Of drugs, denial, and disappearing teaspoons

I have spent a lot of time lately thinking about drug addiction and stigma. I could go into an entire diatribe about how stigma impacts an addict’s ability to seek treatment and receive adequate treatment. After all, stigma informs our public policies and it is in the best interest of the bottom line for insurance companies and politicians to portray the addict as a leech, a moral reprobate, and a criminal. So the public takes the bait and we continue to let people suffer and die because of it. But aside from stigmatization of the addict, there is an equally as destrutive stigma associated with the addict’s family. There are many popular variations on this theme. If you are the parent of an addict, you’ve probably heard them all, or even used them to pummel yourself. Here are a few of my favorites:

“There must have been abuse in the home.”

“I’ll bet the parents are addicts too. The apple doesn’t fall too far from the tree, you know.”

“They were too permissive.”

“They were bad parents.”

“They didn’t engage in their child’s life.”

When used as a tool for self-flagellation, it takes the form of:

“What did we do wrong?”

“How could we have missed the signs?”

“Was it because of the divorce?”

“Was it because I was stressed when I was pregnant?”

“Should I have done more snooping in her room when she wasn’t home?”

O.K. Let’s can the condemnation right now. There is no one single path to addiction, and if you are the parent of an addict, the path your child chose may have absolutely nothing to do with you. Sure there are absolutely things that parents do or fail to do that may elevate a child’s risk factor for addiction, and if your child was raised like a lab rat with no other influences besides parental ones, we could say definitively whether or not it was your “fault.” But real life is not that simple, (and if it were, face it, it would be brutally boring).

If you review the literature on causality, you find that even the experts can’t agree. After years of playing nature-nurture tug-of-war, researchers in the field found they had to make up a word to account for why people become addicted. That word is biopsychosocial, and it is a word that no one who isn’t applying for a research grant would ever use. The rest of us call it “life.” From conception, a child is exposed to environmental stressors in the form of anxiety hormones, environmental toxins, and sometimes they just don’t luck out at the swim meet in the gene pool. If there is drug abuse, sexual abuse, or physical abuse in the home, sure, the kid is at risk for a whole bunch of psychological problems, but addiction may not be one of them. Conversely, parents of addicts may be Ward and June Cleaver, living in the suburbs with a white picket fence and tasteful furniture. Children of police officers may become addicts. Children of clergymen may become addicts. Children of psychologists may become addicts, for fuck’s sake. And now that heroin is hitting the suburbs – and it is – we now see soccer moms and Little League coaches with addiction issues. The point is, if you are the parent of an addict, don’t buy the stereotype and don’t own the stigma.

Now of all the dumb-ass excuses I’ve heard people use to beat themselves up for their child’s addiction, number one on my hit list is, “I guess I was in denial.” This is probably true for a small subset of parents, but let’s look at what denial really is. Denial is a state of utter refusal to believe the facts even when they are staring you in the face. In other words, you walk into your child’s bedroom, see him with a needle dangling out of his arm, and say, “Oh my. When did you become insulin-dependent?” That would be denial. Or your child has just been arrested and he’s carrying several grams of heroin, a syringe, and a prescription for pain killers that doesn’t belong to him, and you say, “I’m sure someone snuck that into his backpack when he wasn’t looking.” That’s denial. OK?

Denial is not missing the subtle cues that might alert you to the fact that something is wrong. After having watched several documentaries involving interviews with parents who had lost children to overdose, the one question they were always asked was, “Were there any red flags that your child was becoming addicted?” Most parents, presumably after innumerable therapy sessions, had learned to say, “Um…not really…well yes, there were a few. I guess I was in denial.” When pressed for these so-called clues, one mother said, “Well when Sean came home from college for the holidays he looked like a wreck.” She put it down to stress and assumed he wasn’t eating right. He also told her he had just come down with the flu. The woman’s whole family had also just come down with the flu. If your child said he had the flu and looked like hell, you would believe him. And you would believe him not because you were in denial, but because your brain has no frame of reference for dope sick. Unless you have seen it before and had other reasons to think of drugs – and bear in mind, this young man had been away at college for a semester – your brain doesn’t go there. Has he looked like this before? Yes, when he was sick. This is your experience as a mom. Thin, unshaven, a little green around the gills, a bit shakey? You’ve probably seen the same look a hundred times when you were raising him (except the unshaven part because frankly, on a two-year-old, that would be weird). This is the context your brain has for this particular look. When your brain hears hoofbeats, as the old saying goes, you think of horses, not zebras.

Another woman said she should of known because her teaspoons kept going missing.  This was a lovely, British, middle-class woman in her sixties. She did not strike me as the kind of person who had spent a lot of time watching people inject illegal drugs in their arms (among other places). What was her brain to make of missing teaspoons? Probably not much. Her brain had no context for connecting teaspoons with heroin, yet she too called this denial.

Another woman had packed her son off to college with a credit card which he was to use for text books and living expenses. At first activity on the card was normal, but then it started to escalate. Unless her child had addiction issues before going to college, what is mom going to think? She’s going to get pretty angry and give him a stern lecture about not using the card to take a girl out to dinner, or buy football tickets, or purchase a bitching stereo system for his car. Why? Because moms with kids in college expect that these are the kinds of things a not-quite-financially-responsible college freshman spends money on. Her brain has no context for thinking otherwise so she imagines what other financially irresponsible young people usually do when given a credit card. That’s not denial, but that’s what she called it.

These are examples of contextual thinking, which is, by the way, how our brains operate when dealing with missing teaspoons and maxed out credit cards. It is our default mode for thinking about the mundane things in our lives. Yes, we all have swell imaginations and use them when the context calls for it. If we were decorating a room, reading a novel, watching a movie, or visiting a museum, we’d let that bad-boy imagination machine have at it. If we are dealing with misplaced jewelry (that our addicted child has stolen, but we assume we’ve put down in one of those infamous “safe places” that we never remember later) or a scruffy kid who looks exactly like he did when he had the flu ten years ago, our brain dispatches with these things in terms of what it knows. It cannot do otherwise. Biologically our brain is still on the primordial savannah. If our primitive ancestors heard rustling in the bushes, they knew from experience it was probably a lion. They did not wait around to see if it was a neighbor bringing over Sunday brunch and a pot of tea. The subconscious conclusions at which we arrive when dealing with ordinary life frees up our much over-rated pre-frontal cortex to contemplate the meaning of life, to do complex long-range planning, and to determine what the fuck James Joyce could possibly have been thinking when he wrote Ulysses.

Most parents today hit adolescence in the sixties and seventies. Our experience of illicit drug and alcohol use was scraping together enough change to get our older siblings to buy us a bottle of Boonesfarm piss-poor wine. If we didn’t smoke pot ourselves, we knew people who did. We snuck cigarettes now and then. Some folks dabbled with hallucinogens and everyone knew at least one person who had. It was a phase, we outgrew it, we moved on with our lives and settled into spectacular, blissful normalcy. If we knew addicts at all, they were almost all aging alcoholics. Most of us know what someone smells like when they’ve been drinking. We know what cigarette smoke smells like. Many of us could identify a bong if we found one in our child’s room. That is the only context we have for illicit substance abuse. How on earth are we to connect missing teaspoons to heroin? How are we to recognize early signs of meth addiction or cocaine addiction?

An addicted child, they tell us, becomes withdrawn and isolated. So what? All teenagers do. You don’t ignore it certainly, but you don’t automatically make the leap to addiction until it is so deeply dug in that the child no longer cares about whether or not you know. That’s pretty far gone. You have to watch who your child hangs out with, they tell us. We do, and we make rules and set boundaries, but unless you are willing to spend your child’s teenage years sitting his room every night (that’s every night for six years) with a shotgun, you cannot know what he does in the middle of the night or who he does it with. Also, bear in mind that many young people do not become addicted until they go off to college. If your child is accepted to Stanford and you live in Milwaukee, you are not in any position to monitor his behavior unless you can afford a private detective doing 24/7 surveillance for the next four years. And even that’s no guarantee.

So what does this have to do with stigma? Simply this. A parent will self-stigmatize by using the word “denial.” If it’s true, by all means admit it and work on that, but merely missing the “red flags” is not the same thing at all. And the more time you waste smacking yourself over the head for something you could not possibly have seen coming, the more guilt you feel, the more you begin isolating yourself, the more likely you are to begin the blame and shame game. The end result of this game is that pretty soon the whole damn family is dysfunctional. Everyone is sitting in their own darkened corner, nursing their own shame, and blaming each other. It is now not only the addict who hates himself. It’s you, it’s your spouse, it’s siblings, it’s grandparents, it’s the kid down the block who unwittingly introduced your child to someone who knew someone who was a dealer. That’s a zero-sum game folks.

There are no positive outcome guarantees for an addicted individual, but there are definitely ways to ensure negative outcomes. Asking yourself “why” is a road with no outlet – unless of course you want to emulate addiction researchers and make up a new word for it. Personally, I wouldn’t worry about linguistic confabulations at this point in your life. Leave that to the experts. If you wait long enough, they’ll come up with something. You have more important things to do. Trust me, if the only commitment you have this week is to drive your addicted child to an NA meeting, you have more important things to do.




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