Who's an Addict: The Many Faces of Addiction

A nurse that I worked with asked me to give a lecture to nursing students about addiction. She wanted me to focus on how to screen for addiction, the symptoms a patient might present with, and a general overview of what treatment for addiction looks like in the clinical setting. I took time to formulate the lecture and was ready with an hour’s worth of slides to discuss these topics in depth. On a whim, I decided to print out booklets of the lecture slides to disseminate. This turned out to be a great decision because I never even had the chance to begin the first slide.


Why? Because the ice-breaker that I had prepared went well. Too well. To begin the lecture, I asked the students to write down the first thing that came to their mind when they heard the word "addict."


Their responses included: loser, thief, liar, pathetic, homeless, failure, poor, disabled, hopeless, guilty, shameful.


While I had anticipated that the responses would skew toward “negative” judgments, I had also expected some “positive” word associations that would make for an interesting contrast and subsequent discussion. Hence the ice-breaker. Given that the responses were one sided, I chose to share my own word associations based upon the individuals that I've worked with:


Successful.


I spoke about Cindy,* A 40-year-old CEO of a successful company who presented to treatment after being arrested. While driving drunk, she hit a traffic barrier and because her 5 year-old daughter was in the car, her actions met criteria for Felony DUI. By societal account, she had been living the dream before the accident. She had an amazing job, a beautiful home and well-behaved children. She also drank alcohol daily.


Cindy knew her drinking was not ideal, but considered herself functional, given her ability to maintain a perfectly manicured outward appearance. During treatment she shared about growing up in a rigid home with very high expectations, which she always met. But she found no personal sense of accomplishment despite these successes...until she began drinking. Drinking allowed her to feel as if she achieved despite being handicapped. Her drinking made her feel successful both outwardly and emotionally. Cindy was addicted to alcohol.


Traumatized.


I shared the story of Jeffery,* who had the most horrific childhood. Aside from the physical abuse he endured at the hands of his mother, he also lived with his alcoholic father whose emotional abuse rivaled the physical scars Jeffery received from his mother. Jeffery ran away from home at age 15, lived on the couches of various friends until 18, joined the military and watched his friend die when his Humvee ran over an IED while fighting overseas.


Jeffery was physically injured in the attack and was prescribed an opiate to help manage the pain. He noticed that, in addition to alleviating his physical pain, it also helped him black out the memories of the past and to rest his always vigilant mind. When his prescription ran out, Jeffery began buying pills on the street. Because the cost was exorbitant, he decided to try a cheaper alternative to pills: Heroin. Jefferey was addicted to opiates.


Lonely.


Dave* never felt like he belonged. Throughout grade school he never fit in. If there was a party, he wasn’t invited. If kids were hanging out in the park, he was sitting in his room, at home, all alone. He reluctantly began 9th grade assuming he was destined to four more years of a similar unsocial existence. Until he met Steven who, on the first day of school, invited Dave to sit with him at lunch. They hit it off and it was not long before Dave and Steven were hanging out after school. One evening, while watching videos on Steven’s laptop, he unzipped his pant pocket and pulled out a joint. He proceeded to light up and offered Dave a hit.


At first Dave was taken aback. He had never seen anyone smoke weed. But Steven was his friend, he didn’t want to jeopardize his relationship, and (he rationalized to himself) if Steven was doing it so flippantly, maybe it was okay. This was the first time Dave smoked marijuana, but his use escalated quickly. He started smoking only with Steven, but then transitioned to smoking every night in his room. He left his window open and his parents were never the wiser. Until the school did a random drug test on all of the 9th graders in April and Dave tested positive. Dave was addicted to marijuana.


Valedictorian.


Monique* was raised by her parents who were both physically and emotionally available. Her family was upper middle-class and she lived in a tree-lined suburban neighborhood. Monique enjoyed dance and was a part of her local dance troupe. In school she was liked by teachers and popular among her peers. She found academics to be easy and thrived in her classes. Monique first began to struggle in tenth grade, when she began to find math challenging. Always used to excellence, this “ordinary” challenge elicited a great deal of stress. She confided in a friend who offered Monique one of her Adderall pills, which the friend was prescribed for treatment of ADHD.


The Adderall proved a “game changer” and Monique, taking Adderall when studying for all her future exams, eventually was appointed Valedictorian of her high school class. Her nonprescribed use of Adderall escalated in college and resulted in Monique self-referring to a neuropsychologist with the hopes of attaining an ADHD diagnosis of her own so that she might get her own prescription. When this plan failed, she began buying pills on campus and was eventually caught buying from an undercover officer. Monique was addicted to stimulants.


Fathers, Mothers, Daughters, Sons, Husbands, Wives...


I spoke about the countless numbers of Fathers, Mothers, Daughters, Sons, Husbands, and Wives who I have treated over my years in practice. Each person with their own intricate life story. Each member of an extended family who was suffering from their inability to break free from the clutches of their addiction.


I left them with the following thought: “As you each go out into the clinical world you will, undoubtedly, encounter addicts. They are often the most difficult cases to treat. Your task is to not think of the person in front of you as an addict. Rather, think of them as someone’s family member who could use your care and support. Think of them as an individual in need of your assistance. Please just think of them as a fellow member of the human race in dire need of help. They are a person, like you or me. Treat them as such.


Because, ultimately, that’s who an addict is."



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*All names and potentially identifying details have been altered to protect the privacy of the individuals mentioned above.



Author: Tzachi Rosman, Psy.D. is a licensed clinical psychologist who specializes in the treatment of issues related to addiction, trauma, and self-esteem. Since 2008, Tzachi has worked at VA Hudson Valley HCS in Montrose, NY serving as Staff Psychologist on the hospital’s residential Substance Abuse and PTSD units. Tzachi has a private practice in Teaneck, NJ, enjoys writing articles about Mental Health, and free-building Lego sculptures. He can be reached at yrosmanpsyd@gmail.com.

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