SAN FRANCISCOMEDICINE - California Society of Addiction ...

Book Review
Steve Heilig, MPH
The Pain Behind Addiction—and a
Miracle Cure
America Anonymous: Eight Addicts in Search of a Life
By Benoit Denizet-Lewis (Simon & Schuster)
The End of My Addiction
By Olivier Ameisen, MD (Farrar, Straus & Giroux)
Addiction to drugs, especially legal ones such as nicotine
and alcohol, results in incalculable costs and suffering
in America. The cumulative medical expense, accidents,
lost productivity, and legal and jail expenses have resulted in the
American Medical Association identifying substance abuse as our
worst public health problem.
“Today, nearly 23 million Americans—9.2% of the population
twelve or older—are hooked on alcohol or drugs, another 61 million
smoke cigarettes, and millions more are slaves to gambling,
compulsive overeating, and sex and pornography,” writes Benoit
Denizet-Lewis in America Anonymous. That opening statement
hints at both some of the strengths and perils of his heartfelt book.
Behind every health statistic is a personal story, and here are
eight men and women from all walks of life who are addicted to
alcohol, heroin, methamphetamine, crack, prescription drugs,
steroids, tobacco, gambling, food, sex, pornography, and shoplifting,
or some combination thereof. Their stories are diverse and moving
in their commonness and tragedy.
Direct exposure to addiction doesn’t always help us understand
and sympathize, as Denizet-Lewis notes. “Even the family
members of addicts seem conflicted. In a USA Today/HBO drug
addiction poll of adults with an addicted family member, 76% called
addiction a ‘disease’ but a majority of those same respondents identified
‘lacking willpower’ as the main impediment facing addicts.”
The personal stories here—with names and locations
altered for privacy—share a common dynamic. As “Bobby,” addicted
to OxyContin, succinctly recalls, “It started as a weekend thing, but
then before I knew it I was craving it, and then I needed it to function.”
But “function” here is a relative term, and that bar is lowered
as the addiction takes hold. Beyond the progressive dependence
lies varying levels of conflict with others, self-debasement, denial,
crime, even violence and incarceration.
Denizet-Lewis discloses that for himself, it was compulsive,
anonymous sex that took control of his life. His own experience
of loss of self-control colors the book, and early on he addresses
the tension caused by an ever-broadening definition of addiction.
“I believe that gambling, sex, food, spending, and work (to name
a few) can, for some people, be as addictive and debilitating as an
addiction to drugs,” he writes. But calling every such behavior “addiction”
can water down the “disease model” now widely accepted
for drug addiction. By calling most troubling behaviors addictions,
we risk eliciting more denial of those who actually are addicted.
So what to do when true addiction is undeniably present As
with other diseases, many have longed for a “magic bullet,” such
as antibiotics were hoped to be for infections. French cardiologist
Olivier Ameisen, MD, thinks he found one such weapon. Utterly derailed
by his alcoholism, he’d tried all manner of treatments but had
all but given up until he came upon a generic prescription muscle
relaxant called baclofen. “Freed by baclofen not only from the biological
prison of addiction but also from the crippling anxiety that
preceded it, I was finally at ease with myself and others,” he exults.
The End of My Addiction is Ameisen’s moving story of his decline,
fall, and redemption, and his crusade to get baclofen widely
recognized and used. He’s understandably evangelistic: “I ask all
physicians who treat addiction to consider prescribing baclofen,”
he says. He also urges more research, while noting that the lack of
a patent for the drug is a huge financial disincentive and that his
own brave published report met “a deafening silence.” Research is
indeed underway, but the jury is still out.
History is replete with “miracle” cures for diseases, including
addiction, but few have stood the test of time. Denizet-Lewis quotes
renowned addiction researcher Dr. Walter Ling’s caution: “I would
distrust anyone who says they can cure addiction.” But another
truism in this arena is that whatever works is good.
On a broader scale, though, as recovering polydrug addict
“Jody” acutely observes in America Anonymous, “Treatment works.
Maybe not the first time, but it works if you do it right, if you give it
the time it needs. For that, you need to . . . fund it. But we don’t do
that. We’d rather build jails and spend millions of dollars cleaning
up the messes of addicts, when we could spend much less and help
them stop making messes!”
And therein lies yet another tragic story.
An earlier version of this review appeared in the San Francisco
Chronicle.
36 37 San Francisco Medicine June 2010 www.sfms.org