Thursday, August 09, 2007

Addiction: The Unending Struggle

This morning I watched HBO's 90-minute special documentary "Addiction" with my colleagues in lieu of our usual multidisciplinary team meeting. Frequent readers of Digital Doorway may remember that I was asked by HBO's public relations team last year to post a review of the film in advance of its original broadcast on the cable network. While I did point out some minor shortcomings in that review, I felt at the time that the film offered the general public and healthcare providers alike a succinct yet moving overview of the most current science vis-a-vis addiction and its treatment, illustrated with real-life stories which drive home the basic thesis of the entire HBO undertaking---that addiction, for all intents and purposes, is a disease of the brain which is chronic and treatable. However, the film never fails to also underscore the fact that addiction destroys relationships, wrecks families, often kills its sufferers, and costs the taxpayer millions of dollars per year in treatment, legal ramifications, lost productivity, and societal costs.

On my third viewing of the film, I was surprised that I still cried at the most touching moments, despite the fact that I have seen those segments a number of times and know exactly what's coming. Thinking that I might be slightly bored seeing the same film yet again, I brought along some paperwork to do in case the experience became tedious for me at any point. However, in that dimly lit room, shades drawn, my twenty-some-odd colleagues transfixed, watching the screen with rapt attention and nary a murmur of comment or side conversation, I was completely engrossed in the film, emotionally hooked into each story and finding my heart and mind opening yet again to the message with which I am by now very familiar.

I'm not sure how the HBO project has fared vis-a-vis its ultimate and overarching goal of energizing a national conversation about addiction, the need for adequate treatment, the stigma which labels it as a moral failing or character flaw, and the science that shows its physiological basis. Still, this film---a series of discrete vignettes which each stand on their own yet work as a comprehensive whole---has had an effect on me well beyond the initial viewing. The thirteen additional short films in the series can all be streamed on for free or seen on HBO on- demand, along with the 90-minute documentary which is the subject of the preceding paragraphs.

Despite all of our training and understanding of the disease model of addiction, we healthcare providers are always at risk of feeling disappointment, anger, resentment, and despair when our patients relapse into drug or alcohol abuse. As much as we try our best to not see it as a moral failing or character flaw, there are still moments in our days when we put our heads in our hands and sincerely question how we can go on being objective when our souls cry out "NO!" when a client picks up again. Even when our brains say "it's a disease, they are powerless over their cravings", we must, deep down, still feel disappointment and anger from time to time, wishing that they could be stronger, more circumspect, more amenable to treatment.

Just as family members struggle between unsympathetic anger and loving compassion, we providers must also wrestle with our judgments and pin our own demons to the proverbial ground. The old adage, "there but for the grace of God(dess) go I" (which I admittedly and unapologetically use ad nauseum on this blog), still holds true. Any one of us is a potential addict, however some of us are more inclined than others, just as some are more inclined to diabetes or heart disease.

Addiction takes its toll on our society in myriad ways, and we all at some point must consider what it means to us, who in our lives may be affected, what we would like to do about it, and how we feel this society should manage such a monster in our midst. Addicts---whether homeless vets or white collar executives---all deserve the same chance at treatment and a life free of addiction and its potentially catastrophic consequences. But as long as a large segment of the population---as well as those in power---see addiction as a failure of will power and personal strength, we will still have a very long way to go.
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