“Did you just order a book about heroin addiction?” That’s what my wife asked shortly after I purchased White Out: The Secret Life of Heroin by Michael W. Clune. It was recommended, I think, in book list I saw in December. Whatever the source, it piqued my interest because I have had a number of conversations recently about addiction. And I think it’s a serious problem.
One set of conversations came up among men doing a program called Exodus 90 this past spring. In short, Exodus 90 is a Catholic program of prayer and asceticism that begins about 50 days before Lent and ends at Easter. It’s meant, ideally, to lead to some permanent changes in habits like praying more, exercising more, etc. All good things. One of the many disciplines that Exodus 90 requires is to abstain from alcohol for the 90 days. Lots of guys struggle with that.
I have done Exodus 90 three times now. After the first one, beginning in January 2019, I decided that I would continue abstaining from alcohol indefinitely after Easter. I did not plan an end date, but I didn’t drink anything until Christmas dinner that year. After that, I resumed my usual habit of having wine at some meals, drinks after work or at work functions, etc. But after nearly a year of no alcohol, I became acutely aware of (1) how prevalent alcohol was in gatherings of attorneys and some friends, (2) how a lot of people seemed to have problems with alcohol they refused to acknowledge or address, and (3) how many bad things happened after people had too much to drink. When I started Exodus 90 the second time in mid-February 2020, I stopped drinking for good.
Since February 2020, I’ve met a lot of people who do not drink as a rule. I know a physician who does not drink for similar reasons as me—to be mentally sharper and not have chemicals affect sleep, etc. (Caffeine intake, for me, is a different story.) These people gave up alcohol as a personal or religious discipline, or to enhance athletic or professional performance. But I’ve also met and read about plenty of people who gave up alcohol because they had to—some when they were barely of legal drinking age. For them, it was an addiction, and giving up alcohol was the only thing that could save them.
Tom Coyne is one of those people. He’s a sportswriter. He is also a recovering alcoholic. In his Golfer’s Journal article, “The Lucky Ones,”1 he recounted: “I didn’t want to drink, I had to, and I understand that’s hard for normal drinkers to understand. They might view addiction as a matter of self-will or strength of character, and I wish I had the choice to believe that too. We lose a lot when a chemical takes control of our minds and bodies, and choices are the first to go.” He continues, “A friend told me that if I wanted to quit drinking, I only had to change one thing: everything.”
Some people may not be addicted to alcohol like Coyne was. He tells a story about being the keynote speaker to a group at Pebble Beach—ironically, a group of salesmen from a liquor company—and being so drunk during a morning round of golf that his caddie had to help when he blacked out between golf shots. But addictions are not limited to alcohol: “Whether it’s sugar or shopping, voyeuring or vaping, social media posts or The Washington Post, we all engage in behaviors we wish we didn’t, or to an extent we regret.” Anna Lembke, MD, Dopamine Nation, 2–3. Lembke defines “addiction” as “the continued and compulsive consumption of a substance or behavior (gambling, gaming, sex) despite its harm to self and/or others.” (16) And these substances and behaviors are easier than ever to obtain. In fact, “[t]he world now offers a full complement of digital drugs that didn’t exist before, or if they did exist, they now exist on digital platforms that have exponentially increased their potency and availability. These include online pornography, gambling, and video games, to name a few.” (23)
I remember being in high school when Pulp Fiction came out. I have seen that movie more times than I can count. And it was perhaps the first time that I saw drug use discussed in such an ordinary way. It was something everyone did, just part of one’s daily routine. And even though I’ve never done drugs, movies like that deaden your senses. By popularizing the behavior, it seems less harmful.
Within four years of Pulp Fiction coming out in 1994, Michael Clune tried heroin for the first time. He describes the first time as a white cloud that sticks with you. “The secret is that the power of dope comes from the first time you do it. It’s a deep memory disease.” (7) The disease renews an addict’s memory with each heroin use: “Dope never gets old for addicts. It never looks old. It never looks like something I've seen before. It always looks like nothing I’ve ever seen. I kind of stare. I’m kind of shocked.” (7) “It’s always new,” Clune says. “It’s a deep memory disease.” (7)
A memory disease seems like a good way to describe addiction based on the neurological literature. As Lembke explains, “a drug like cocaine can alter the brain forever. Similar findings have been shown with other addictive substances, from alcohol to opioids to cannabis.” Dopamine Nation, 63. I remember a seminar I was in where they talked about how online addictions—gambling, pornography, etc.—can actually rewire your brain. Your brain literally creates new neural pathways for information to travel.
Those new pathways can change our very personalities. Lembke describes “[o]ne patient who seemed to be doing well on antidepressants told me she no longer cried at Olympics commercials. She laughed when she talked about it, happily forfeiting the sentimental side of her personality for relief from depression and anxiety. But when she couldn’t even cry at her own mother’s funeral, the balance for her had tipped. She went off antidepressants and a short time later experienced a wider emotional amplitude, including more depression and anxiety. She decided the lows were worth it to feel human.” (131) The prescribed antidepressants in this case did what many addictive drugs do—what addicts want them to do—they numb all feeling.
Lembke is quick to note that many prescription drugs do wonderful things for the patients who take them. And they are a useful tool for physicians. But there is a trade-off, “there is a cost to medicating away every type of human suffering, and as we shall see, there is an alternative path that might work better: embracing pain.” Dopamine Nation, 135.
In a sense, recovering addicts are those who are able to embrace pain to get out of the addiction cycle. They are “the lucky ones,” as Coyne calls them. But as Clune explains, it’s difficult to get out of the trap of addiction: “A thousand little things, a thousand considerations of the most rational, the most progressive, the the most reasonable kind can prevent a person from taking that step out of themselves, out of everything they know and are, out of the skull with the single interior eyeball, out of their mind. And if you don't go out of that mind, you die.” (xxi) His friend thought recovery was not attainable: “‘It’s impossible, Mike,’ he said, straightening up and looking me right in the eye. ‘After the last time, I promised myself. I’ll never try it again. Quitting chews you up and spits you out, and you are still hooked. It’s impossible to quit. Just forget it. Waste of time to even try.’” (32)
But it’s not a waste of time. There is life on the other side. On the other side, there is a sense of purpose, accomplishment, and immense gratitude. As Coyne writes about a group of sober golfers near Philadelphia called The League: “None of us got sober to improve our résumés; we were as desperate as the drowning, and we’re one drink away from being back there. But I remember walking into that first dinner and seeing proof in every seat that being an alcoholic was my strength and not my shame. I could do anything, because so many of them had.” Even Clune had a similar experience: “This morning I arose refreshed, smiling for no reason. This is why I got clean. I didn’t know it then. The cure keeps working also. Growing. I said the first time I did white tops lasts. The cure lasts too. The way out of the white out. It gets stronger. At first I saw only one way out. Now I can see more ways.” (98)
Lembke has identified these myriad ways forward and put together a blueprint of sorts for addicts to move forward. These “Lessons of the Balance” are the main themes of her book. (234)
The relentless pursuit of pleasure (and avoidance of pain) leads to pain.
Recovery begins with abstinence.
Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures.
Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world.
Medications can restore homeostasis, but consider what we lose by medicating away our pain.
Pressing on the pain side resets our balance to the side of pleasure.
Beware of getting addicted to pain.
Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset.
Prosocial shame affirms that we belong to the human tribe.
Instead of running away from the world, we can find escape by immersing ourselves in it.
I’ve spoken with people who have been caught up in addiction who struggled with these very things. They had different types of addictions, but the patterns were consistent. (Coyne quips in his article, “We all had different stories that were exactly the same.”) And they seemed like perfectly functional people, even while addicted. I think if people looked around, they would admit there are more functioning alcoholics or drug addicts in their workplaces than people might think. It has become part of the human condition, but one that exists just below the surface. Clune discusses how he remained a fully functional doctoral student while heavily addicted to heroin:
Naturally, I was careful. If I had to be around people who I didn’t want to know about my habit, I used great care. Showers. Clean shirts. And just enough dope to keep the withdrawal away. So it wasn’t obvious, unless you knew what to look for. And most people don’t. So my family, my professors, my old friends noticed only a slight souring of the space between them and me. Of course, there was probably a healthy helping of denial on their side. People don’t want to think someone close to them is a heroin addict. (160)
Some may say that most of America is in denial right now. There is an addiction epidemic in our country. “The quadrupling of opioid prescribing (OxyContin, Vicodin, Duragesic fentanyl) in the United States between 1999 and 2012, combined with widespread distribution of those opioids to every corner of America, led to rising rates of opioid addiction and related deaths.” Dopamine Nation, 18. At this point, “more than one in four American adults—and more than one in twenty American children—take a psychiatric drug on a daily basis.” Dopamine Nation, 38.
Many people talk about addiction as a way to escape. They talk about pain. There’s the obvious pain of withdrawal. But there is a more intense and profound pain—the pain of coming to terms with who you are. “To pass through addiction is to come to terms with not being where you are. More and more people are entering the modern world by passing through addiction.” White Out, 164.
“The only way to recover from the memory disease is to forget yourself.”
White Out, 214.
Although addiction may be an odd, modern coming-of-age story, many people become addicted to avoid dealing with this very thing. They are not comfortable with themselves, do not want to be themselves, or just cannot handle the pain of life. But to get past addiction, “[t]he trick is to stop running away from painful emotions, and instead to allow ourselves to tolerate them. When we’re able to do this, our experience takes on a new and unexpectedly rich texture. The pain is still there, but somehow transformed, seeming to encompass a vast landscape of communal suffering, rather than being wholly our own.” Dopamine Nation, 83.
When the pain is transformed and someone has passed through the crucible of addiction, they can go back and tell others what it was like and how to get through themselves. But even for an addict, it’s hard to explain the magnitude of the problem to other people. “Addiction is a public problem. But it doesn't have a public solution. It only has private solutions.” White Out, xxi.
The musician Jelly Roll (don’t ask me, I’ve never listened to him) testified in Congress recently about his own struggle with addiction, the need to help others, and the magnitude of the problem:
And I was speaking outside to the media and I gave them a statistic that said 190 people a day overdose and die every single day in the United States of America. That is about a 737 plane. That’s about what a 737 aircraft can carry. Could you imagine the national media attention it would get if they were reporting that a plane was crashing every single day and killing 190 people?
But because it’s 190 drug addicts, we don’t feel that way – because America has been known to bully and shame drug addicts instead of dealing and trying to understand what the actual root of the problem is with that. But the sad news is that that narrative is changing, too, because the statistics say that in all likelihood, almost every person in this room has lost a friend, family member, or colleague to the disease known as addiction.2
“As philosopher and theologian Kent Dunnington wrote, ‘Persons with severe addictions are among those contemporary prophets that we ignore to our own demise, for they show us who we truly are.’” Dopamine Nation, 2.
Clune describes the addiction problem a different way: “[T]he stigma isn’t the problem. Social attitudes aren’t the problem. Never in my life—whether during my ten years as an actively using addict or during my twenty-plus years living clean and sober—never once have I suffered from anyone’s negative attitude about addiction. I’ve been arrested, robbed, beaten by cops, beaten by dealers, beaten by junkies, shot at, overdosed, seen friends overdose, seen friends die, and never once was anyone’s bad attitude about addicts or addiction the problem. The problem was drugs. And drugs are still the problem.” (xiv)
So if X is the problem, the solution to avoiding addiction seems to stay away from X. It’s a process called “self-binding” in the literature. “Self-binding can be organized into three broad categories: physical strategies (space), chronological strategies (time), and categorical strategies (meaning).” Dopamine Nation, 92. In common terms, you avoid the people, places, and things that cause you to fall into addiction. If going to a bar means you will drink to excess, don’t go there. If there is some activity you associate with addiction, avoid that activity. “Binding ourselves is a way to be free.” Dopamine Nation, 118. Self-binding is a path to true freedom—freedom to become the person you’re meant to be rather than the false freedom to do whatever you want.
This is a lesson that Clune learned a bit late, but once he learned it, this simple idea still helps him recover one day at a time. “That’s some steps to getting high. It don’t just happen. Every one of them things is things you can not do, and if you don’t do every one of them things, the dope can’t get in you—You will never get high.” (223) “But there’s a trick,” he says. “There’s a secret. It seems that dope comes from everywhere and goes anywhere, that it’s omnipresent, omnipotent, a white god. But it doesn’t and it isn’t. It just seems that way. . . . In reality, it hides in certain places, certain spots, and if you know where those spots are, you can shut the window before it gets in you.” (224) For Clune, he boiled it down to a simple process: “The first part is to be alert when you’re passing the place where the dope is hiding. The second part is to not snatch the dope out of that place and do it. This two-part trick is called a ‘choice.’” (224)
Clune’s “choice” is merely one of the many repeated self-binding actions Lembke describes. We have the ability to avoid addiction (or recover if we are in that state), but the key to either avoidance or recovery is to make small choices throughout the day. As James Clear writes in Atomic Habits, “Every action you take is a vote for the type of person you wish to become.” (38) If you want to become different, choose to make it so, one step at a time.
Remember to turn every page. Enjoy your weekend. Please let me know whether you need anything.
Best,
Aaron
PS - In addition to running a law practice, I am working on my first book. These posts are going to move to a monthly format for the foreseeable future. Look for them on the first Friday of each month.
“The Lucky Ones” was named the best feature story of 2020 by the Golf Writers Association of America.
https://www.brown.senate.gov/newsroom/press/release/watch-jelly-rolls-powerful-testimony-in-support-of-browns-fend-off-fentanyl-act