by David Sheff
Nic
For me, whatever small ups the drugs gave me were always accompanied by more extreme downs. Most drugs, when you take them, give you a boost of dopamine, the “feel-good” chemical in the brain, but when the dopamine goes up, it also comes down. The depression—the complete, overwhelming despair—that followed was so powerful, it always made me feel like I’d be willing to do pretty much anything to take that pain away. So that would lead me back to doing more drugs to try to feel better, which would make the cycle continue. Pretty soon, just to try to stay at all normal-feeling, I was having to use drugs all day long. But then even that wasn’t working. No matter how much I used, those hopeless, depressed feelings wouldn’t go away, and that was when I came closer to ending my life than I’d ever been before.
Earlier we talked about how drugs work by turning up the go system—as Nic said, dopamine floods the brain, causing a person to feel intense pleasure. Those with addiction appear to be more susceptible than others to drug-induced pleasure.
Compared to someone who gets high once or twice at a party and then stops, an addict’s motivation to use drugs is vastly different, a difference we’ll get into in a moment. But that difference explains why when people are addicted, their behavior will only get worse. They will do things that stun even them. A person’s brain adapts so it’s dependent on a drug. Without it, an addict can feel depressed, overwhelmed, and as if they can’t function in life without drugs. They may lie and steal. Formerly gentle people can become violent as their addiction deepens. It’s truly as if they become a different person, and in a way, they do. Our identity, consciousness, memories, sensations, and other things that define us are centered in our brains. Our brains are us. If our brains change, we change.
AN ILLNESS
Not long ago, many people believed that the addicted were weak and selfish. They wanted to get high no matter how much they hurt others—and themselves. If they wanted to stop, they would; that they didn’t stop was a sign of their weak character and lack of willpower.
Research over the past three decades has proved beyond a shadow of a doubt that addiction is a disorder of the brain—a form of mental illness. Just as no one chooses cancer, no one chooses to be addicted. Substance abusers suffer physically and feel enormous guilt and shame. They would stop if they could, but most can’t—without help.
Drugs work differently in the brains of people with addiction than in others’ brains. As we explained, dopamine is a chemical neurotransmitter that’s necessary for us to feel pleasure, and pleasure is necessary for us to survive. The dopamine system doesn’t function properly in the brains of people with addiction; the chemical doesn’t properly circulate. This lack of a normal flow of dopamine explains the cravings for drugs. Addicts are not choosing to use for fun. Their craving is the brain’s attempt to compensate for a deficit.
When they begin using drugs, their brains, which were experiencing a shortage of dopamine, get a flood of it. The flood doesn’t last, however. Once the dopamine is gone again, the damage has worsened, so there’s even less dopamine or, depending on the case, less access to it. So someone who’s addicted takes more of the drug or stronger drugs or mixes them in an effort to replenish the dopamine flow. The cycle is unending. The brain reacts as if it will die without the drug—and in some cases, with some drugs, if the withdrawal isn’t properly managed by a doctor, it can die.
Some people who start as casual drinkers or drug users will stay that way. But others will become substance abusers or dependent, convincing themselves that they need a drug to feel alive. There’s no distinct line between moderate substance-use disorder, or SUD, and severe substance-use disorder, or addiction. Medical professionals, however, use a set of criteria to distinguish between these two levels of the disease.
The essential feature of a substance-use disorder is a pattern that causes the user to experience harmful consequences. Some signs are missing work or school because of drugs, getting arrested, or engaging in reckless activities, including driving while intoxicated.
Addiction is more severe. With addiction you’ll see a person who’s unable to stop, exceeds self-imposed limits, spends more and more time using or getting drugs, and needs more of a drug to get high because they’ve built up a tolerance.
In the past, we thought “drug addicts” were like Nic or Kevin, who used to the point that they’d fall down drunk or pass out on drugs, who’d often get arrested and were always high. In reality, all sorts of people become addicted. Scientists once considered drug “abuse” different from drug “addiction.” As they have learned more about the disease of addiction, they’ve determined that there are many forms, some milder and some more severe, of SUDs.
Some people with SUDs keep their addictions hidden—from the outside, it looks as if they’re fine. Some of those with addictions get drunk or stoned every night, and some only binge on occasion. Some “only” smoke pot, some “only” take prescription medications, and some “only” get drunk on weekends. However, like some kinds of cancer, kidney diseases, and Alzheimer’s disease, addiction is a progressive disease. That means it often gets worse if it isn’t effectively treated. This disease is also chronic, like diabetes, heart disease, and epilepsy. This means that its effects might be experienced throughout a person’s life. And like many progressive and chronic diseases, addiction is potentially a terminal illness—if the progression isn’t stopped, it can kill.
There are many ways to define addiction. One that sums it up for us comes from the National Institute on Drug Abuse, which studies alcohol and drug use in America: “Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” The consequences may start out minor, but they can escalate to something terrible. Addiction can destroy a life or end it.
How do you know if a person is addicted? The best way is to get an assessment from a professional. If you’re concerned about yourself, you can take a self-test on the next page right now.
SELF-TEST FOR ADDICTION
(FOR TEENAGERS)
FROM THE NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
DO YOU HAVE A DRUG PROBLEM?
TEST: ANSWER THESE QUESTIONS AND TALLY THE NUMBER OF TIMES YOU RESPOND YES.
Do you use alcohol or other drugs to feel more self-confident, more sociable, or more powerful?
YES | NO
Do you ever drink or get high immediately after you have a problem at home or at school?
YES | NO
Have you lost friends because of your alcohol or drug use, or started hanging out with a heavy drinking or drug-using crowd?
YES | NO
Do you feel guilty or bummed out after using alcohol or other drugs, or ever wake up and wonder what happened the night before?
YES | NO
Have you gotten into trouble at home or school, missed school, or been busted or hospitalized because of alcohol or other drugs?
YES | NO
Do your friends use “less” alcohol and/or other drugs than you, or do you consume alcohol or other drugs until your supply is all gone?
YES | NO
Do you think you have a problem with alcohol or other drugs?
YES | NO
RESULTS:
How many times did you answer “yes”?
ONE: You’re at risk for alcohol or drug addiction. You may have things under control right now. Nevertheless, we suggest you continue to monitor your use and take this opportunity to learn all you can about alcohol and drugs. That way you can give yourself the best chance to keep ahead of any possible problems later on.
TWO: You may already have an alcohol or drug dependence. You should consider arranging a personal meeting with a professional who has experience in the evaluation of alcohol and drug problems.
THREE OR MORE: Your problem is serious now, and it will probably get worse unless you get help right away. You should arrange a personal meeting with a professional wh
o has experience in the evaluation of alcohol and drug problems
The NCADD offers this disclaimer:
The results of this self-test are not intended to constitute a diagnosis of alcohol or drug dependence and should be used solely as a guide to understanding your alcohol and drug use and the potential health issues involved with it. The information provided here cannot substitute for a full evaluation by a health professional.
There’s also a simpler test recommended by Dr. Shoptaw: Don’t use any drug for a month.
Can you?
Self-tests are just guides, but they can give you insight into whether you should seek help. And here’s a simpler guide. If you think there might be a problem, there probably is one. It’s time to find out.
CHAPTER ELEVEN
Addiction is a Family Problem
The experts say that addiction is a family disease. For a long time, I didn’t understand what that meant. When Nic became addicted, I thought he was the one with the problem. He was the one who needed help. But my son’s addiction wasn’t destroying only him. It was destroying our family. It was destroying me.
—DAVID, CLEAN
Nic
When my dad and stepmom first told me I was going to have a baby brother, I was actually super excited. I was only like ten or eleven at that point, but already I had this feeling like I really wanted to be a great big brother—like I wanted to be a good role model. I wanted to teach him about cool music and books and movies. And I wanted to make him feel safe and confident and loved.
Seriously, I remember thinking about all that stuff.
I really, deep down loved him. And as he got older, that love and caring just got stronger and stronger.
When he was a toddler, preschooler, and kindergartner, sometimes I spent more time with Jasper than I did with my own friends. We’d draw a ton together, or play music, or I’d tell him stories.
Then, when our sister, Daisy, was born two years later, it was the same way. I carried her around, played like crazy with both her and Jazz—and I had this intense love for them.
When I was a kid, I had kind of a rough time. I mean, sure, it was nothing compared to what a lot of kids go through, but I was way overly sensitive and uncomfortable in my own skin and really kind of hated myself in a lot of ways. And I think, for me, I wanted to protect Jasper and Daisy from those feelings. I wanted them to have all the strength and confidence and self-love that I lacked. I wanted them to have a perfect childhood. I wanted that more than anything.
The thing is, they did have this perfect, idyllic childhood—at least, as much as anyone has. And I ended up being the one who took that away from them. In fact, I ended up terrorizing them—and terrorizing our parents. In my first book, Tweak, I wrote about the time I got arrested in front of our house. When the sheriff put the handcuffs on me, Jasper burst into tears and tried to run up to save me, but the sheriff yelled at him to get away. Afterward, he was inconsolable for hours.
And that’s just one example. I stole money from Jasper’s piggy bank. I got in huge screaming fights with both my dad and stepmom. I brought girls back to the house in the middle of the night and would try to sneak them out in the morning. And then, of course, I began to withdraw completely. I disappeared from them, only to show up weeks later emaciated and sick and strung out and crazy-looking.
Even worse, though, was when I would go into treatment, get sober, and start to build a relationship back up with them, only to suddenly vanish again. Once when I was sober I worked at their elementary school in the first-grade class. Daisy was in kindergarten then, so every lunch I was there hanging out with her and her friends. We’d play tag, or wall ball, or whatever. Jasper and I would splash around in the pool together after his swim lessons.
And then I’d be gone. I’d steal some money and run off to the city and my folks would be sent into a panic trying to save my f—ing life again. And Jasper and Daisy would try to understand.
But how could they?
How could they possibly understand something like that?
Most adults can’t understand it, let alone a couple of little kids.
Hell, I barely understood it.
All I know is, I was in a ton of pain and I kept reaching out to the drugs to try to feel better—and then, once the drug hit me, the addiction would take hold.
Of course, it always tore me up to hurt those kids like that. Honestly, they were one of the only things I ever felt like it would be worth getting sober for.
Because I hadn’t lost it, you know?
I hadn’t lost that desire to be a good big brother—to be a role model for them—to save them from all the stupid-ass mistakes I’d made. I still wanted to give them that perfect childhood—the one I’d always wanted for myself but had given up on a long time ago. I wanted so badly to be there for them.
But I kept failing.
And eventually, it got to the point where my parents would no longer let me see my little brother and sister. They wouldn’t even let me talk to them on the phone. I’d hurt them enough, they said, and they couldn’t bear to watch their kids’ hearts get broken again.
Christ, I couldn’t bear it, either.
I also couldn’t bear the thought of never seeing them again.
But I was gonna have to.
I mean, that’s the way it was.
And it didn’t seem like it was ever going to get any better.
Really, it seemed hopeless.
Like I could never rebuild all the trust I’d shattered.
I didn’t even know where to start.
Well, first things first, right? I had to get sober.
I went off to residential treatment somewhere, and then to outpatient, and I started meeting a whole lot of people who were going through pretty much exactly what I was going through with Jasper and Daisy. So many addicts I met in early recovery were in my same situation. Basically, we’d all totally screwed over the people we loved in our lives, and finally they’d had enough and cut us off, in one way or another. For me, and for them, getting those relationships back seemed impossible.
The counselors didn’t provide many answers.
“Time,” they’d say. “It’s just going to take time.”
But none of us wanted to hear that. At least, I know I didn’t.
Anyway, what good was time going to do?
How, after everything I’d put them through, was my family ever going to let me back into their lives? No amount of time could erase what I’d done.
But then, slowly—you know, with time—I couldn’t help but notice some of the other people in my group beginning to put the pieces of their broken lives back together, starting to rebuild relationships with their loved ones. They would call their mom or dad or their wife or ex-wife or their child and they would talk. It would be hard and awkward at first, but, as everyone assured me, gradually, things would get better.
And so I did it.
I tried.
I sent an email to my dad.
It was short—maybe one or two lines.
Just, you know, I’m sober and would you be willing to talk to me?
To my surprise, he wrote back.
We emailed a few more times, and then, finally, we were able to talk on the phone.
But when I asked to talk to Jasper and Daisy, he wouldn’t let me.
In fact, he wasn’t even going to tell them he and I had talked.
Still, I kept trying. I tried and I tried and I began talking to my dad more and more. Then I started talking to my mom, and then, almost two years later, I was able to talk to Jasper . . . and then to Daisy.
It was just like the damn counselors had said.
Time.
Over the years we continued talking—me and the kids—and eventually, it even got to the point where we could see each other in person. And so I flew up north and hung out with them and, you know, the thing is, after all my worries about how I’d ruined their childhood, they’ve actually grown up to be two of the best, mo
st caring people in the whole world.
Now I’d say I talk to them on the phone pretty much every day. And I miss them when I’m away. In fact, a lot of the time I think about moving back to Marin just so I can be closer to them.
Jasper is totally the sweetest, funniest guy. And he is so deeply good and loving. I didn’t think it was possible for a person to be as open and gentle and kind as Jasper is, but he truly is.
And Daisy is my little soul sister. She is amazing. Beyond amazing.
She and Jasper are my best friends.
But it’s crazy scary to think about how close I came to destroying our relationship for good, you know?
A FAMILY AFFAIR
One hundred million of us live with an addict in the family. It can be hell. There’s no other way to put it. That’s why experts say addiction is a family disease. Having an addict in the family is confusing. It’s maddening. It’s terrifying.
We often travel around the country speaking at high schools, sharing with students our experience with drugs and alcohol, depression, and bipolar disorder. Usually, we share our stories for about half an hour, and then we open it up to the auditorium for a question-and-answer period. Many of the questions come from young people seeking advice about specific situations.
They don’t just ask questions, though; they also share their experiences with us. It’s surprising how open students can be in such a public forum—they often say they haven’t talked about these things before because they’ve been afraid to, but now they’re sharing with their entire grade or school. They talk about their own drug use, or in many cases, about drug use in their home by their parents, brothers or sisters, or other family members.