Christianity Today: How Good Church People Become Addicts – and How They Recover

Timothy King’s article Just Say No to Shame in the December 2016 issue of Christianity Today includes a very insightful comment: “My recovery from opioid addiction began when I realized my addiction had chosen me.” King fell to the disease of opioid addiction following suffering from acute necrotizing pancreatitis caused by a surgical procedure. He said, “I had known pain before: crutches, casts, and stitches. But until this moment, pain had always been experienced as something outside of myself. Now it was all that was left of me.”

An opioid, from the root word opium, is a class of pain-relieving drugs that can vary in intensity from fentanyl (extreme) to codeine (mild). According to the Department of Health and Human Services, more than 240 million prescriptions were written for legal opioids in 2014 – more than enough for every adult in the United States to have their own bottle. From 1999 to 2014, the period in which opioid overdose deaths quadrupled, so too did the sales of prescription opioids.

The widespread nature of the opioid epidemic that reaches across typical class, race and geographical stereotypes has challenged myths of who drug addicts are. It has also widened the lens, revealing more moral actors participating in the crisis beyond the addict. Years of distorted public policy, overworked and unrestrained doctors, intentionally misleading pharmaceutical marketing, and even watered-down theology that reduces people to disembodied moral characters instead of whole human persons created in the image and likeness of a good God, have all contributed through sins of both omission and commission.

Many opioid addicts began using these drugs for legitimate physical ailments, merely following their doctor’s orders. In fact, the American Society of Addiction Medicine reports that four out of five heroin addicts started with prescription opioid medications, with nearly all reporting that they eventually switched to heroin because of the price.

Our mental picture of an addict should include the high school honors student who breaks her arm skateboarding and is prescribed an opioid by her doctor. Or the middle-aged factory or construction worker who has permanent back pain from his job and is prescribed an opioid by an overworked doctor who misses the fact that his patient is severely depressed. Or a white, college-educated, employed, middle-class Christian (as in my case, and the case of Timothy King, the author of the article) from a good family who grew up in small-town America.

When King’s doctor informed him he had become addicted to pain medication, he told King, “That isn’t a judgment on you. I’m not saying you’ve done anything wrong or that you aren’t still in pain. But we’ve been giving you this pain medication for so long, your body is now dependent on it. It has gone from helping you to hurting you.” The doctor told King he was not going to just take the pain medication away when he needed it. But he asked King to commit to taking less whenever he could. The doctor said, “For a while you couldn’t have made it without the pain medicine. Now to fully heal, you need to eventually stop taking it.”

In July of this year, Congress passed legislation to address the opioid crisis and heroin epidemic. Even the language  of “crisis” and “epidemic” to describe the bill indicates a shift in mentality. The legislation acknowledges a growing medical consensus that the addict is subject to a disease – one with deep biological and psychological roots that often preclude individual choice. This landmark legislation marked an important step forward in reorienting public policy to reflect this new consensus. Framing addiction as a chronic disease does not remove the moral choices involved, but gives us a broader framework for understanding them. We can’t ignore the reality of our bodies, and when it comes to opioid addiction (as well as other addictions), part of the effect of those chemicals is to actually rewire the brain, making it more difficult, if not nearly impossible, to change patterns of thought and behavior.

King discusses one commonly used analogy helping us understand addiction: heart disease. Like all analogies, it doesn’t explain everything, but it has the virtue of pointing out how clogged arteries cannot be cleared up by giving a pep talk to the patient or urging him to stop breathing so hard after climbing a set of stairs. Its causes are found in a mix of hereditary, environmental, and lifestyle choices. It’s also helpful to think about how often our physical state and surroundings influence our actions.

But the sense that addiction is solely a moral problem is hard to eradicate. After I clearly understood my addiction as a disease (which took nearly four decades and several encounters with the criminal justice system), I still battle internally with my self-image to this day. I grew up with the “Just Say No” anti-drug campaigns aimed at warning youth about illegal drugs. In that model, those with moral fortitude say “no,” and moral degenerates say “yes.” Those who said “no” received praise, and those who said “yes” were shamed and punished.

King recalls how he began to back down from taking opioid painkillers. He writes, “I removed the fentanyl patch first and switched to taking only Dilaudid. Within a day I could again feel my body in ways I did not realize I had been missing. At the same time, it felt as if a thick protective comforter had been ripped off from around me while I lay shivering and naked on my bed. Pain that had been blunted refocused and pressed out from the inside. The doctor was right. I could handle the pain now without the same levels of opioids. But I couldn’t  have continued my recovery if it were all up to the strength of my will alone.” King added, “So much more powerful than saying ‘no’ to an opioid was the opportunity to say ‘yes’ to a slow return to a life of flourishing.”

King said goodbye to narcotic pain medication, but indicated it was not an easy goodbye. He said the feeling was like the tremor in your hand when your blood sugar drops. Desire spreads out to every cell of your body as if each one is making its own demand, aching and promising to be satisfied with “just a little more.” Feelings of withdrawal and the troubled sleep that often comes with them are typically intense for the first few days. They can flare up even months down the road as a reminder of what had been, and the perilously thin line between you and the mounting numbers of long-term addicts and overdose victims. For me, I always thought I could control my usage. I was convinced I would never “take too much” and overdose. And yet it happened. I don’t recall anything from the moment I became unresponsive in my parents’ living room, through the ambulance ride to the ER, and ripping out my IV, to being sedated with haldoperidol. I woke up the next morning in a hospital room.

King relates, “I’ve realized that the word ‘addict’ is a particularly useful descriptor for who I have always been. I always resonated with Paul’s lament: ‘I do not do the good I want to do, but the evil I do not want to do – this I keep doing.’ (Romans 7:19) Some who have never experienced the furious grip of chemical dependence are tempted to split the world into addicts and non-addicts…morally bad and morally good.” He added, “I did not realize how fully I had embraced this view until faced with my own opioid addiction.” For me personally, I will admit I didn’t know I could have an addiction problem and still be a good person.

While addiction science has made strides, there is still no silver bullet. Already there are stories of innovative addicts who have found new ways to abuse the medications intended to help them. Any approach that reduces addiction to a mere problem of brain chemistry and fails to acknowledge humans as moral actors will ultimately fail. But leading researchers and those discussing public initiatives have gone a long way to acknowledge the importance of a both/and methodology.

Churches can be cultural epicenters for shifts in societal norms. The longer that addiction is seen as a struggle for the “sinners out there” and not at the heart of the struggle of each and every one of us, the longer this problem will make headlines and remain in the shadows. Remember, sin takes its deepest root in the cover of darkness where it is never given a name.  King concludes, “When our affliction is named for what it is and brought into the light, that’s when darkness may be overcome.”

Methamphetamine

The German chemist who first synthesized amphetamine, the forebear to methamphetamine, wrote in 1887, ” I have discovered a miraculous drug. It inspires the imagination and gives the user energy.” Amphetamine stimulates the part of the nervous system that controls involuntary activity – the action  of the heart and glands, breathing, digestive processes, and reflex actions. One effect is the dilation of the bronchial passages, which led, in 1932, to its initial medical use – as a nasal spray for the treatment of asthma. Later studies showed that the drug was also helpful in treating narcolepsy, calming hyperactive children, and suppressing the appetite. In addition, it enabled individuals to stay away for extended periods of time.

By experimenting with a simple change to the molecular structure of amphetamine, a Japanese pharmacologist first synthesized methamphetamine in 1919. It was more potent than amphetamine and easier to make, plus the crystalline powder was soluble in water, so it was possible to inject it. Methedrine, produced in the 1930s, was the first commercially available methamphetamine. In an inhaler, it was marketed as a bronchodilator; in pill form, as an appetite suppressant and stimulant. An ad read, “Never again feel dreary or suffer the blues.”

Meth was widely used in World War II by the Japanese, Germans, and U.S. military to increase their troops’ endurance and performance. Beginning in 1941, relatively mild formulations of methamphetamine were sold over the counter as Philopon and Sedrin. A typical advertising slogan: “Fight sleepiness and enhance vitality.” By 1948, these drugs were used in Japan by about 5 percent of the country’s sixteen- to twenty-five-year-olds. About fifty-five thousand people had symptoms of what doctors first termed meth-induced psychosis. They ranted and raved. They hallucinated. Some became violent. Mothers ignored or, in some cases, abused their babies.

in 1951, the U.S. Food and Drug Administration classified methamphetamine as a controlled substance. A prescription was required. According to a report published that year in Pharmacology and Therapeutics, methamphetamine was effective for “narcolepsy, post-encephalitic parkinsonism, alcoholism, certain depressive states, and obesity.”

The illegal speed craze, including crank, a meth derivative that is a pale yellow powder that is snorted, and crystal meth, a purer form, the first to be injected (it is snorted, too), hit in the early 1960s. Illicit meth labs emerged in San Francisco in 1962, and speed inundated the Haight Ashbury, presaging the first national epidemic in the middle of the late 1960s. David Smith, the physician who founded the Haight Ashbury Free Clinic, recalls the drug’s arrival to the neighborhood. “Before meth, we saw some bad acid trips, but the bad tripper was fairly mellow, whereas meth devastated the neighborhood, sent kids to the emergency room, some to the morgue. Meth ended the summer of love.”

Prior to founding the clinic, Dr. Smith had been a student up the hill from the Haight at the University of California Medical School. When the hospital emergency room began to see overdoses of this new drug, he started the first clinical research on its effects. He administered small doses to rats, and every one of them died of massive seizures. Rats caged together died when given even smaller doses of meth – the effect was quicker, and the cause of death changed. The rats had interpreted normal grooming behavior as an aggressive act, and, as Smith recalls, “they tore each other apart.”

In 1967, Smith came down from Parnassus Hill to work in the community. When he arrived in the Haight, he says, “I found a big rat cage – people shooting speed, up all night, paranoid, total insanity, violent, dangerous.” Smith issued the original “speed kills” warning in 1968 at a time of meth “shoot-offs” at the Crystal Palace, a bar. A circle of users passed around a needle. “I’d get calls at seven in the morning, when the guy who was the fastest draw was totally psychotic,” Smith remembers. The shared needles led to a hepatitis C epidemic. “When I warned the meth addicts about hep, they said, ‘Don’t worry. That’s why we put the yellow guy last.'”

Use of methamphetamine in America waned, waxed, and waned again since the drug’s initial heyday. Now many experts say that it’s more potent and pervasive than ever. Whereas a few years ago it was concentrated in western cities, meth has now crept across the country, inundating the Midwest, the South, and the East Coast. Meth us is an epidemic in many states, but the enormity of the problem has only recently been acknowledged in Washington, partly because of the lag between the time it took for the newest wave of addicts to fill up the nation’s hospitals, rehab facilities, and jails.

Meth users include men and women of every class, race, and background. Though the current epidemic has its roots in motorcycle gangs and lower-class rural and suburban neighborhoods, meth has basically marched across the country and up the socioeconomic ladder. Now, the most likely people and the most unlikely people take methamphetamine. Internationally, the World Health Organization estimates thirty-five million methamphetamine users compared to fifteen million for cocaine and seven million for heroin. The various forms of the drug go by many names, including crank, tweak, crystal, lith, Tina, gak, L.A.P., and speed. A particularly devastating form, ice, which is smoked like freebase cocaine, had rarely been seen in U.S. cities other than Honolulu, but it is now turning up on the mainland.

The most common form on the mainland is crystal, which is often manufactured with such ingredients as decongestants and brake cleaner in what the DEA has called “Beavis and Butthead” labs in homes and garages. Mobile, or “box,” labs in campers and vans, and labs in motels, have been discovered in every state. Home meth brewers get the drug’s key ingredient – pseudoephedrine – from nonprescription cold pills, prompting many states to initiate restrictions, including limits on the number of packages of Contac, Sudafed, and Drixoral that can be purchased at a time. As a result, the makers of these drugs are reportedly working to change the formulas so that they can no longer be used to make meth. In the meantime, a lot of pharmacy chains have moved them behind the counter.

From 1993 to 2005, the number of admissions to rehab for treatment of meth addiction more than quintupled, from twenty-eight thousand a year to about one hundred and fifty thousand, according to the National Institute on Drug Abuse. Crime rises dramatically in communities inundated with meth. Eighty to 100 percent of crime in some cities is meth-related. In some states, law enforcement officials have attributed increased murder rates to the drug. In cities where meth is the predominant drug problem, there are high incidences of spousal and child abuse – indeed, tragic stories of child abuse are common.

As many as half of all meth users, and a large percentage of ice users, tweak. That is, at some point they experience the type of meth psychosis first identified in Japan in the late 1940s. It is characterized by auditory and visual hallucinations, intense paranoia, delusions, and a variety of other symptoms, some of which are indistinguishable from schizophrenia. The hyperanxious state of tweaking can lead to aggression and violence, hence the following, from a report for police on how to approach meth addicts: “The most dangerous stage of meth abuse for abusers, medical personnel, and law enforcement is called tweaking. A tweaker is an abuser who probably has not slept in 3-15 days and is irritable and paranoid. Tweakers often behave or react violently. Detaining a tweaker alone is not recommended and law enforcement officers should call for backup.”

Tweaking or not, meth addicts are more likely than other drug users (with the possible exception of crack addicts) to engage in antisocial behavior. A successful businessman took the drug to work longer hours, became addicted, and murdered a man who owed him drugs and money. An addict shot his wife, another fatally bludgeoned his victim, and another murdered a couple for a car and seventy dollars. A couple, both meth abusers, beat, starved, and then scalded their four-year-old niece, who died in a bathtub. A Pontoon Beach, Illinois, man was under the influence of meth when he murdered his wife and then killed himself. In Portland,  a woman on meth was arrested for killing her eighteen-month-old child, strangling her with a scarf. In Texas, a man high on meth, after arguing with a friend, tracked him down and murdered him – shooting him six times in the head. An Omaha man was recently sentenced to forty years for murdering his girlfriend’s child after shooting meth. The child had been smothered and had numerous broken bones. A mother in Riverside County, California, was accused of murdering her baby because she nursed him while on meth. During her trial, she said, “I woke up with a corpse.”

 

  • People with addiction should not be blamed for suffering from the disease. All people make choices about whether to use substances. However, people do not choose how their brain and body respond to drugs and alcohol, which is why people with addiction cannot control their use while others can. People with addiction can still stop using – it’s just much harder than it is for someone who has not become addicted.
  • People with addiction are responsible for seeking treatment and maintaining recovery. Often they need the help and support of family, friends and peers to stay in treatment and increase their chances of survival and recovery.

 

Some people maintain that designating addiction as a brain disease rather than a behavioral disorder gives addicts, whether they are using alcohol, crack, heroin, meth, or prescription drugs, an excuse to relapse. Alan I. Leshner, former director of NIDA who is now the chief executive officer of the American Association for the Advancement of Science, agrees that addicts should not be let off the hook. “The danger in calling addiction a brain disease is people think that makes you a hapless victim,” wrote Dr. Leshner in Issues In Science and Technology in 2001. “But it doesn’t. For one thing, since it begins with a voluntary behavior, you do, in effect, give it to yourself.”

Dr. Volkow, NIDA’s current director, disagrees. “If we say a person has heart disease, are we eliminating their responsibility? No. We’re having them exercise. We want them to eat less, stop smoking. The fact that they have a disease recognizes that there are changes, in this case, in the brain. Just like any other disease, you have to participate in your own treatment and recovery. What about people with high cholesterol who keep eating French fries? Do we say a disease is not biological  because it’s influenced by behavior? No one starts out hoping to become an addict; they just like drugs. No one starts out hoping for a heart attack; they just like fried chicken. How much energy and anger do we want to waste on the fact that people gave it to themselves? It can be a brain disease and you can have given it to yourself and you personally have to do something about treating it.”

Direct link to: National Institute on Drug Abuse