When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much.
Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was before, had a game room, and a gym and, he told me, the food was a hell of a lot better. In any event, he fed me the kinds of stories I had only read about. Looking back, he probably just wanted to help me, so I wasn’t poking him over and over since I was the one charged with getting his blood samples.
A teen mom told me that she tried crack for first time during her 7th month of pregnancy so the baby would come out early and small. I didn’t believe her at first, but a pediatrician told me that was in vogue among the city high schoolers, both pregnancy, and the forced premature delivery.
But besides my bedside conversations, I never really learned much about helping people get over addictions. I think we figured that was something for someone else to worry about, like the people who run Alcoholics Anonymous.
Things may be changing. On March 29, at the national summit on drug addiction, the Obama administration pledged $1.1 billion in new funding to combat widespread opioid addiction, in large part to expand access to treatment. At the same time, 60 medical schools announced that this fall, they are going to offer some kind of class that teaches doctors-to-be about prescribing opioids.
Still, according to medical writer Maia Szalavitz, what’s needed is a massive overhaul of the way we understand and treat drug addiction. Szalavitz has been writing about the science of addiction for about 30 years. Before that, she was an addict, shooting up heroin and snorting coke. In her latest book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, Szalavitz weaves her own story (gifted, geeky Ivy-league kid turned user and dealer, who, at one point faced 15 years to life in prison) with insights gleaned from interviews and extensive reading on the subject.
Simply put: She says drug addiction is a learning disorder. Or as she explains, it changes your brain chemistry much like falling in love. And much the way you can fall out of love (and undo all that jumbled circuitry), you can do the same for drug addiction.
She also argues against the notion that all addicts are born that way — hard wired for addiction. She argues against the notion that addiction is a weakness, and the only way out is to pray to a higher power.
Her book is convincing and a good read because she uses analogies to make the nitty-gritty science easy to digest and then breaks up the research reports with her own story, that includes some pretty crazy scenes.
When she was 17, she went back to Jerry Garcia’s seedy hotel after the Grateful Dead played in New Haven, and they snorted coke together. It was her first time. How could she say no? Then there’s the time, when she shot up so much heroin and cocaine, she was convulsing and wailing so much that her strung-out friends in the next room assumed she was having sex. Somehow, she survived that and everything else. The partying with Garcia was before she started Columbia University. The drug overdose was after. She eventually dropped out, finishing her degree from Brooklyn College.
“What I’m arguing here is that the reason it looks like a choice is because you have learned something, that changes the way your brain sets priorities, and when that happens, it’s kind of as though you’ve fallen in love with a drug and you feel as if your emotional survival depends on getting that drug no matter what. When you fall in love or have a kid, you will put priority on that no matter what in order to have those people necessary in your life. When you do that involuntarily with a drug, it can be problematic.”
To say the least. She is not blaming her addiction on anyone or anything else but speaks of learning as the re-wiring of your brain circuits that manage your centers of reward and pleasure. Her point is that if we think of the problem as wires plugged into the wrong places, we can use the same kind of learning to get them back in order.
As she describes it, pop science would have us believe that drugs zap dopamine, the pleasure center, in the brain. The more we fire up those chemicals, the more drugs we need to keep the flame going. But it’s really more complicated than that. First of all, she explained, there’s two kinds of pleasure: desire and reward. Or as she puts it, the pleasure of the hunt and the pleasure of the feast.
Her mission, in addition to preaching her gospel about addiction, is to persuade medical educators to update their outmoded curricula. “Medical students need to learn that people with addiction are people first, not some kind of scum trying to defeat your efforts to cure them.” (She’s had a few bad experiences with doctors, as you can read in her book).
“If you understand why they feel the need to escape, you’ll be a lot more compassionate and a lot better to help.”
Compassion — more formally known as humanities in medicine — seems to be the buzz word around medical school campuses these days. But Szalavitz has a point and if nothing else her book is a gripping read.
As for me, well, my friend/patient — the drug addict in the corner room — kept his word. He told me that through years of experience he could get blood from the tiniest veins between his toes, and he showed me how to do the same. I was too embarrassed to ask a nurse or the resident to go over the nuts and bolts of blood drawing. I’m not sure we helped him overcome his addiction (actually, I know we didn’t), but we tried as best as we could in those days to care for him while he succumbed to AIDS.
Randi Hutter Epstein is a writer, reporter, and physician. She is the author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. She can be reached at her self-titled site, Randi Hutter Epstein, and on Twitter @randiepstein.
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