Addiction

Shana introduced me to Phillip K. Dick when we were 16, he was part of the packaged world we collapsed into the oncoming reality in lettered mirror fragments and window shards.  Shana was a beautiful writer with true fascination of works she left me to roll in, my therapeutic sandbox of her cyberventure.  I don’t know how she’d feel about any of this, but I wish she were still here. So would anyone else who had the opportunity of knowing her grace, which she truly had more than I ever could. 

From Philip K Dick, a Scanner Darkly:

"Some people who were punished entirely too much for what they did. They wanted to have a good time, but they were like children playing in the street; they could see one after another of them being killed--run over, maimed, destroyed--but they continued to play anyhow. We really all were very happy for a while, sitting around not toiling but just bullshitting and playing, but it was for such a terrible brief time, and then the punishment was beyond belief: even when we could see it, we could not believe it. "

"Drug misuse is not a disease, it is a decision, like the decision to step out in front of a moving car. You would call that not a disease but an error in judgment. When a bunch of people begin to do it, it is a social error, a life-style. In this particular life-style the motto is "Be happy now because tomorrow you are dying," but the dying begins almost at once, and the happiness is a memory. It is, then, only a speeding up, an intensifying, of the ordinary human existence. It is not different from your life-style, it is only faster. It all takes place in days or weeks or months instead of years. "Take the cash and let the credit go," as Villon said in 1460. But that is a mistake if the cash is a penny and the credit a whole lifetime."

In recent years it’s been trendy to call addiction a disease in the medical world and in popular PC language.  People I talk to are usually more forgiving of the subject, there’s the occasional fascist in denial who advocates for sterilization of addicts and I have been the occasional goose shit on a document reflecting my functionality that somehow is interpreted as more human than anyone else who hasn't had the opportunity to check off the boxes no one can fit in any more or less than me, as we overflow those boxes filled with all the history, love and pain of a family riddled with addiction. In spite of the presence of these disturbing attitudes, at least the public is more likely to acknowledge how much harder it is for some people to stay away due to genetic influence or upbringing. While it’s called a disease a particular person’s problem is usually kept quiet in social circles, or behind closed doors.  My peers talk about illnesses in general with varying degrees of discomfort.  It is a painful subject, but addiction is treated with a discomfort of not only sadness but shame. For many this discretion is important, without it people could lose their jobs and opportunities further perpetuating an addiction.  This silence shouts the underlying truth; people don’t want to lose respect and their better friends don’t want to compromise their reputation with gossip and that fear is justified.  No matter how much people call it a disease their eyes usually look downward on addiction with quite a different assessment of the situation.  Even most addicts feel vexed with guilt and confusion over how much responsibility to take for their habit. They have to choose to stop, voluntarily, but it’s not like any choice they’ve ever made and most of the time the difficulty of assessment leaves them using the drug but in an absentminded way, like going to the bathroom.  It’s technically voluntary movement, but even the thought to go to the bathroom is instigated by involuntary sensory motor systems that we can not directly control.  We can only estimate our body’s reactions to conscious decisions we made hours in advance about what to consume.  When we choose to go to the bathroom our involuntary movements, our voluntarily controlled movements and the links between the two in our gut and spinal cord mingle for a brief moment of synchronicity between choice and being, intensity and relaxation. This is in many ways exactly like doing a drug.  Except what if walking out into traffic was what you absent mindedly did when you got up in the middle of the night half dazed.  You’re at a party and you aren’t enjoying the conversation, you need an excuse to leave and the most socially acceptable way to bow out of the situation is simply to walk out into traffic.  Your body tells your mind in the morning and at night to make a “voluntary” choice to walk out into traffic, then after every big meal, eventually at every social gathering.  The quotes blanket the word “voluntary” because if you don’t do it you’ll become incompetent, sick, and obsessed with the idea of doing it.  Eventually it falls into its own category of bodily function right next to eating and sleeping, you go to work and do what you do almost without questioning the entire reason is so that you can seamlessly perpetuate these functions.  In your mind there are all these other things happening, but really you wouldn’t be doing any of it unless it were ultimately leading up to the point you could walk out into traffic.  Unlike bodily functions which ensure survival, your mind has tricked you into treating your rapid demise as a function that will insure survival.

Does this make it a disease? A summarized dictionary definition of disease:

‘a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.’

By those standards yes, it is a disease.  The closest analogy to any disease not routed in conscious behavior I would compare it to is HIV or an autoimmune disease.   It’s like an autoimmune disease of our mind’s ability gage our basic comfort level.  Our bodies kill themselves by tricking our body into believing it’s an act of protection even though many of the proteins and cells are reacting negatively to the deterioration.  The comparison is contentious because we cannot choose to stop HIV at any given moment. On the other hand it’s much harder to choose to turn down a drug than it is to hold your pee at a reception, but it is possible. 

While it may technically be a disease by medical definitions, the knowledge that it is even possible to cure it with conscious change makes the label a white lie.  A soft word pillow to cushion the blow of the bullet that is medical students on clinical rounds joking about the poor stupid delusional crack head behind the hospital curtain who can clearly hear them.  That bullet that is family members and friends not saying anything to anyone, comforting them and encouraging them as they deteriorate until they finally give up on them.  It is the bullet of fundraising events and initiatives to stop crime and reduce poverty, that will not employ or host people who have a criminal drug record. The bullet has words etched in the side of it “But you could stop, you’re the reason this is happening to you.”

Thing is the only way to voluntarily walk into traffic without a severe death wish is to not think about it, to treat it like taking a shit, it’s just something you do.  We all do this everyday when we get in our car.  In most places in the US car collisions are the leading cause of accidental death.  Yet it is so normalized we are taught it’s a mark of independence when we receive our license. When we have enough credit to owe car and insurance companies a third of our income every month we have achieved a respectable status amongst peers and are trusted with more responsibilty.  We are trained to believe that polluting the earth and putting ourselves at the greatest risk for a sudden violent death is an efficient, practical, and responsible method to arrive and leave from destinations for any reason.  Everyone who is afraid of getting shot or mugged in their car is much more likely to die from unintended collision at the next intersection.  We know all of this, but we all do it every day anyway. The only thing in New Orleans that kills more people than car accidents every day is heroin. It is currently the leading cause of accidental death in the city according to the New Orleans DEA, and that’s only referring to opioids specifically. The amount of deaths directly caused by or related to other drug addictions pile on top of that sorry statistic burying so many beautiful individuals. 

“It is not a choice, it is a disease” “It is a disease, not a choice.” Neither are sound statements, the conflicting premises are not mutually exclusive.  We all have genetics for diseases, but with most diseases you acquire after birth just having a gene for a disease does not guarantee the disease will manifest.  You have to choose to smoke a pack a day and eat fried chicken. You have to choose to not exercise.  Sure, smoking and fried chicken are common knowledge examples, but I only gave three amongst hundreds of known and thousands of unknown much more subtle risks for any given illness. With any of the risks, it’s usually impossible to predict with accuracy how much it will impact a particular individual as predicted.  We all have heard stories about the man in the Cuban cigar shop who smoked for the last 40 years of his long life eating only hamburgers and didn’t die until he was over 100. Or the woman who did yoga every morning, ate her vegetables, didn’t do drugs, and died of cervical cancer at 35.  These factors are so overwhelming, individualized, and idiosyncratic that while we may be ‘voluntarily’ at risk for diseases all the time, we don’t say it’s somebody’s fault when they get cancer, or diabetes, or lung disease.  Furthermore, once they have it, there are life style choices that can encourage remission or prolong life, but it doesn’t seem as cut and dry as the answer that addicts have. The cure should be obvious. You do the drug, you get addicted, you stop the drug. you recover, so why is it the leading cause of accidental death?

Science traces the lie of our minds obtusely like a finger painting of thought.  The genetic predisposition for addiction is passed down through generations with increasing frequency as more addiction occurs.  Even without a family history, this cycle can begin independently with the introduction of a drug addiction to a single person.  Over time they’re genetic expression changes to accommodate their thought patterns, their descendents are thereafter more likely to experience addiction.  The more addicts in a family, the more likely proteins are expressed which heighten reactions within the ‘reward center of the brain’ in off-spring.  The ‘reward center’ commonly referred to in pop psychology articles is in reference to an area called the Nucleus Accumbens largely responsible for simple positive and negative reinforcement.  A nucleus is a high density cluster of nervous system cells or neurotransmitters.  The Nucleus Accumbens is located in the Amygdala, the largest localized neural mediator of emotional states.  The most well-known neurotransmitter involved with positive feelings or reward in this area is dopamine. The release of dopamine in the Nucleus Accumbens and the corresponding relay systems to other areas of the brain correspond to satisfaction. 

This system produces conscious signals that encourage us to eat tasty food, to do pleasurable activities, and generally encourages people to crave things they enjoy.  Usually it will have useful responses encouraging emotionally satisfying experiences.  The heightened physical stimulation from sex, sugar, an adrenaline rush, or a drug will also be mediated through this area.  The intensity of positive feelings per a given amount of a time is a physical phenomena.  Like any chemical reaction the solute or chemical component per volume of the entire chemical solution in a given time frame effects the intensity of a reaction.  The more you get at once, the higher the high and lower the low. Following the onset of relatively intense positive feelings, the return to baseline will feel unusually depressing. In a controlled environment this experience of reward is quantitative.  In reality the complexity of our conscious associations, our environment, and our context makes happiness or sadness much more than a scale you can read off of in a doctor’s office.  Every withdrawal from positive reinforcement, whether it’s somebody saying something nice to you or a drug will instigate cravings to do whatever it is that makes you feel good, but that all depends on who you are and everything else about that moment.

Within your own particular neurological boundaries consciousness can alter the use of the internal stores of neurotransmitters and the electrical pathways they activate.  Everyone has a unique ability in a particular moment to excite or inhibit any positive feelings from a experience through dictating conscious awareness.  The more positive feelings associated with an experience under these conscious directives  the more these pathways are activated in response to similar stimuli (components of stimulation). The more the pathways are activated, the more available they become.  It requires less energy to make the same decision in the future, and more energy to make a different one.  This is true of the brain in general with any decision, with repeated excitatory stimuli of a positive experience this pattern is even more profound. In an addict the physical framework supporting this conscious pattern becomes nearly automated and produces desires and cravings in ways that are difficult to compare to any other human activity.  

With mild rewards that produce a steady slow positive reinforcement it’s easier to make a decision that weighs in all the factors we would ideally assess in order to maintain our health. Ice cream isn’t great for us, yet it tastes delicious and the sugar gives us a rush of positive feelings.  It’s usually relatively easy for anyone who isn’t a binge eater to stop eating before they get sick. This ease is possible only when the positive feelings produced by the reward center are meak enough to be potentially offset by conflicting signals from other areas. For example, the hypothalamus can relay info on bodily function telling you to stop eating because you’re full, or from the medulla to stop drinking because you’re nauseated. We can offset instant reward with frontal lobe activity relaying any necessary judgment that different activity is necessary, that’s how we know when we can’t eat and sit on the toilet all day because we have to pay taxes or go to work.

In contrast experiences like sex or an adrenaline rush produce an extreme and sudden positive experience with so much strong initial electrochemical activity it can temporarily overwhelm someone. It is immediately more difficult to weigh judgment of repeating the activity against any conflicting input.  We have to use more energy to maintain awareness of physical health, memories, inhibitive judgement, or any other manner of inputs which would normally factor into our judgment besides feelings of reward. The reward, and the subsequent craving as it diminishes becomes the central focus of cognition. 

When an external chemical synthetically induces the same excitement as an experience, like heroin or sugar, the same thing internally occurs as with a positive experience except for the return to base line is in higher contrast to peak excitement.  The withdrawal from the experience is more painful,  and the bodies ability to regenerate baseline is less attainable.  In most cases when we take drugs that increase a neurotransmitter well above normal levels, the amount of active receptors to bind that neurotransmitter diminish over time along with the conscious effects they produce.  The body attempts to downregulate our ability to react to the chemical so that the same dose produces weaker conscious awareness of its ingestion as we build a tolerance.  There is reduced subjective response to the drug, but the ingested substance will continue to have the same physical effects and risks with only a slightly altered effect compared with the new user. The effects of cognitive deterioration, impaired perception and motor activity, interrupted sleep, changes in glucose activity, and damage to digestive organs continue even as the awareness of the drug’s effects subjectively diminish.      

Experience and conscious decisions are mitigated and somehow produced by neurotransmitters in ways we may never fully understand, but they also activate neurotransmitters and direct them in ways we can observe both subjectively and scientifically. Regardless of prior chemical ingestion or experience, there is some variably independent component of our being that can change the ways that we react to the reward center. Anyone who has seen someone successfully quit a highly addictive drug against all odds knows this to be true, human choice can prevail. Withdraw rates from dopamine, the plasticity of the cells within the nucleus accumbens area, and the corresponding impact on a persons’ judgement can change throughout a lifetime, before and after drug abuse.  That being said I believe we only have so many attainable choices in life and these options are narrowed and platformed by our history and its effect on our biology. People who have experienced addiction of any kind will have a heightened sensitivity to their reward center.  It is easier for them to respond to a physically pleasurable activity with an immediate sense of craving that ignores potential risks, conflicting bodily feedback, and higher cognitive decision making.  This is reflected biologically in people who are genetically predisposed to addiction, they are more likely to rapidly down and upregulate receptors in response to a drug.  This biological disposition can produce a rapid tolerance, heightened cravings, intensified euphoria, and increased plasticity of the reward center. Furthermore, people from a genetic history of addiction are likely to have been raised in an environment where drug use is normalized as a coping mechanism in day to day life.

Many recovery programs are based on the foundation that once a person is an addict they are always an addict, the structural and functional cognitive changes are part of an incurable disease.  I think this is a necessary mindset for many addicts to have. the word disease seems often intentionally misinterpreted in such a way that removes any responsibility from the subject.  While I don’t believe that any person is wholly independent from their illness, it’s never fair to blame someone with an illness to an extent that would inhibit recovery or suggest they deserved to be ill.  No one intends to get sick, but some people have the foresight not to make out with everyone at the company Christmas party during flu season.  Who could blame the folks that do? After all some folks refuse to kiss anyone under any mistletoe, and they’re the first to catch the flu.  The pay off for being attentive, careful, and even unpleasant is often ambiguous or negligible.   It would seem intuitively less ambiguous with drug addiction.  You have to choose to take the first hit, the first drink, and then you have to choose to continue doing it.  While this may be true I’ve never heard of someone intending to be a drug addict, they simply lacked foresight in the face of ambiguous consequences in a game with much more at stake than work tension and a common cold.  

With the stakes so much higher, why would anyone risk it? Why do gamblers go all in after having the win of their life? What if choosing to take the first hit wasn’t like the choice to make out at the Christmas party, it was more like choosing to go to the bathroom to avoid an awkward conversation.  It seems subtle, socially acceptable, utterly normalized.  After you take the leak than you’ve realized what you actually did was walk out into traffic, but it was bafflingly difficult to perceive this event until you’d completed it.  Only moments ago at the party it had seemed much less ridiculous than kissing your coworker, it was simply a completely normalized and socially acceptable reaction, a bodily function.  What if, when you tried to stop choosing to go to the bathroom, knowing you’d end up in traffic, everyone around you continued to do it all the time.  Eventually all you have to do all day is go to the bathroom, until the point of stabbing abdominal pain and all of your coworkers are happily taking group trips asking what your problem is. 

Somewhere in your conscious mind you know that you’re not the problem, that they’re not just taking a leak, they’re walking in to traffic, but you have to know this with an abstract awareness and ignore that it seems as negligible and transient a risk as getting in your car in the morning.  You might die if you get in your car, in fact there’s a higher likelihood that you’ll die doing this than at any other point in the day.  There are other options, you can find something to do or somewhere to live that doesn’t require a commute, you could ride your bike.  Ok, so, why not try? That would involve an entire change of your lifestyle,  braving the weather on a bike over a non biking road, the risk of getting in a bike accident, and doing so many other things that seem so economically and logistically unpheasable that the very thought can quickly pass. 

 ‘No, it’s ok, I’ll just drive to work today,  I won’t die. I can control it.’  

‘I’ll just walk into traffic.  Maybe tomorrow I’ll figure something out, but today I’m just going to walk into traffic this one last time, I can dodge the cars’

Drug addiction is a choice and it is a disease; but it is not a normal choice, nor is it like any other disease. Unlike other diseases its complications are not entirely dependent on the internal mechanisms that instigate and maintain it, a component of the disease is a choice.    Unlike other choices, the choice to get healthier requires the addict to expend energy and employ will power that many will never subjectively know.  It is a disease of its own terrifying category, a disease that attacks our ability to make a choice, and then self perpetuates that choice.  It’s almost as if drugs produce their own sentience, hijacking our consciousness like a virus trying to prolong its life cycle in our minds.   There are as many medications and caretaking techniques available for addiction as there are for any other disease, but that nearly impossible choice is the only sour medicine that will ensure survival of the addict. Given care, if they’re making those hard earned choices an addict will survive, but they will not be cured. In order to cure an addiction, a person must restructure their entire conscious relationship to their reward system. 

One drug is only that: a button, the trigger accelerating a vicious clock, but we all look at that same clock to check the time and it was certainly ticking before the trigger was pulled. The heart of addiction is not in the drug but in the societal and internal structures of decision making that create the choice to take it in the first place.  Those downward glances at doctor’s offices and family gatherings, they see the stop button and want to tear it out of the walls of the addict’s minds in frustration. It’s just one choice!  One button!  Why can’t we just get people to push it or to not push it?  Thing is, it was never just one button, the internal clock is wired to an internal bomb, you have to cut the wiring just so or the entirety of our western societies’ faulty notions of pleasure and pain tear the patient, eventually the hospital, the city, and finally the country limb from limb. 

You take away the drug just right, slowly release the trigger, the bomb loaded with 4Cs and all of the internal mechanisms are still there waiting for a new stop button. 

The fatality of addiction is the oncoming traffic you walk into, but the disease is the desire to walk into it in the first place.  It is the inability to gage danger in the face of a mental goldmine of pleasure.  HIV is a disease, but it’s not what kills people, it just mames their bodies ability to detect and cope with danger.  We can not cure people of HIV yet, and many claim addiction can not be cured either, but at least death looks preventable on clinician paperwork if you can get people to live with their perpetual intense desire to ignore dysfunctional systems of reward that may or may not lead to likely or certain death.

If an addict does choose to stop using their drugs of choice, they’re usually inclined to adopt a new addictive substance or habit, getting a new stop button then quickly succumbing to the same habits they knew previously.  The varying levels of intensity of the new stop button might make their behavioral adaptation to the disease more or less apparent.  They may switch from alcohol to amphatamines, or simply to AA meetings, television, coffee and cigarettes, exercise, televangelism.  These activities are so grossly disparate in their nature, many of which don’t entangle external chemicals.  Sure the addict may be at less risk for sudden death with compulsive AA attendance or coffee benders than if they choose to smoke meth everytime they want a drink… but the underlying mind set of their addiction, their subservience to their mentality, their handi cap, and their own persistent belief in their lack of agency is what truly holds the disease next to the ticking of their heart.  It is a disease that effects many people who have never even used narcotics.  Addiction is embedded in the mental framework of western culture, the extreme physiological and neurological manifestations of which are biologically expressed in addiction. The disease of addiction is born from a systemic mentality very much on the same coin that diabetes has physically manifested within the extreme negligence of a society that increased average sugar intake by at least 300% over the course of a few centuries, fabricating a need alongside a fabricated dependence on the slave trade economy to those willing to sell their souls to sell others.  

We are in a culture that commends a feeling of satisfaction so great it comprehends no obstacles, not even death.  Freedom is not just a sacrifice of security, it is over coming electrical short cuts, short circuits- automated judgments. The opposite of freedom is addiction, forfeiting willpower to the lie that I'm not good enough telling others to tell me just to make sure I remember it lest I almost forgive myself.  The phenomenon of addiction is neither mutually inclusive or exclusive with the actual existence of any externally manufactured and targeted chemical force. Blaming an addict or a drug undermines not only the internal emotional conflict an addict scientifically experiences, but it also white washes the entire drug war, the ill fate of those who graduated from the DARE program, and the amount of money private prison systems make off of the American peoples in the corporation of justice that's simply a word costume for contemporary race and class based slavery with a xenophobic swirl.  It's a well versed money making machine, but how often do more sober individuals stay on that soap box when deciding how to handle 'that guy' at a party.  How much compassion do I give myself or anyone else when we are ostracized, self isolated, and finally made to feel like a victim to chemicals, systemetized discombobulation, disorientation, and romances of desirable disengagement. We believe there is a love that is worth self harm, there is a positive feeling that is worth risking illness, there is a state of mind that is worth increasing likely foul behavior and imminent deterioration.  The romantic notions of self destruction, and the concept that their antithesis necessitates the apathy and blind conformity of the bourgeoisie is, in lew of any possible measurement likely the greatest predictor of addiction.  It's walking in to traffic as if it would properly overwhelm my aversion to a company Christmas Party full of horny zombies.  There are physical structures in humans to support these notions unto death once you simply introduce any ingredient that is as harmful as it is enjoyable. These physical structures are succeeding and developing from generation to generation through conscious acceptance of our own demise in the face of self loathing hedonism. The truest momentary pleasure is usually depicted as the thrill of near death, I’d love to instead celebrate the synchronicity of odds with my self awareness. I want to be happily surprised with myself as much as I want to know you feel it too. Self awareness is neither bourgeoisie, nor self destructive.  It is an awareness I want to make sexy, satisfying and truly rewarding within my ability to see all of the outcomes and have them overwhelm me. Wishful theoretical rambles but I must do it with so much more than a wish and yet so much less, or I will wash away in a sea with more dangerous litter than poison.  MOOP Miscellaneous objects out of place.  I refuse to become moop, a tragic trace burners pick up so they can keep partying in obscenely treacherous environments on some huburous distortion of hallucinagenic invention.  I want it to be a slow stead self awareness growth, a tumor that infects me with joy and bleeds electrifying beauty from my pours like electron dances between ours and yours. True stability without the material guise of my honky goose femme glitter shit CV or candid status updates featuring only two checkboxes for my job and my lover.  It is stability not security, in fact this awareness comes at the greatest risk of breaking all concepts of sanity.  It is so painful, arduous, and overwhelming that I go through life and accept so much unnecessary pain avoiding this awareness like so many others.  Many believe it's too much to compute, to change, but it as simple as any condescending med school student would think refusal of a crack pipe is.  It’s a simple no, I won’t do it, I will be the change.  No he can’t objectify me, no I don’t have to get married, no I don’t have to work in a cubicle, no I don’t need to drive that car to work, no I don’t have to look cool and tattooed, no I don’t have to bite the bullet, no… I don’t have to sacrifice my well being, my life, to this coping platform laid down before me, and the only escape is so much more than a narcotic, it’s an entirely new way of being.  It is a life that I have to figure out in America as a community with you, with all of us, within communities, and build communities doing it regardless of our histories with a particular narcotic or obsession or self reflection.  I have to pay the bills, you have to feed your children, we have to go to school, we must stay at this job, but fuck we can take anything within our power away as long as we find something more beautiful to replace it.  Sometimes you have to swim against the current to even know it's direction let alone be carried by it's flow. Death is never worth the thrill, love is never worth death, ideas are never worth self mutiliation even in our eternal paradox.  My truest romance and spontanaeity is knowledge, awareness, skilled decision making.  Responsibility is bravery, it is not cowardice and defaults.  The moment when I reward myself with candy, with spending money for making money, with a night of black out drunk damage for aceing a test, with doing X amount of drugs for wethering a sour relationship, these are the moments that lay bricks on a highway with unlabeled exits. The fast lane and the middle lane are all still on this highway that we have built with no speed limit, no signage, and a death wish masked in the desire to ‘get there’.  Burn it down with me, walk through our fear of melting into intentional mutation, when we see each other with no road or destination or journey beyond each other and ourselves then I will truly be cured.Chill the fuck out and there's no great glass elevator to chase only levels to comprehend in all directions where our wits begin.