For what it's worth

I've been trying to write about my experiences at the 12-step treatment facility, but it's been a lot more difficult than I ever thought it would.

It's always a shock when you leave a class and go out into the real world, and are suddenly forced to turn facts and statistics into people, real people. I should have expected it, but I was still shocked on the first morning of my first day, when my father and I typed up the paperwork of the first patient to be admitted -- a 19-year-old girl. It shouldn't have surprised me; I hear often enough about new patients at the addiction office who were in my high school class. Kids my age, in the 15-to-25 bracket, are some of the highest-risk for substance abuse and addiction.

But knowing the statistics, and having friends who you know smoked pot in high school, is different from meeting someone who could have been your friend -- someone you can see yourself in -- being admitted to rehab for heroin and ecstasy. When she walked in, the dynamic of the room changed; it wasn't my father and I as medical figures on one side with the patient on the other, it was two kids rolling their eyes as the old man took ten minutes to answer a text message.

It was uncomfortable for both of us, and she left as quickly as she could. I saw her plenty of times over the next week, and though I was going around asking the patients questions, I never said anything to her. I was afraid she would think I was judging her. I was afraid she was judging me -- and her opinion mattered in a way that the opinions of the older men and women there didn't. I was there on the afternoon when she got up and told the group her story -- she came from a well-off family and had had a nice childhood, with siblings and vacations and pets. She read a letter her dad had written her, full of support and love.

Whatever had happened that caused her to wind up here, in rehab for every drug I'd ever heard of, could probably have happened just as easily to me or to anyone else I know.

Back when I was first starting to plan for this summer, the idea of spending a lot of time in a rehab center was scary to me. I imagined that the people I'd meet would be the drug addicts that are on TV -- the dope fiends, methheads, crackheads, dealers, junkies -- all dangerous and unpredictable and hardly human. That's what addiction looks like in our culture, and it's a frightening picture. And it's catastrophically wrong.

There have been a handful more kids my age admitted to the rehab center in the past few weeks, and one 20-year-old named Jeff who finished his 28 days and left. I got to attend his farewell ceremony and hear about how excited he was to have his family come and pick him up the next morning. I've felt that, too, but only at summer camp, where I didn't have thirty patients and two counselors warning me that the rest of my life was going to be a struggle I would have to be prepared to face.

Friday was my last full day interning at the rehab center. Halfway through, I overheard that the girl I admitted on my first day had left treatment, two weeks into the month-long program. I don't know whether she went back home to her parents, or went back to live with the boyfriend she'd been using heroin with. I do know that this rehab center was her second in two months, and I hope that she left because she thought she'd learned all she could from it. And I hope she doesn't have to go to another treatment facility next month, or ever again.

Introduction

Hi, my name's Lisa. I'm not an alcoholic.

What I am is a student at a university in Boston, going into the last year of a biopsychology major and preparing to apply to medical schools. This blog is going to be a place for me to talk about my summer at home; the internships I'm going to go through, the people I'm going to meet, and the treatment strategies -- medical and otherwise -- that I'm going to witness. This summer, I'm going to learn about addiction.

My father is a physician, a general practitioner by training, and the chances that I was going to follow in his footsteps have always been pretty good. I grew up in and around his family practice, watching him administer flu shots and chickenpox vaccines, give physicals, and treat all sorts of everyday problems. Then, ten years ago, he came home from a conference, announced that everything had changed, and bought the space next door to his office to open a new practice while the old one was slowly dismantled. The examination tables, the EKG machines, the scales, the otoscopes and opthalmoscopes all vanished. The patient population changed. The new practice was a specialty practice, providing care to a segment of the population that has been, and is, desperately sick and criminally underserved: the addicted.

At that life-changing conference, my dad discovered buprenorphine, the partial opiate agonist that acts to eliminate cravings and prevent withdrawal symptoms in people who have been addicted to opioids, even if the addiction had been ongoing for most of their lives. Almost as soon as the new practice opened, I got to see patients coming in and thanking him tearfully for giving them their lives back, for helping them to feel normal, for freeing them from this compulsion that had been dogging them for years and that they had given up hope on ever being able to shake.

Around this time I was in high school, first discovering evolutionary psychology and the biological mechanisms of behavior. By the time I got to college I knew that the brain -- that absurd, impossible, fantastic mechanism whose complexity we're only just beginning to comprehend -- was my true passion, the thing that I would devote my life to studying. And addiction, a disease of the brain, fascinated me -- just as the way people seem to blame its symptoms on conscious behavioral causes baffled and enraged me.

So I decided to go to medical school, to follow in my father's footsteps and get the degree that would enable me to treat the chemical imbalances that facilitate addiction and all the suffering it causes. And at the same time, to fight the deep-rooted misconceptions that have led to the demonization and marginalization of those suffering from this disease.

This summer, I'm studying addiction from as many angles as I can. I'm going to work in my father's practice, which is based purely on medication maintenance; I'm interning and observing at a 30-day inpatient facility run on the 12-step model; and at the end of the summer, I'm going to intern for a month at an upscale spa-like holistic treatment facility. I'm going to write about it all here, and try to get as thorough an understanding of this field and these people as I possibly can before I start on my own path to help.

The title of this blog comes from the definition of addiction given by the American Medical Association:

"Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. The addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Like other chronic diseases, addiction can involve cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

It's my hope that this summer, and this blog, will give me a greater and more meaningful understanding of the state of treatment and the ineffective mythologies of addiction than I could ever get in classes.

So, that's my story. I'm not an alcoholic, and I'm looking forward to a world where nobody else is, either. And this summer is where I'm going to start.