addiction

Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism. —Carl Jung

 

I’m not sugar-coating this one for you: addiction among creatives is too common and too frequently undiagnosed. Even when it is diagnosed, it has previously been almost impossible to “cure.” Some handle it better than others, but we’ve lost too many, from Janis Joplin to Amy Winehouse and, apparently, even Prince. And those are just the names you recognize. I’ve seen addiction in photographers old and young, ruining creative lives before their full vision is ever realized. Writers seem to be especially prone to addiction. I’ve had several tell me they couldn’t even start to write without being high or being drunk.

I’ve always taken a hard line in my attitude toward addicts. I don’t like them. I don’t want them around. Addiction is something I’ve always seen as a weakness, a fundamental flaw in one’s character. If you know you have a problem with something, stay away. Understanding how anything can control someone to such a fatal degree is not something I’ve been able to do. I try to be sympathetic for those struggling, but I tend to blame them for their own problems.

Now, the American Society of Addiction Medicine (ASAM)  has me re-thinking my disdain for addicts. As it turns out, taking such a hard line has probably been exactly the opposite of what those people have needed. Shoving them into rehab facilities might not have been as productive as we thought. 12-step groups could possibly be completely misdirected.

Maybe we were all wrong.

A New Definition

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex.  That’s the direction the ASAM is now taking in regard to addiction. Stop and think about that for a moment. Addiction is a chronic brain disorder. Let that sink in. All these years, we’ve been looking at addiction as a character flaw, perhaps a psychological psychosis brought about by some childhood trauma or something. We have ultimately looked at addiction as a choice one makes and faulted them for making that choice.

Here’s the first part of the ASAM’s short definition of addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Make special note of the use of the word “chronic.” That’s important. “Chronic” puts addiction is the same class as heart disease and diabetes. “Chronic” means that it’s not going to go away. Either one deals with addiction their entire life, religiously, continually, or they risk dying. There is no cure. There is only treatment and without that treatment, the disease gets worse.

Obviously, there’s some disagreement with this definition. Therapeutical psychologists, the folks who make their living getting one to lie on their couch at $500 an hour, don’t care much for this definition because it means their attempts to treat addiction as a psychosis is misdirected. One is not an addict because their father slapped them when they were four-years-old or because they didn’t get the bicycle they wanted when they were seven. Instead, genetic factors are responsible about half the time. We’ve been looking at this totally wrong.

A Personal Story

Mark Cummings was one of the best young photographers I ever knew. We first met out on assignment, both of us covering the same event for different entities. He was sharp, funny, and had an incredible eye for seeing things that everyone else was missing. He noticed, for example, that one particular Senator from Oklahoma always had his shoes untied. Always. He caught the look of burnout in a young pop star whose label was pushing her too hard. Mark infuriated editors because he didn’t capture the image they wanted to see. Instead, he captured a dark reality that was unnerving.

Mark also had an addiction to alcohol. He carried a flask of whiskey in his camera bag. Always. He would have another in his car, a third in his suitcase, and kept a bottle hidden in his office. Mark started the day with  a shot of whiskey in his coffee, then dropped the coffee by 10. In the three years that I knew him, I don’t think I ever saw him sober. He was functional. He took fantastic pictures. Mark Cummings was never sober.

Cummings wasn’t one to admit he’d had too much. Truth was, most days he was over the legal blood alcohol limit by noon. One evening, after being yelled at for over an hour by his editor for “wasting” five rolls of film and not getting anything printable, Mark was “extra thirsty.” When I saw him, he was already six glasses in. I stayed for two more and tried to get him to share the cab ride home with me. He wouldn’t leave.

I received the phone call early the next day. About three hours after I left, and who knows how much more whiskey, Mark put his head down on the bar, fell off his bar stool, and died from alcohol poisoning. Another brilliant photographer, gone.

Understanding The Problem

Again, quoting from the long definition of addiction from the ASAM:

 Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.

Understand, two decades of neurological research have gone into formulating this definition. Mark, along with every other creative addict we’ve known, was repeatedly told he had “a problem.” What he should have been told was that he had a neurological disease, one for which there is no cure, only treatment. I can’t say that would have saved Mark. He was stubborn, as a log of addicts are. It would  have, however, made a difference in how everyone responded to him.

The causes of addiction are worth noting as well. Again, from ASAM:

When persons with addiction manifest problems in deferring gratification, there is a neurological locus of these problems in the frontal cortex. Frontal lobe morphology, connectivity and functioning are still in the process of maturation during adolescence and young adulthood, and early exposure to substance use is another significant factor in the development of addiction. Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.

There’s a lot more that I encourage you to read on the ASAM website.

Our Response Is Part Of The Solution

Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition, states, “… we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”

When I think of all the times we’ve gotten it wrong, I want to cry. We blamed Mark for being a drunk, for not taking responsibility for his “habit.” His boss tried to control Mark’s drinking by pairing him with writers who would confiscate any alcohol they found. People would laugh at him when he couldn’t stand or took pictures too blurred to tell what they were. Every last one of those responses was wrong.

We have to change our way of thinking about addiction. If someone has a stroke you don’t laugh at them, do you? Should a friend you’re with suddenly have a heart attack, are you going to tell them they need to do something about that problem and walk away? No, you help them get help. Addicts are exactly the same. While the choice to get help is ultimately their own, we have to guide them toward professionals who genuinely understand the problem. While a 12-step program might help, they need a lot more than just a weekly meeting or two.

The ASAM states:

Recovery from addiction is best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals.

Each year, we lose too many wonderfully creative people to addiction. Help them get help. The ASAM can help connect you or a friend with the appropriate professional. Let’s stop treating addiction as just “a problem” and treat it like the disease that it is. Let’s do more to save our addicted friends. The world needs their creativity.