[By Patrick Mackenna]
They made clumsy small talk. The weather, the kids, the job…fragments of each topic covered and nothing was gained. Defending themselves from silence was more important than moving the discussion forward. Finally the receptionist slid open the glass and said, “Mrs. Burns…you can come back.”
The doctor was reviewing paperwork inside a folder as they entered the office. He removed his glasses and gestured for them to sit.
“Mrs. Burns. I won’t waste my time. You’ve lung cancer.”
It was apparent that the weight of the diagnosis was jarring. Her facial expression pleaded for reprieve…are you sure???
“I’m not sure why the confusion Mrs. Burns. You’ve been a smoker nearly 40 years.”
“well…yes, but…”
“I’m sorry? Was there a ‘but’ at the end of your sentence? You know how to read, don’t you? Here, take a look at this surgeon general warning, tell me what it says.” He tossed her a pack of cigarettes.
She picked the cigarettes up off the floor. Her fingers shook and her thoughts were racing. Lacking the composure to properly handle the situation, she began to cry.
“Smoking causes…” her words trailed off into tears. Her son reached over to comfort her.
“No, no, no…Mrs. Burns, finish the reading.”
She looked up with wounded eyes. “Smoking causes Lung Cancer, emphy…”
“That’ll do Mrs. Burns. Now, let me ask you a few questions. Had you ever read this label before? I imagine that you have. And if you have and continued to engage in this behavior…then what do you expect me to do for you? You know Mrs. Burns, there are legit cases of lung cancer out there…prolonged exposure to asbestos and so on. Victims Mrs. Burns, victims.”
“I tried to stop Doctor. Many times, I swear. Once, I quit for nearly a year.”
“A lot of good it did. I suppose that your effort should serve some nobility Mrs. Burns? Perhaps we should cheer your efforts? Congratulations Mrs. Burns. Thanks to your own doing, you’ve terminal lung cancer and despite my better judgment-I’ll be recommending that we approve you for treatment. Personally, I don’t think you’re worthy-given that you caused the illness. Because I must grant you treatment, I will…I do not however, need to grant you my sympathy. I hope it’s clear that I find this whole ‘disease’ idea is a crock.”
This entire scenario sounds absurd. Doctor’s conducting themselves in this way should not practice. Medicine does not allow for moral interpretation of illness. Medical practitioners do not evaluate patients for ‘worthiness’. Illnesses are no less valid if the individual engaged in behavior causing or contributing to onset. The scenario reads much closer to Old Testament fable than to an interaction with a doctor in the 21st century.
Let’s alter the scenario slightly. What if Mrs. Burns is being diagnosed with an addiction to opiates instead of cancer?
Mrs. Burns’ lung cancer was contracted through years of smoking; had she opiate addiction, it would have been contracted through significant use. Mrs. Burns was aware that smoking negatively impacts her health and could cause cancer; had she been addicted to opiates, she would likely know that excessive drug use negatively effects health and could cause, contribute to various illnesses. Mrs. Burns attempted to quit unsuccessfully on several occasions. She likely shared her attempts with friends, perhaps pronouncing things like, “I haven’t had a cigarette in two weeks”. People would likely give positive feedback about having quit smoking. Had she an addiction to opiates, Mrs. Burns would likely be more guarded about sharing her sobriety in fear that she may be stigmatized or viewed through an unfavorable prism by peers.
Mrs. Burns had medically objective tests to find the cancer. Doctors could isolate the cancer and perhaps show it to her on a scan. There would be a pre-determined course of action guiding treatment for her. She might receive chemotherapy, go through further testing. Depending on the phase of the cancer, definitive time tables may be discussed regarding the treatment. The evaluation, diagnosis, treatment recommendation and prognosis are relatively clear cut.
Addiction is also evaluated, but not in the same fashion as something like cancer. You cannot take a scan and bring addiction up on a chart. Instead, the diagnostic impression is completed through scaling the severity of ones use. Among the criteria: (1) increased tolerance (2) neglect social, family, vocational/educational obligations due to use (3) experience of withdrawal or use to avoid withdrawal onset (4) persistent desire to cut down or unsuccessful efforts to control use (5) great deal of time spent in obtaining, using or recovering from substance (6) substance taken despite knowledge one has physical or psychological problems that are caused or exacerbated by the substance (continued alcohol use despite knowledge of ulcer; continued use of opiate pills despite knowledge of liver damage) (7) substance taken in larger amounts or for longer periods than intended. The trouble in understanding this as an illness is that the above are all behavioral. Naturally, one might think: don’t engage in the behavior and you won’t have a problem.
Notwithstanding the above scenario presented to illustrate the inconsistencies in our beliefs related to substance abuse as opposed to other illnesses, people have long been warned of the dangers related to drug use. Nancy Regan made the phrase, “Just say no” a piece of the national discussion. Although many remember the phrase, not many with knowledge on the subject would argue it to have been successful as a PSA. Abstinence instruction related to drug use or sex education has both proven to be ineffective ways to manage health issues. We’ve to get to a place that accepts that young people experiment and provide reality-based education, awareness related to these issues.
Addiction is not an event. One is not made an addict in the course of a singular using episode. Rather, addiction unfolds as a process by which substance use and obtainment increases in importance while one’s priorities are neglected. Generally defined, the phases leading to addiction are experimentation, recreation, habituation, abuse, dependence and finally addiction. The lack of intent with which one navigates the terrain is one of the defining characteristics of addiction. Individuals experimenting with drugs might decide that they enjoy it and will do it more often. They may decide to try other drugs that they previously held beliefs against using. They do not decide however, to become physically addicted; they do not aspire to mistreat their loved ones, abandon commitments…and yet, these are the stories you hear about addicts all the time.
Mrs. Burns had the support of family. More importantly, she had no reason to believe family would be anything but supportive. The notion to conceal the illness from family never even crossed her mind. An ability to lean on loved ones through difficult, scary times can be taken for granted…and perhaps that’s a good thing. Some people do not take this ability for granted.
The experience of being addicted is typically lonely. Initial artificially-induced connections made with fellow users tend to fade once one becomes addicted. Substance obtainment and use supersede connection to others. Addicts are constantly aware of two things: the amount they’ve left and the need to replenish once it’s gone. These two thoughts are among the final contemplation before bed and the first as they awaken. The rest of life, throughout the process of addiction-onset, slowly becomes deprioritized. Things considered important, obligations and responsibilities become obstacles standing in the way of use. In order for the addict to attend to other matters, they must have resolved their need to obtain and use drugs.
(To be continued…)
(The preceding article is a guest submission for NiagaraHub.com. The content or opinion expressed within does not necessarily reflect the opinion or views of NiagaraHub.com. Readers are encouraged to submit articles and videos, but NiagaraHub.com expresses the right to approve or disapprove each submission. Each submission will be posted as is.)
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