This weekend, the East Coast was shocked and frightened by the approach of hurricane Irene. Though the hurricane didn’t do as much damage as the news media had forecast, people from North Carolina to Maine feared for their lives and property, and rushed to gather emergency supplies and find somewhere safe to wait as the storm approached.
The hurricane was highly unusual, but the fear and panic that came before it were things I had seen before. For someone suffering from addiction, every day can be like the day before a hurricane. They are constantly living in fear of withdrawal, to the point where every minor headache, cold, or stomach pain is seen as a sign that the storm is about to break, and the wretched withdrawal symptoms are about to hit them with the force of hurricane winds. People who haven’t experienced addiction tend to think of withdrawal as being similar to the flu; it’s uncomfortable, but after a while it goes away and you’re no worse for wear. They don’t realize that one of the symptoms of the disease of addiction is heightened sensitivity to the kind of pain and discomfort that withdrawal brings, to the point where it becomes completely crippling. I’ve had many patients who relapsed because they were unable to ‘wait out’ the withdrawal symptoms, which they say felt worse than a non-addicted person could imagine.
It’s understandable that addicted patients start to panic if they think they are about to experience withdrawal, and that will cause many of them to use. But it extends beyond the panic of a single moment. For addicted patients, withdrawal is always looming on the horizon, and they constantly have to take steps to ensure that they don’t suffer from it. As soon as they get one fix, they have to be looking for the next one. If they have to change cities, or take a trip on business, or deal with some big event like a wedding, they have to ensure that they’ll have an adequate supply of their substance if they don’t want withdrawal to overtake them. The frenzied planning and desperation many patients feel under the threat of withdrawal is similar to what East Coast residents experienced under the threat of hurricane Irene.
Those who say that addicts are ‘dirty’, that relapsing makes them ‘weak’, should consider that perspective before they make their judgements. It is possible for some people to wait out withdrawal symptoms, just as some people were better able to handle the fear and uncertainty produced by the weather predictions last week. But the desire to protect ourselves against perceived future threats is a deeply human trait, and no addiction treatment can be complete without taking it into account. Physicians in addiction treatment must be aware of what the world looks like to their patients, and they must be willing and able to reassure their patients that the storm of withdrawal isn’t a problem. 12-step detox programs attempt to just get their patients through the storm, patching up damage as it occurs and making no attempt to prevent further damage. Wouldn’t it be better to keep the storm from hitting at all?