Friday, January 30, 2009

Harm Reduction Part 1: Addiction, Substance Abuse and Therapy

If you haven't already, I would like to strongly recommend that you listen to this podcast, or read through some of the transcript here. It will provide a very solid introduction to the Harm Reduction approach to addiction treatment. And please, do not take anything said in this post as an excuse for addictive patterns that lend themselves to self-abuse. This is something ideally discussed with a therapist. Short of that, discerning what any individual is really dealing with in their substance use requires a great deal of honest self assessment.

I am having some trouble with pushing on through this discussion. I want to warn you that one, I am using some strong language in this post and two, I am going to take a while to tie it all together. I expect to put two more posts into this discussion. I really am going somewhere with this and am arrogant enough to say that it's a point worth getting to. I really hope you will understand that while I am not afraid to discuss whats going into this, what I am talking about is rather painful - pain that I am dealing with right now. Bear with me, I like to think it will be worth it.

More...I am really glad that I decided to relax last night, instead of pushing through and finishing the post I was working on. Not only do I feel better now, I have a somewhat altered perspective to talk about. I had a rather busy morning and really have a fair amount to get done this evening and into tomorrow. But I think I need to take the time for this right now.

I just had a very intense session with my therapist. On top of my general neurological proclivities, on top of being in school for the first time in sixteen years, I am trying to muddle through the very worse experience of my life. And it's been fucking brutal. Not one to deal with stress and anxiety very well in the best of times, it takes a lot for me to simply stave off meltdown. Add to that, that I have been abstaining from cannabis, traditionally my warm comfort in times of extreme anxiety. For the first time in years, I'm really having the urge to drink and get trashed (as apposed to simply wanting a beer or good bourbon, because I enjoy them).

To make things worse, I have been trying to get in to see the doctor so I can get on meds. I set an appointment for the 20th, back in early December - only to have them call and cancel because they made a mistake. So I tried to reset, twice they've set then canceled, again, due to mistakes. This has not helped with my anxiety issues. All together it's everything I can do not to curl up in a corner and descend into fucking hysterics. The upshot, is that I have an appointment Monday, to see the doctor I grew up with. It will cost money I really don't have, but it will also help me succeed in school and make it easier to avoid losing it.

What the hell does any if this have to do with addiction you ask?

I am an addict, an abuser of substances. By most measures I'm an alcoholic, in spite of being capable of the occasional drink without falling into a binge. It wouldn't be inaccurate to call me a marijuana addict. No question I'm thoroughly addicted to cigarettes. I could go on, but I think you get the picture. I'm an addict, an addict who has a fairly high degree of success at manging his addictions - excepting the cigarettes. But according to the dominant addiction paradigm, I am an abysmal failure.

My measure of success is not that of the dominant addiction paradigm. I am not abstinent. Even though I am not drinking, it's because I know that if I have a drink right now, I could well lose it and fall into self-abusive behaviors. A year from now, hell maybe in a few months, it will probably be perfectly safe for me to have a drink. I like good beer and I love good bourbon, but my fondness is limited to a single drink, two at the most. Beyond that I don't like to drink.

My reasons for abstaining from the weed are a little different and will probably be a very long-term, if not permanent decision. It was no longer performing the function I wanted it to and in some cases was actually increasing my anxiety instead of reducing it, as it traditionally has. Beyond that I have other motivations for quitting that far outweigh the desire to get stoned.

How did I get here?

Several years ago, I had a fortuitous encounter with a cognitive psychology professor who busted me, sitting in on one of his lectures. We ended up spending more than an hour talking in his office and one of the topics that came up was my ADHD and a theory that's been floating around for a long time about it. He explained that it seems likely that ADHD is in part a dopamine deficit. This was ultimately pretty earth shattering for me, because it ended up having a profound effect on how I looked at my use of psychoactive drugs and even some of the things I love to do, like writing and playing music.

Over the course of the weeks, months and years after that conversation, I began to formulate a whole new personal drug use paradigm. The initial concept was simple and not necessarily well affected - it's ok to get high, the problem is getting wasted all the time. As time passed, I began to take increasing ownership of my drug use. Never having heard the term, I had stumbled upon the harm reduction approach to substance abuse, or as Dr. Denning puts it, substance use issues. I am far from unique in this. I don't have some special knowledge or brilliant fucking insight that no one else can have. I figured this out because with a bit of introspection it just makes sense.

I will continue this discussion a little later, maybe tomorrow. It was a productive day and a very good session in therapy, but it has also been a fucking brutal day in many regards.

Here I am, I am just a man
this is my life, starting all over again
nearing the end my last life was broken.....


Juniper Shoemaker said...

Please take care of yourself.

DuWayne Brayton said...

No worries, while I am having a lot of trouble right now it's moving in the right direction. Yesterday (and right now really) was difficult because I have a very good therapist and I'm not on meds. It's really hard to deal with what comes out of a productive therapy session, but the whole point of being in therapy is to deal with shit.