A Row of Nips: Social Perceptions of "Addiction" and "Recovery"

I was wandering around with my camera at hip a few weeks ago waiting for a train at a station with an old station house that is no longer in use and currently being reclaimed by nature. I was struck by a neatly lined row of nips, most of them paint thinner grade vodka and an empty jug of juice. They weren't mine, but a few years ago they easily could have been. I found myself wondering "what was the person that drank these tiny bottles of distilled potato water feeling at the time? What led them here? Did their silent pain dissipate 50ml at a time? Were they here in the morning? At night? Did it matter?". A lot of questions I know, but having once been homeless and drinking out of control, these are the kinds of things that cross my mind when I see what others might just deem obnoxious trash. I see a story.

I've been to a lot of AA meetings, and a few rehabs too. I've talked to doctors, friends, family members, hell even random strangers about the nature of addiction. The only thing I can be certain of after all of that discourse is that no one really knows exactly what it is, but many will be more than happy to tell you what to do to fix it. Strange.

The fellowship of Alcoholics Anonymous will tell you it is "spiritual malady, a hopeless condition of the mind and body characterized by an abnormal reaction to alcohol where once you start you can't stop and once you stop you can't start, but all you do is think about starting and you'll be restless, irritable and discontent unless you turn your will over to the care of God as you understand them". So basically it's a disease with mental and physical symptoms, but a spiritual cause and therefore God is the remedy. I've tried to believe that, but I honestly just can't. My mind is very analytical and I refuse to believe that the reason I used to drink too much is because I was "spiritually unfit".

Don't get me wrong, I certainly believe that each and every one of us should do the best that we can to live a life that is considerate of others and contribute something of value to the world. I also know people who I would consider pseudo-saints who have found themselves struggling to loosen their grip on the bottle, or needle, or chocolate cake, or a smartphone. To me the compulsive use of all of these things are one and the same, the main difference among them is the consequences inflicted upon the user as a result of both continued use and inability to remain completely abstinent, the bulk of which are a result of one stigma or another, personal or social.

To make a point let's consider one of the more socially offensive and one of the more socially benign of the two, the alcoholic and the smartphone user. There are plenty of people who suffer consequences in their lives and block themselves from their families and avoid doing things that they really should be doing because they're busy doing something on a smartphone. It can even be deadly, 1 out of every 4 accidents in the United States is caused by texting and driving. That's 6 times more than the number of accidents caused by drinking and driving. If you are caught drinking and driving your right to operate a motor vehicle is suspended and in many states part of the condition of you driving again is installing a breathalyzer in your vehicle, out of your own pocket, and in many cases the conditions of your probation are that you completely abstain from consuming alcohol for the duration of your term.

Contrast this with the smartphone user who is trying to get that perfect shot of their Starbucks iced coffee for Instagram while they plow into the car in front of them. Sure the police will come, the person will probably even admit they were on their phone and likely be charged with distracted driving. In every state but Utah this is just a ticket, you'll have a fine to pay, you won't lose your license and no one will say you can't use your phone even when you're not driving.

Now I realize that drinking is not talking on your phone, but the issue remains that due to the stigma and social perception of those who chose to drink and drive the proverbial book is thrown at them and the punishments are in some cases ridiculous. In my own personal case I served 60 days in jail (which I think is plenty reasonable and am in NO WAY complaining about). What is ridiculous is that because I lost my license for drinking and driving the reinstatement fee which is $50 for your average citizen is now $800 for me. Reinstating a license is reinstating a license and it should make no difference why you no longer have your license. I paid fines to the courts, I spent time in jail, I have not driven once since my license was taken away. I barely drink at all any more.

The truth is, it's really fucking up my life not being able to drive due to how much the government wants for me to have a license. The breathalyzer I'll have to install costs about $300 plus about $60 a month to have it calibrated, I say about for both of those because the state lets private firms install them and charge whatever the fuck they want even though it is state mandated and not something anyone would just go and do on their own. I'd love to volunteer to do community service to at least pay the reinstatement fee, but the Registry of Motor vehicles is an entirely separate from the District Court and the Registry only takes cash, checks or debit cards. That's a big part of the problem, I've served my debt to the court but now I have a secondary punishment from the Registry that is completely inflexible. I've written to judges and asked for leniency, they've said they would, but they CAN'T.

Now back to the Venti Iced Mocha Instawarrior, they clearly suffered some consequences from their excessive smartphone use and arguably put the public at risk of greater danger than I did when I drank and got behind the wheel. When they get home I'm sure a picture of the ticket will be posted on Instagram along with some cheeky little caption. They'll be driving home that day and no one will question if they should be allowed to use smartphones for a period of time as punishment.

All of this is evidence of the fact that a great deal of the "addiction" problem in America is matter of perception. It truly is.

Heroin is a substance that relieves pain and induces drowsiness. Prolonged use of heroin can result in a physical state of allostasis known as dependence, this means that when the user stops their body has acclimated itself to the presence of opiates and changed it's neurochemistry. Certain receptors are overexpressed (there's more of them) like dopamine, to handle the flood of dopamine brought by opiates, in fact after a while the brain just makes less because heroin provides more than enough. When the user stops, things are out of whack. Most people call this being dope sick, it's described as having a really bad flu.

Caffeine is a substance that relieves pain and induces alertness, mainly by blockade of the adenosine receptors.
Adenosine is a naturally occurring compound that builds up in the body throughout the day. The build up of adenosine is what makes you feel sleepy at night, hence caffeine's magical ability to keep you awake. Prolonged use of caffeine can result in a state of physical dependence. Due to the repeated use of caffeine the body will increase the number of adenosine and dopamine receptors and decrease the production of both. This is caffeine dependence. When the user stops using caffeine they become incredibly tired because adenosine is now capable of hitting the receptors that were once blocked by caffeine and also depressed because the exogenous dopamine from caffeine is no longer present. To put it simply, stop drinking coffee, even if you drink just one cup a day and you will be sick, not all that unlike a heroin addict in withdrawal.

So what's the difference? Perception, acceptance and stigma.