used more and more, my depression became more pronounced. Use as a coping mechanism became more and more engrained, until finally, my reflex on a bad day was to reach for a drink or a drug. And at some point, the bad days outnumbered the good. As recently as a year ago, there were at least as many good days as bad, but over the last year that has changed because the addiction became primary. Once that happened, I started to lose things. Jobs, money, friends, and, now, my family. I literally am no longer able to function without drugs and alcohol. A severe depression, under these circumstances, is almost obligatory. I drank because I was sad, I was sad because I drank. An aside: how depressing to come to the realization that – contrary to my vanity that drugs expressed my individuality – I was really no more than a walking cliché.

Getting back to the question I posed above, I believe that substance abuse can take a case of mild to moderate mental illness – depression and impulse control, in my case – and make it severe. In such an instance, drug dependency perhaps was both the root cause and the primary symptom of the problem at one time, but once addiction is manifest, the addiction has exacerbated some underlying condition to the point that that condition must be dealt with for recovery to happen in a meaningful way. 

I am not blazing any trails with this assertion; it is intuitive. Drugs attack the parts of the brain that control impulse (frontal lobes) and they wreak havoc on the naturally occurring chemicals (dopamine and serotonin to name two) in the brain that regulate mood and allow us to get pleasure and enjoyment out of the everyday. The result is something called anhedonia, the inability to derive pleasure from normal activities, and which is a symptom of long-term drug abuse. I could not personally tell you where my depression ends and anhedonia begins, and it doesn’t really matter because the condition is the same, whether the cause is a natural chemical imbalance or an unnatural chemical imbalance. So far as I can tell, counseling and antidepressants will treat both. Furthermore, I also believe that this effect – call it the exacerbation effect – diminishes over time, as the brain’s chemistry returns to “normal” (you’ll almost always see me use this word in sneer quotes, because I chafe against the notion that there is such a thing). 

To that end, Thursday (April 14) I start detox-ing under the supervision of an MD. We considered a full-blown inpatient medical detox, but got sticker shock ($4,000-$5,000), and instead found an MD that would do a supervised detox at my parent’s house for half that. Alcohol detox seems to scare the bejesus out of addiction experts – what with the strokes, the hypertension, the myocardial infarctions, the cardiac arrests, the hallucinations (okay, this is the one symptom I’m hoping for) and the seizures, and all – but I will apparently have enough phenobarbitol or sodium pentothal  (I can’t remember which; they’re both in the barbiturate family and are both used to treat the symptoms of alcohol withdrawal) in me to control the seizures and the high blood pressure, and enough clonidine in me to control the anxiety (I have a history of panic attacks. Yay.). If my memory serves me correctly, sodium pentothal is also known as truth serum, as well as the drug that is used in lethal injections. Presumably, I’ll be getting a less-than-fatal dose, and we’ll just have to hope that I don’t get any questions along the lines of “does this make me look fat?” Yes. Yes it does.

Detox lasts five fun-filled days, during which I can expect tremors, nausea, anxiety and hallucinations. To be honest with you, outside of the hallucinations, it sounds like a bit of a drag. However, I have every reason to believe that detox will make for some interesting posts. My pain and possible detachment from reality will be your gain. Inasmuch as SoulWornThin has a staff of one editor and one writer, and that person – on most days anyway; the good ones – is one person (more than one personality, perhaps, but one person). So not to get all network TV on you, but April 14 to 20 promises some good programming, my audience of five people; please tune in.

Once I am beyond the danger zone of alcohol detox and withdrawal, then off to treatment I go, most likely somewhere near an ocean (I won’t disclose exactly where). For this blog to work, I need to preserve my anonymity for the duration of my treatment. I hope to pick up readers along the way, and I don’t want people in treatment with me to think I am going to “out” them, nor do I want to have an artificial effect on the treatment I get from my doctors and counselors. I will be going to great lengths to preserve the anonymity of all involved. I will also try to limit my use of the word anonymity, because it’s hard to spell.  On to Part Two…

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