Addiction: Why Can't They Just Stop? New Knowledge, New Treatment, New Hope

Addiction: Why Can't They Just Stop?

Why Can't They Just Stop?

It was like a hard-hitting reality--"I am an alcoholic." I am one of those people I see on TV. I am one of those people I used to criticize, thinking, How can they be so weak?

JULIE, RECOVERING ALCOHOLIC

It was December, a peaceful evening, the sidewalks covered in fallen leaves. Along with a few colleagues, Timothy* ducked out of his office. The 42-year-old engineer wore a new blazer and gray wool slacks underneath a gray overcoat, which he pulled tighter when he felt the cold night.

Timothy, tall with hazel eyes and dark hair parted on the side, ran a small, elite R&D division at a software company. He was a popular boss. He loved his job, though not the required seasonal office parties like the one he was walking to that evening.

En route, Timothy held back from his colleagues for a moment. Retrieving his cell phone from underneath his coat, he dialed home. Lara*, his wife, answered on the first ring. Their 14-month-old was singing in the background and banging on a toy drum.

After asking about the kids and Lara's day, Timothy promised, "I'll be home in a couple of hours. I'll escape as quickly as humanly possible." When Lara told him to have fun, he half groaned. "You know what these things are like," he said. "I'll pay my respects and be home soon. I love you."

"I love you."

The restaurant was decorated for the holidays with twinkling white lights, a flocked Christmas tree, and red-leafed poinsettias on white-clothed tables. A jazz combo, set up in a corner of the room under mistletoe, played a vaguely recognizable version of "O Holy Night."

Timothy's colleagues dispersed, making their way toward other early arrivals, and meanwhile a waiter approached him and asked what he would like to drink. Without giving it a second thought, he asked for a sparkling water. In recovery for three years, he had made sparkling water a habit. At AA meetings, he joked that it had become his drug of choice--having replaced the drugs that previously had vied for that title: cocaine, methamphetamine, and prescription pills such as Valium and Vicodin. It was those drugs, when mixed and combined with a new Toyota Prius, that landed him in a hospital emergency room. The car was totaled but he was fine. Miraculously. The greatest miracle, however, was that he had driven his car into a tree and not an oncoming car. Afterward, he dwelled on this detail. A head-on collision probably would have been fatal, but that wasn't the worst scenario. Much worse, Timothy knew, would have been to have survived the accident but harmed someone. Or killed someone. He could not have lived with that. It was a sobering realization. Figuratively and literally.

Timothy claimed that even if not for the DUI and threatened criminal charges, he would have checked into rehab. It was his second time. In the initial rehab three years earlier, he learned that there's a myth that addicts and alcoholics have to hit bottom--whatever that is--before they become sober, but the reality is that everyone is different--there is no predicting what will impel someone to seek treatment. That first time, he had been in wretched shape. His wife had threatened to leave him if he didn't get help. But the accident was the clarion call of the variety that many addicts speak about in twelve-step meetings. "I got it," he would say when he told his story. "Only by the grace of God was I still here. That was that. I checked myself into treatment." For the second time. He promised his wife--he vowed--there would not be a third time.

Since then, he and Lara had another child, a beautiful daughter with large brown eyes and a serene smile. His career, which had floundered while he used, was back on track. He was committed to recovery, a regular attendee at Alcoholics Anonymous meetings. He had a full life, a happy life.

At the Christmas party, soon after his call home and after he ordered the sparkling water, something caught Timothy's eye. Later, he describes it. "It sat there on an isolated table," he says. "The rest of the room--the people, the sounds, the light--it all faded away. I sort of laughed it off. Like God was testing me. You can't fool me, I thought." A glass of Scotch, abandoned, set by a poinsettia on a white table, illuminated as if by a spotlight. He walked over, picked it up, and sniffed it. "A billon thoughts went through my mind," he explains afterward. "A billion thoughts and no thoughts." He spoke wistfully. "The glistening amber liquid. The intoxicating smell. Wood smoke. Euphoria."

Maybe, in that moment, he could have made a different decision--or maybe that moment was too late. "My mind simultaneously raced and froze," he says. "I thought, After three years a sip won't hurt. I am so bored. What a waste of good liquor. I deserve it. I hate parties. It's a night of celebration. Christmastime. I am impervious. I am one of the lucky ones. My gorgeous children. My family. Three years sober and a sip. A sip. Half thoughts like those and no thought at all."

He says it was almost like watching someone else--someone in a movie. Like he left his body. He felt a sense of horror, he says. Horror and also, incongruously, reckless delight. He sipped the Scotch. He breathed it. The taste was "heaven." He sipped again. "Glorious." He drained the glass. The reaction inside his head was instantaneous and intense. "I was filled with electric warmth," he recalls. "A smoldering fire was rekindled. I felt enlivened. The taste was . . . and I felt so . . ." He could not find the exact words. "I was horrified and felt perfect, both, but perfect won."

He said the required goodbyes and left the party. Again wrapped in his overcoat, walking to his car, he thought, See? They say that I can't have one drink. I can and I did. A glass of Scotch. One glass. I am in recovery. Three years. My judgment isn't impaired. It's sharper than ever.

Driving, he thought, One drink. I missed the taste. The faint buzz. No problem. I've licked my addiction. Maybe "they"--"they" in the rehab programs, "they" in AA meetings--can't have just one, but I am not like them. I never have been. I talked the talk and walked the walk. I played along. But I'm not like them. He laughed. Aloud.

He drove home, had every intention of driving home. His car came to the same intersection he drove through every morning and every evening before and after work. The car turned. By itself. Left instead of right. He smiled. Nervous now. The car had a mind of its own. Right would have led home. Left led to . . .

Peter*.

For a little holiday cheer, he told himself. I deserve it after three years. Everything is in my life is great. Celebration. I am not like them. One line.

Some addicts think it's okay to drink or smoke--"Just a little pot," "One beer"--as long as they don't use whatever was their drug of choice. However, according to Richard Rawson, PhD, associate director of UCLA's Integrated Substance Abuse Programs, an addict is far more likely to relapse on hard drugs if they drink or smoke marijuana.

Driving this familiar route, Timothy felt what he later describes as "a secret thrill. It filled my body." Driving itself, the car wound down a quiet suburban street--he chuckled as he always did when he turned on the road because it was called High Street--and pulled over in front of a cheery house. Peter. His friend. His buddy. The house dressed brightly for the holidays with a wreath on the front door.

Inside, after a bear hug from Peter, he noticed a clock. It was 7:30. Early. Plenty of time. At nine o'clock, he ignored his chiming cell phone. It rang again at 9:12. Then again. At 9:30, after the incessant ringing, he shuddered and turned off the phone. At dawn, he thought, I am making up for lost time. I'm flying. How I have missed this in my life. Who have I been kidding? Later he explains that there was something else inside him, a barely remembered sense somewhere in some part of his consciousness: Lara. The children. Home. Christmas. His job. Friends--a life.

Addiction is a disease that impacts 1 in 4 families.

Someone else's life. That life was an abstraction so distant as to be unreal. What was completely and utterly real was the moment: life coursed through his veins. "I felt powerful and alert. Whole."

Earlier there had been a first line--the first line in three years-- followed by another. At eleven or so, he asked Peter if he had rigs (syringes). Peter smiled. "What took you so long?" he asked, embracing his friend. "I've missed you, bro."

Addicts or their family members must contend with what may be one of the most difficult concepts of all to comprehend: at various points on the road to recovery, addicts may relapse.

Timothy shot up, thinking, And I have missed this! How could I have lived without it? I am in control. I'm fine. A celebration. One night after three years. I'll go home soon and sleep it off. He says later, "High again, I felt immune, invulnerable, at peace."

He was awake. At four in the morning. Shooting. It was as if no time had passed between him and Peter, his dearest, truest friend. They drank Scotch and smoked weed. They talked. How he had missed talk like this--genuine and open and alive. "I'm glad I'm over this shit," Timothy said at one point. "Now I can take it or leave it."

The following day, he thought for a fleeting moment that maybe he should call Lara, but he pushed the thought aside. He shot up more and another day and another night were gone.

Lara's husband had not returned home for seventy-two hours. Three days. Lara did what wives and parents and children and lovers and friends of addicts do. She imagined every scenario, no matter how implausible. Timothy had been murdered. He had been kidnapped. She imagined a terrorist attack and accidents. Horrible accidents that involved dozens of cars. Ludicrously, sleepless in the middle of the night, she imagined a 747 hitting the freeway. She concocted preposterous scenarios, while all the while knowing that the truth was simpler. He had relapsed. It was the obvious but most discouraging explanation. She had already done what people who love addicts do. She had called his friends and colleagues and then, bracing herself, called the hospital emergency rooms and the police. Nothing.

Not knowing but knowing. She felt what family members feel: the horror, the dread, the terror. After the imagined 747 crash, she replayed much more likely fantasies--horrific fantasies. He has overdosed. He has gone out to kill himself. High, he crashed. Again. He is dead. She thought, What did I do wrong? Besides the self-blame, she also felt guilt for something else that flooded her--another thing that most people who love addicts feel and simultaneously feel guilty for feeling: she was enraged. By habit and for the children, her rage was contained. But tormented, she thought, How could he do this to us? The bastard. Again. She felt rage toward him and blamed herself. Both. How could I have trusted him? I am a terrible mother. How can I put my children through this? The bastard. Poor Timothy. Poor Timothy? Poor us. The bastard. Where is he?

Dawn on Monday the sky was smoky gray. Normally, Timothy would be on his way to work, stopping for coffee and a newspaper. That morning, however, he shakily drove across town and parked in front of another building that was familiar to him. A pallid, jittery ghost with sunken eyes, he walked up a flight of stairs and pushed through the glass door of the same rehab facility he had graduated from three years ago. By coincidence, the first person he saw was a counselor with whom he had been close. She glanced up and noticed him. She looked again, closer, and knew. She shook her head and without a word came up and hugged him. He wept.

Through tears, he whispered the obvious: "I relapsed."

"But you're here now," she said.

RELAPSE: PART OF THE ROAD TO RECOVERY

Addicts or their family members must contend with what may be one of the most difficult concepts of all to comprehend: at various points on the road to recovery, addicts may relapse. In some cases, it may be a failure of their treatment. "Some addicts fail to respond," says Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). "There are many reasons. It wasn't a good program. The treatment was good, but it did not fit the person." In most cases, however, a relapse does not mean the efforts in recovery thus far haven't been effective.

Like other chronic illnesses, addiction--with the proper treatment--can be managed, so that an addict can live a life without drugs.

"Some heavy users will go through treatment once," says UCLA's Rawson. "They will stay sober after that. But for many, it will take multiple tries." Michael Dennis, PhD, a senior research pyschologist in the Lighthouse Institute of Chestnut Health Systems in Bloomington, Illinois, says that 70 percent of the patients relapse after their first time in treatment. "It's not like fixing a broken bone," he says.

Gantt Galloway, PharmD, a scientist in the Addiction Pharmacology Research Laboratory at the California Pacific Medical Center Research Institute in San Francisco, explains, "If we look at recovery as a lifelong process that may include one or many relapses, a far more realistic view of success emerges. We need to think of a treatment trajectory: it may take five, seven, nine times before they get it. Chronic depression has similar success rates. Seizure patients? The noncompliance rate is just as high. High blood pressure? All they have to do is take their medicine. It's not as difficult as staying sober, but the rate of noncompliance is just as high."

"Relapse is not a failure of treatment," says Anna Rose Childress, PhD, research associate professor at the University of Pennsylvania School of Medicine. "Relapse is part of the disorder." Kathleen Brady, MD, PhD, director of the Clinical Neuroscience Division at the Medical University of South Carolina and president of the American Academy of Addiction Psychiatry, explains, "[Addicts] have changed their brain in ways that make them vulnerable to relapse."