I am fortunate that I grew up in a stable family and did not grow up around addiction. My only addictions are to social media and Diet Coke. I could quit any time. Just not today.
After over 20 years in medicine, my understanding of addiction has evolved from certainty to complete ambivalence. Going back to Facebook, ambivalence best describes the posts related to this issue where there are strong opinions on both sides with a clear absence of a solution.
After finishing residency in Ohio, I moved to Redding where I worked as family physician in a community health center. I was out to save the world. After a few years in family medicine, I realized that the world may be beyond salvation and eventually my moonlighting in emergency medicine became my full-time career. In both settings, it was clear to me that addiction was a matter of choice. The choice to take a pill, to smoke a drug, and certainly to inject a drug was a matter of free will. In retrospect, that was the benefit of youth and inexperience where the world was so black and white. Over time, the world has evolved into shades of gray.
I witnessed the depths to which those who suffered from addiction would sink. In the emergency department, I witnessed patients who suffered horrible side effects of the drugs they used but appeared powerless to stop. I saw an alcoholic fill a bag with his vomit and then drink it to recuperate the lost alcohol. That even grossed me out, and I see a lot of nasty things. I took care of a patient who was shot in the chest as a result of his addiction and continued use methamphetamines despite that experience.
I slowly began to realize what immense power addiction had over so many of my patients. I also was frustrated at the lack of resources for those who desired sobriety and needed help to get there.
Two years ago, I began working at a clinic again because I found myself a full-time single father. I was invited to the NoRxAbuse committee for Shasta County, a multidisciplinary group that includes physicians, pharmacists, case managers and law enforcement with the lofty goal of preventing all deaths from opioid overdoses in the county. I eventually began to provide outpatient treatment for addiction with generous support from the Redding Rancheria.
I have learned a great deal about addiction. Most of my patients have a family history of alcohol or opioid addiction, and 10 percent of the population has a genetic predisposition for addiction. That means that their first drink of alcohol or a Norco they may take after surgery may trigger a series of events that causes their lives to spiral out of control.
Many of my patients started with a prescription for opioids (Norco, Vicodin, Codeine, etc.) for a minor injury or surgery that triggered a loss of control that eventually destroyed their lives. When they could no longer get prescription opioids, they turned to heroin. What we may judge as a choice is often something that started from a legal prescription and snowballed into an otherwise good person’s life destroyed by drug abuse. With the help of treatment, many of the same patients have managed to get clean, get jobs, and are people that you would enjoy sitting down and having a cup of coffee with. Not a drink, a cup of coffee.
In the primitive part of your brain lies the Nucleus Accumbens. If you eat a great meal the dopamine released that makes you feel may go up to 150% of normal. If you have good sex, it may jump to 200% of normal. If you use heroin, that goes up to 800%; nothing you can reproduce in normal life. Combine methamphetamines and heroin, you’re over 1000%, a feeling that your primitive brain then has overwhelming cravings to reproduce. In mice who have an electrode that stimulates that area of the brain, they will keep pressing a button that stimulates that dopamine reward system until they die of starvation, ignoring food and water. This is a part of the brain that those of us without addiction just can’t understand.
I told you I can quit Diet Coke and Facebook at any time. Maybe tomorrow.
I drive around Redding and I lament how our city has gone downhill as many of you have. Unfortunately, I’m stuck somewhere between bleeding heart liberal and “get the hell out of my town”. These are real people who are suffering and the problem is far more complex than just more police or spikes on benches. They need treatment and compassion, but they also need accountability and responsibility. I don’t know the answer to our growing problem with drugs and homelessness, but clearly something different needs to be done.
I will continue to do my part treating addiction and working with the county to help those who want help. What will you do?