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CONTENTS
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What is addiction?
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Drugs and addiction in the media
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‘Addictive’ by Bernadette Perez
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Why ‘substance abuse’ is a label we should all reject
14/15 ‘The Addict’s Lament’ by Francis de Aguilar
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Fact vs Fiction: Substance abuse on film
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Drugs and addiction in the media
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‘The Isle of Annihilated
Rationale’ by Bob McNeil 3
The idea that addiction is a disease stands up to scrutiny. In order for something to be considered a disease it needs to be diagnosable and in order for it to be diagnosable you need to be able to identify consistent symptoms.
What is addiction or dependence? T
his is the case with addiction or “dependency” as the medical profession calls it. As far back as the 1980’s the term “Alcohol Dependency” appeared in a book called DSM (Diagnostic and Statistical Manual of Mental Disorders), this is the official list of diagnostic criteria. The term also appeared in another book called ICD (The International Statistical Classification of Diseases and Related Health Problems), these are the two manuals used by the medical profession worldwide. They are in there because there is an identifiable set of symptoms. There is also a term called “alcohol abuse” and this is a separate diagnosis.
It soon became clear that the symptoms of both fitted a wider range of substances and behaviors, so they work for alcohol and drugs as well as a range of other ‘addictive processes’, Gambling for example Importantly the distinction between dependency and abuse is that those who are diagnosed as dependent rarely manage to control their use and so abstinence from all mood altering substances is often the treatment of choice. This is why a thorough assessment is critical.
As soon as we accept the idea of addiction being a disease, a number of possibilities open up. First we see the person with this illness as the sufferer rather than as a bad or weak person who is somehow willfully continuing in this behavior. This means that the substance abuse is not freely chosen; rather the excessive drinking or drugging is beyond the control of the sufferer. If I were to come to the conclusion that I had an illness where before I had seen myself as a bad weak person, I would have something I could feel hopeful about, something that was not bound up in shame and guilt, something that I could do something about. OK let’s look at some of these symptoms, what does it look like: Firstly a dependent person consistently fails in attempts to control their use of their substance of choice. They take more than they mean to, attempts to, ‘cut down’ are short lived, and they have a
tendency to return to previous levels of use very rapidly after a period of abstinence.
Negative consequences, have little impact on use, rationalization, blaming and justification are used
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Image by Justin Maxon
to deflect any link between what’s happening and the individual’s substance use.Using increasingly gets in the way of social, occupational, recreational, family activities. It is as if the dependent person has become powerless and of course that’s very frightening, and so is often denied by the dependent person. A typical response is to ‘act’ powerful. This reaction is often referred to as denial.
So it would seem that: 1 Yes it is classified as a disease. 2 The disease model is a helpful idea in terms of approach.
3 It is supported by outcomes; in that
those who meet the criteria for dependence fare much better when they are treated by abstinence based programmes that subscribe to the disease model.
4 Treatment that promotes controlled
use or use of separate mood altering substances on the basis that “they were not the problem” have poor outcomes with dependent individuals.
It is important not to confuse physical dependence with the term “Addiction” the two are not necessarily linked. Yes a Heroin addict will be physically addicted and will experience withdrawal symptoms when the substance is removed, as will an alcoholic experience withdrawal symptoms when the alcohol is removed. Completion of detox ; i.e. when the physical dependence is no longer a factor and withdrawal is completed, does not mean that the “addicted” individual is recovered, far from it. This is when the real work of recovery and treatment begins. The psychological element of addiction is a complex matter that requires an intensive programme of treatment to address. If this process is not entered into by the dependent person, the probability of a return to addictive use is statistically very high. Francis de Aguilar ©2012
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DRUGS AND ADDICTION IN THE MEDIA
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by Bernadette Perez Addiction to particular substance, work, exercise, food or sex just to name a few can interfere with everyday living. Struggles control us making life difficult and unbearable. Disadvantages imposed by haunting reoccurrences. 8
Addictive Have been to the point of no return Temptations press precedence Extract a secondary source Bad habits are difficult Yet I tango with simplicity Protect me from my passions Stress rolls over frustration Flattens ability to think Stalkers who drape themselves at my window Clinging to misinterpretation Wait impatiently I look for an escape Wanting what I can’t have Believing all is real When in reality Desires tear me apart I Am Addicted Selfishly I fulfill my need Demons haunts me They lure me in Teasing temptation Flaunting my faults Urging me to lose control I give in I’ve lost control Enslaved to habit A sustained fight Armed with emotion I will engage Determined to win Fight Gain the support to achieve Pretend not to be Choose To Be The Best One Can Be
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Why ‘substance abuse’ is a label we should all reject
“Abuse” is an ugly word. “Child abuse,” “sexual abuse,” “physical abuse,” “emotional abuse,” “domestic abuse.” And then, of course, there’s “substance abuse.” But one of those things is not like the others.
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n all of the other types of abuse, there is a perpetrator who is harming a victim. In substance abuse, however, it makes no sense to argue that the victim is the poor innocent line of methamphetamine or a glass of Chardonnay. The damage done — both by the problem and by the term — is focused primarily on substance users themselves. The label is far from innocuous, and I vote that we retire it. Debates over language often seem absurd or trivial. However, they make a difference in how issues are framed and therefore what solutions are proposed. Frame addiction as “substance abuse” and it is easy to see why it should be a crime, but call it “substance use disorder” and it sounds like something to be treated medically. If we want to make progress in ending stigma, we should think hard about the words we use. In the case of “substance abuse,” there is empirical evidence of the harm that this framing can do. In a 2010 study, researchers surveyed over 500 mental health practitioners at a conference — two thirds of whom had Ph.D.s. participants were asked to
determine treatment for two hypothetical patients who were identical except that one was labeled as having a “substance use disorder” and the other was said to be a “substance abuser.” The “substance abuser” label encompasses the whole person, defining him or her by dysfunction. In contrast, the “substance use disorder” tag simply describes one problem, rather than an entire identity. Despite their training, the practicing clinicians favored a more punitive approach when the patient — who was described as having relapsed during court-ordered treatment — was labeled as being an abuser as opposed to having a disorder. More clinicians supported jail or community service rather than further treatment for the “substance abuser.” This is one reason why the recent revision of the DSM — psychiatry’s diagnostic manual — no longer includes “substance abuse” as a diagnosis. The term brings up stigmatizing associations between abusive behavior and drug taking — even though
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the vast majority of people with drug problems do not engage in child abuse, sexual abuse, or domestic violence. While the DSM revision made many mistakes — for example, it conflates the milder substance-problem diagnosis with the more severe one (mild problems do not require abstinence and the last thing we need is more reason to apply “one size fits all” treatment in this area), the editors were right to get rid of the abuse label.
‘As much as anything, having a politically correct term for a condition chosen by those affected also signals that our activism is coming of age and gaining power’ But there is another reason why labeling someone a “substance abuser” or as having a “substance use disorder” matters. That is, the “substance abuser” label encompasses the whole person, defining him or her by dysfunction. In contrast, the ”substance use disorder” tag simply describes one problem, rather than an entire identity. It will be hard to get rid of a term that is so ubiquitous that it is enshrined in the name of the research agency of the federal government that studies drugs (the National Institute on Drug Abuse) and in the most popular (though actually ineffective) prevention program,
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DARE, or Drug Abuse Resistance Education. However, advocates in other areas have managed to remove many other similarly common and abusive terms from public dialogue and polite company. As much as anything, having a politically correct term for a condition chosen by those affected also signals that our activism is coming of age and gaining power. Advocates for people with mental illness have long argued for language that puts “people first”: In this case that would mean that instead of using the terms “addict” or “alcoholic,” use “person with addiction” or “person with alcoholism.” While in principle I agree, in practice I occasionally slip because the phrase makes for clunky language. Still, I think that using “people first” language forces the writer to think about stigma and how they are portraying their subjects. While it probably has a less conscious effect on readers, it at least subliminally asserts the fact that those who suffer from these effects are human. We have been seen as objects by other people for too long. As much as anything, having a politically correct term for a condition chosen by those affected also signals that our activism is coming of age and gaining power. (For example, ironically many autistic people actually reject the “person first”
approach and prefer the term “autistics” because they do believe that their condition defines their identity — and the media is beginning to use this language as activists have spoken out about it.) People with addiction also need to think hard about other language we use. Take the terms “junkie” or “dope fiend.” I think they are acceptable only if used ironically or by people who have addictions — just as stigmatizing words for black people or gay people are only acceptable when used by members of those groups. I also believe that when we use these terms about ourselves, we need to consider their implications: Am I using this word because it is the right one for the situation or because I still have remnants of the self-hate that the stigma of addiction exacerbates? If we want to be understood as patients with an illness like any other, careful use of language is essential — as is making sure we do not inadvertently further stigmatize ourselves. For example, consider the commonplace assumption that addiction is always accompanied by compulsive lying and other criminal behavior. In fact, many people with addictions do not lie except when it comes to hiding their condition — and some do not dissemble even then if the conditions of their life permit this. Research shows that addicted people tell the truth about
their use (as correlated with objective measures like urine tests) so long as acknowledging their use will not be used against them. The connection between addiction and lying is in part an artifact of the criminalization of some drugs. The rest of the link can be accounted for by the fact that people with personality disorders like antisocial personality disorder are not only more likely to become addicted and more likely to be criminals, but more likely to be compulsive liars.
‘If we want to fight addiction, the way to start is by being careful about what we call ourselves, about what we see as the essential characteristics of addiction and how we understand our condition.’ The same is true for the link between violence and drug problems: Violence among drug users is linked to drug prohibition, antisocial personality disorder, and to having grown up with violence, not addiction per se. Most drugs — with the exception of alcohol — are not themselves pharmacologically linked with violence, and when they are, the perpetrator almost always has a prior history of it. Addiction doesn’t typically make people into unrecognizable monsters: It exaggerates the problems they already have.
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THE ADDICT’S LAMENT by Francis de Aguilar
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I have a friend who I have lost. We were so close for so long, every day entangled and connected In every way mutually directed. Every need of each, clambering to the top. Survival forcing collaboration drove us to inseparable bond, A friendship that could not stop. Smokey’s lines either way unknown, made sense to sing. Like Brothers or lovers, contra mundi we fought off attacks upon our troth. Until at last we stood shakily alone surveying the bloody carnage. We had fought long and hard for this this empty victory over life. Collapsed to the littered ground we embraced and eye to eye agreed, that our journey was done. With nothing won we went our separate ways. I howled out loud and begged them return. I was unknowing and opaque, without alliance or protection before the ordinary world. Despite the certainty of our defeat and the clarity of our disunions need. Despite desolations greedy stare, like a severed limb, I missed my friend. This need eclipsed my cloudy mind, all thoughts scattered and split. A constant grief driven drone became an insistent pull to reunite. In the thinnest moment, an echo. My friend and I face to face, eye to eye. That knowing instant, that certainty. We were done or dead, let go let go. Written by Francis de AguilarŠ2014
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No two drug abuse or addiction stories are the same in real life or on film for that matter.
FACT VS. FICTION:
SUBSTANCE A  W
hile there may be some common features of the addiction experience, such as the spiraling out-of-control effect of drugs, each story of addiction illuminates a different facet of this illness. Film portrayals of alcohol and other drug consumption provide insight into how society perceives these substances and copes with these disorders. Alcohol differs from other drugs in one important respect – ever since the repeal of Prohibition in 1933, alcohol has been legal. Since much of the high crime and media sensationalism associated with alcoholism evaporated when alcohol was re-legalized, some scholars argue that drug legalization would reap similar public benefits.The debate on drug legalization aside, one thing is clear, Hollywood and independent film makers alike have a penchant for making films that spotlight illegal drug trafficking. Some top fiction (or fictionalized) films about drug trafficking and their box office gross sales (as an indication of consumer interest) include:
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BUSE ON FILM
The Panic in Needle Park (1971)
• Scarface (1983) Domestic gross: $45,598,982 • Traffic (2000) US box office gross: $124,107,476 • Blow (2001) Domestic gross: $52,990,775 • American Gangster (2007) Domestic lifetime gross: $130,164,645
Films about heroin often channel the “strungout” effect that this drug creates, as well the desperate lengths addicts will go to procure this opioid. Memorable film portrayals of heroin-addicted couples include The Panic in Needle Park (1971) and Requiem for a Dream (2000). These films manage to enrich the drug addiction storyline by romanticizing it; the plots play out so as to illuminate the horrors of addiction, which are amplified in the couple dynamic. In both films, although the couples stay together (at least for most of the film), their drug cravings take the number one priority in the relationship and instigate betrayals, such as the women engaging in sex work to earn money for drugs, which undermines the sanctity of the relationship. 17
‘BLOW’ 2001
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‘The official toxicity limit for humans is between one and one and half grams of cocaine depending on body weight. I was averaging five grams a day, maybe more. I snorted ten grams in ten minutes once. I guess I had a high tolerance.’
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s in life, it may not be that drug addicts betray their loved ones, but that drugs betray everyone.These films are realistic in that they convey the acuteness of drug cravings, and the addicts’ determination to feed those cravings, however unlawful or damaging to relationships their drug-seeking tactics may be. The fact that cocaine is a stimulant, and a comparatively expensive one, may contribute to the cinematic sensationalism around this drug. However, the aptly named movie Blow (2001), starring Johnny Depp, proved that truth is often stranger than fiction, and more entertaining. Based on the real-life king drug runner George Jung, the first and second act of the film make a sport of the good times marijuana, cocaine, and millions of dollars brings into this drug dealer’s life. But this movie is particularly endearing in its portrayal of George Jung, as by the third act, sympathy runs high for this international drug trafficker (and colleague of Pablo Escobar, in the film and in real life). Although the film character George consumes so much cocaine that he has a heart attack in the delivery room while his
wife is giving birth to their daughter, having a child causes him to turn over a new leaf and he becomes abstinent for years, and even quits drug running. However, in the high-stakes criminal world of drug trafficking, friends are few, and George’s former colleague trades him into the police on a deal for a lighter charge. George ends up in jail once, then again for a long sentence, which is true of the real George Jung (he is not out of prison). Perhaps the most compelling detail of the film and the real man’s story is that his daughter eventually disowns him. If there’s one message Blow sends, it’s that the highs of drug use and trafficking are not worth the devastating lows, in this story, of losing family relationships. Films that focus on the individual experience of drug addiction abound and offer an array of perspectives on substance abuse disorder. Marijuana, heroin, cocaine, and methamphetamines have made numerous debuts as the drugs of abuse in films, as they have in the lives of many Americans.
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DRUGS AND ADDICTION IN THE MEDIA
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THE IS ANNIHIL RATI 22
SLE OF LATED IONALE Thought you were Amerigo Vespucci Exploring a hemisphere called Drug Analogs. Thought you were Christopher Columbus Traveling to a virginal land fertile in Ritalin. Thought you were Francisco Pizarro Colonizing a southern terrain of Crystal Meth. And amidst your sensory vagabondage, I thought those voyages Led you to The Isle of Annihilated Rationale. by Bob McNeil Copyright 2016
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abuser user junkie druggy space cadet tripper mainliner hype hypo cokey stoner tweaker pill popper metho smack head hophead hoppy needle man schmecker snowbird dope viper
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