Addiction and Loneliness

Addiction and Loneliness

A little while back I wrote about the connection between isolation and addiction that Sam Quinones described in his book Dreamland. I wrote about the Former Surgeon General of the United States, Vivek Mirthy, who has also recently published a book about loneliness in the United States, arguing that we have a loneliness epidemic that is causing a number of health issues for people across the country. Mirthy was interviewed on Ezra Klein’s podcast, and the idea of loneliness has been one that Klein has returned to over and over in his show, with small comments or questions to many of his guests during conversations about a wide range of problems in American life.

 

The connection between addiction and loneliness is also something addressed by Johann Hari in his book Chasing the Scream. Hari focuses on the importance of community in helping people avoid drug misuse and addiction, and in helping people recover from addiction. On loneliness he writes, “One recovering heroin and crack addict on the Downtown Eastside [of Vancouver, CA], Dean Wilson, put it to me simply. addiction he said is a disease of loneliness.”

 

Addiction is not limited to people who live on the streets or who have no friends and find themselves in an apartment, isolated from any friends or family. However, isolation in that manner does make illicit drug use, prescription drug abuse, and addiction more likely. Addiction is also not limited to chemical substances. Hari argues that when we feel isolated, when we lack meaning, when we have no community to participate with as part of a broader mission than buying shiny consumer products, we are more likely to form bonds with chemicals, with sex, or with behaviors such as gambling. A sense of loneliness leaves us wanting something more and something different, and often, we can find ourselves addicted to something to distract from our loneliness.

 

Punishing people with addiction challenges, making it harder for them to be part of society, limiting the opportunities for them to have a meaningful job and work toward a social goal makes it harder for them to overcome their addiction and loneliness. Hari writes, “The heroin helps users deal with the pain of being unable to form normal bonds with other humans. The heroin subculture gives them bonds with other human beings.”

 

If we try to fight the addiction and the drug itself, we create a subculture of other lonely humans, who bond together through  their shared addiction and isolation. We almost guarantee that people struggling with addiction will be trapped, unable to find meaning in their life, stuck in isolation, and miserable. The answer from Hari is to instead focus on redeveloping our communities and social infrastructure. To fight loneliness and not addiction, to give people more meaning in their lives by developing more connections between us, and to reinvest in our communal spaces. By building institutions and cultures that push back against loneliness we address the upstream causes of addiction, and help cut away from the pressures that drive toward addiction. This is the ultimate message of Hari’s book, and it is not just a way to fight addiction, but a way to help us all have more meaningful lives.
Addiction and Community

A Final Thought on Addiction and Community

In the afterword of his book Dreamland, author Sam Quinones includes a quote from an obituary written for a 24-year-old man who lived in Avon Lake, a town of about 24,000 people just west of Cleveland. The parents of the young man who died from addiction wrote in their son’s obituary, “They say it takes a community to raise a child. It takes a community to battle addiction.”

 

Everyone, including those of us who are not parents, know that it is true when we say it takes a community to raise a child. Historically, new parents have been in their early to mid twenties (this is changing now – possibly for these communal reasons), and with lower incomes in early stages of their careers and fewer immediate resources, new parents have relied on family members and friends to help with child rearing. As kids get older, they enter public schools, where everyone, parents and non-parents, contribute financially, typically through local property taxes. We know that it is hard to raise a kid on your own, and that it makes a big difference to live near family, to have close friends who are raising kids at the same time, and to have supports from work for the times when our kids are sick and need extra love and attention.

 

The quote from the parents in their son’s obituary, and all of Dreamland demonstrate that the same is true for how we should approach addiction. Asking someone to overcome addiction on their own is like asking a child to raise themselves. It can happen, but it doesn’t often turn out well. People battling addiction need supportive relationships in their lives. The family members and friends of people with addiction need help, because it can be challenging and taxing to help someone else stay sober and find meaning in life beyond addiction. We need communities where we can help each other, watch out for one-another, and provide support in times of need. Many of us have lost this along our way, as our culture has pushed us toward staying inside, watching TV in our own homes, and filling our lives with stuff rather than with the people we love and care about.

 

This is a tough time to find new connections and community as we work to prevent the rapid spread of a new virus, but we should be thinking forward nonetheless to a time where we can better connect with those around us and find new ways to live in community with those who matter. It might just save the life of someone we know whose struggle with addiction has been hidden from us.
More on Isolation and Addiction

More on Isolation and Addiction

I previously wrote about pain medicine ideas that Sam Quinones presents in his book Dreamland. He is critical of the idea that we can take a pill to alleviate chronic pain without making substantial changes in our lives to address the root cause of our pain. Even if we can’t completely stop chronic pain by changing our habits, our environment, and our lifestyles, Quinones shares information which suggests that our experience of pain is connected to many parts of our lives, and that we can change how we think about and relate to pain, even if we cannot eliminate it completely. This is a holistic approach to pain and pain management that Quinones thinks is a crucial piece for understanding our nation’s current opioid epidemic.

 

Chronic pain and its mismanagement is a common route to opioid addiction. Quinones views opioid addictions similarly to how he views chronic pain. In his book he writes, “Chronic pain was probably best treated not by one pill but holistically. In the same way, the antidote to heroin wasn’t so much Naloxone; it was community.”

 

Naloxone is a drug that helps prevent opioid overdoses by binding to opioid receptors in the body to block the effect of opioids like heroin. This drug has helped save thousands of lives, but on its own it won’t stop addiction. Quinones argues that a big problem with addiction is the way in which we hide it from others, whether it is addiction to drugs, gambling, or something else, we don’t allow anyone to know about our addiction. Without talking about addiction, without acknowledging that it has had impacts on our families and lives, and without having meaningful connections with others, we languish in our isolation and addiction.

 

The argument that Quinones makes in his book is that we need more community. We need more things in our lives where we interact meaningfully with others. We need to find more ways to be in service to other people, to work together for meaningful causes, and to have greater social connections with the people around us. By developing meaningful relationships with others, we provide community for everyone, and that helps push back against the forces that drive toward isolation and drive many of us toward substance addiction. Community provides us the space to discuss our challenges, our addictions, and our discontents, and hopefully gives us the chance to build constructive spaces in which we can connect and find solutions to problems that we cannot find in isolation.
Making People Feel Valuable

Making People Feel Valuable

Toward the end of his book Dreamland, Sam Quinones quotes a the VP of sales from a shoelace factory in Portsmouth Ohio named Bryan Davis. Speaking of the company that Davis helps run, and discussing how Davis and a few others took over a failing shoelace company and reinvented it, Davis says, “It’s all been about money, the mighty dollar. The true entrepreneurial spirit of  the U.S. has to be about more than that. It has to be about people, relationships, about building communities.”

 

Quinones writes about how the decline of manufacturing has harmed cities across the United States. He understands why companies have relocated oversees, and in some ways accepts that businesses move and that economies change, but he sees the abandonment of American workers and the lack of supports for those workers when opportunities disappear as a major contributing factor to the Nation’s current opioid epidemic. When people suddenly lose the job they have held for years, when there is no clear alternative for them to turn to in order to feel useful, valuable, and like a contributing member of society, an alternative to ease the pain of their new reality is often pain killing opioid medications. It is an easy recipe for widespread addiction.

 

I don’t understand economics well enough to place criticism on businesses and factories that move operations to different cities, different states, or different countries altogether. I won’t criticize or praise these companies, but what is clear to me, is that we need to find ways to be more respectful of the people who work for and with us. We need to find real ways to make people feel valuable in their jobs, whether they are call center staff, healthcare workers, or a VP of a successful company. We can’t set out with a goal to make money and then withdraw ourselves from the lives of our fellow Americans and communities. We have to develop real relationships with people across the political, economic, and cultural spectrum of the communities where we live, otherwise we turn toward isolation, which isn’t helpful or healthy for ourselves or others in the long run.

 

This is the idea that Bryan Davis expressed. We can be inventive, creative, and push for economic success, but we should do so in a way that supports our community and values relationships with those around us and in our lives. If we only drive toward our own wealth and bottom line, we risk exploiting people, and that ultimately leaves them in a vulnerable position where isolation, depression, and isolation are all the more possible.
Isolation and Addiction

Isolation and Addiction

American’s are isolated, and it’s not just because we have all been asked to work from home, stay inside, and intentionally distance ourselves from others to prevent the exponential transmission of COVID-19. We have been isolated for a while, so much so that former Surgeon General of the United States, Vivek Murthy, recently published a book about loneliness and the importance of human connection. Loneliness and isolation are new problems that we are starting to look at in new ways. In his book Dreamland, Sam Quinones connects isolation and addiction in ways that change the discussion we have about addiction and our values as Americans.

 

Quinones is critical of how our society interacts today, or rather how our society doesn’t interact. He writes, “the most selfish drug [opioids] fed on atomized communities. Isolation was now as endemic to wealthy suburbs as to the Rust Belt, and had been building for years. It was true about much of a country where the streets were barren on summer evenings and kids no longer played Kick the Can as parents watched from porches. That dreamland has been lost and replaced, all too often, finally, by empty streets of bigger, nicer houses hiding addiction that each family kept secret.”

 

To atomize means to convert into very fine particles or droplets, and is used by Quinones to show that we have separated our communities into individual, isolated nuclear units. We hide inside our houses, rarely venturing outside to just be outside. We drive to our suburbs, stop at the mailbox from our car, park in our garages, and rarely spend any time outside. If we do get out, we are in our private backyard where we cannot be seen. We have cut out everyone else, leaving us with just ourselves in our ever larger houses filled with ever more things for our individual enjoyment.

 

Quinones argues that this lifestyle has been brought on by our own selfishness. We want our own stuff, we want to show it off, and it holds more value today than it did in the past. Consequently, we are also more jealous of those who have more than us, and more guarded of our things. We lock out other to protect our stuff, but in the process we locked out a crucial part of our humanity: our connections and community.

 

Community shows us that there is more to life than just our desires. Isolation and addiction are linked because when we withdraw from community, when we focus only inward on what we want, our purpose of helping others and interacting with others disappears. Quinones believes that a lack of interaction with others fueled the opioid crisis. We hid addiction in our homes, withdrew from community, and and took away the joys and connections that made us human. We left ourselves vulnerable to pain killing addictions, and took away the best tools to cure the epidemic we now face.
Constructive Thoughts on Wellness

Constructive Thoughts on Wellness

There is an argument in the world of public health that the American medical system is too focused on solving problems rather than preventing problems. This argument that is presented in Sam Quinones’ book Dreamland, expressed by Dr. Alex Cahana, “The U.S. medical system is good at fighting disease, … and awful at leading people to wellness.”

 

The difference between fighting disease and leading people to wellness has to do with where you step in to help with people’s health. Our country generally focuses on providing medical care and attention after someone has gotten sick. We ask doctors, nurses, and medical professionals to correct a huge range of problems, many of which stem from bad habits, unhealthy environmental factors, and conditions that are generally beyond the control of an individual, and not open to medical interventions. Attacking the problem once it has already developed, once a set of factors have set in that promote the health problem, makes any real changes expensive and difficult.

 

Wellness requires that we think about medical care, costs, and health further upstream, before anyone ever gets sick. Consider the idea of wellness in the context of car maintenance (I know, I know, I just wrote about the problems with comparing ourselves to cars, but this will be helpful).

 

If you regularly change your oil, rotate your tires, and drive as if your grandma was in the car with you, then your vehicle is going to operate more smoothly with fewer major costs (in general) throughout its entire life. You are making small interventions along the way to make sure your car is operating optimally. The costs of changing your oil and putting in the necessary effort to keep it working well are not trivial, but we know that those costs are less than what we might face otherwise.

 

Failing to maintain our vehicle could lead to a catastrophic engine failure. Driving our car like a teenager that just downed two Redbulls is going to put a lot of strain on the vehicle, wearing out our tires and breaks much faster. When things wear our quicker, when unexpected failures occur, we suddenly have to pay a lot more money to keep the car going.

 

Our bodies are similar, and whether it is our national Medicaid or Medicare systems, or our private health insurance systems, the cost we pay for healthcare is interconnected with where we step in to try to make people healthy. Paying for interventions downstream, once we already have health problems is expensive. It is equivalent waiting until our human check engine lights turn on before we consider doing anything to help our health. The solution that many medical professionals and many public health researchers encourage is moving upstream from the actual health problems that develop to focus on interventions before anyone develops terrible disease. The idea is to focus on wellness first, and hope we don’t have to pay for as much medical care for the prohibitively expensive diseases down the road. Rather than focusing all our effort on solving disease, we can redirect some of the money and effort into improving our environments, finding new ways to help people adopt healthy lifestyles, and finding more ways to connect and help us share in wellness as a community.
Technology & Pain

Questioning Our Confidence in Technological Solutions

Sam Quinones interviewed Alex Cahan, a pain medicine specialist in New York, for his book Dreamland. He is quoted in the book talking about the approach that most people have toward pain and alleviating their pain. Many people want an immediate solution that comes from technology and allows them to continue living their life as they always have.

 

Quinones writes, “Cahana saw stuff [Author Note: unproven medical treatments, more surgeries, more pills, etc…] as the problem. Our reverence for technology blinded us to more holistic solutions.” The holistic approach is not one of mystic arts or managing ones energy, but is an approach focused on how we live and what health habits we have. Smoking, minimal exercise, and living with stress that we can’t regulate are all parts of our life that can make the physical pain that we experience much worse, or can lead to worsening health and pain developing from other real medical conditions. An approach to pain medicine that doesn’t consider our actual lifestyle cannot help address the root of our pain.

 

Quinones continues with a quote from Cahana, “We got to the moon, invented the internet. We can do anything. It’s inconceivable to think there are problems that don’t have a technological solution. To go from I can do anything to I deserve everything is very quick.” 

 

Cahan’s argument is that our technological innovations and the stories we tell about our scientific progress blinds us from the reality of the human body. We are not machines, we are not our own technological innovations, even if we like to believe that we can all be Iron Man. The reality is that we have to think about how we live, about the things we do, and about what could be changed, adapted, or included in our lives to help us be more healthy and experience less pain. We don’t have to believe in a mystical energy around our bodies. We don’t have to turn to medical treatments that are not proven to be safe or effective. But we do have to think about what is important in our lives, what values we hold, and how we can make changes that help us align with  those values in a healthy and reasonable way. Once we have seen where we can make changes in our actual lives and what habits can help us improve our health and reduce our pain, it is up to us to live accordingly, not up to technology to instantly solve our problems.
Developing Self Esteem

Developing Self-Esteem

One of the reasons I write this blog is because I believe that we need deeper conversations about minor aspects of our lives. I think we need to be more considerate about what is truly important, and we need to think more deeply about how we can remove some of the less important things, so that we spend more time engaging with what is meaningful. I want to pull out the crucial ideas within the aspects of our lives that go overlooked and that are under-discussed so that hopefully someone can have a more thoughtful conversation about these important topics.

 

One topic, which came to mind from Sam Quinones’s book Dreamland, is the development of self-esteem for adolescents. I’m not a parent, so I am sure that I am missing some important points here and I’m sure that my perspective is limited, but from my experience and observations I feel  confident to say that important conversations about meaning, value, and expectations are not taking place with adolescents. What I’m thinking about now is how parents, coaches, and people in society can help young people develop a sense of self-esteem aligned around meaningful values that help make the world a better place.

 

Quinones quotes Ed Hughes, the former executive director of The Counseling Center in Portsmouth, OH, “You only develop self-esteem one way, and that’s through accomplishment.” Quinones himself is critical of parenting in the 90’s and 2000’s writing, “Parents shielded their kids from complications and hardships, and praised them for minor accomplishments – all as they had less time for their kids.”

 

The critique that Quinones and Hughes make is that parents have gone through great lengths to give their kids everything and to try to ensure that their children are never bored, never unhappy, and never potentially harmed – either physically or mentally. The result, according to Quinones and Hughes, is that children are unprepared for real life. They lack self-esteem because any accomplishments that they have are minor, and were parent assisted or directed. Many kids did not struggle on their own, did not learn from mistakes, and were propped up with empty praise. This left them feeling bored, empty, vulnerable, and inadequate, which made drug addiction all the more likely.

 

What I hope we can do, not just as parents but as a society, is talk about real opportunities for taking meaningful actions in our lives. I hope we can back away from terrible work schedules and the pursuit of ever more money and consumer goods, and move toward a society which encourages real interaction and contribution toward involvement and engagement. This can be done starting with our youth, with the opportunities we provide them to be engaged in something meaningful, and with the conversations we have with them about what is important in life.

 

If we don’t have these conversations with our youth, if we don’t help give them opportunities to do something meaningful, then they will look to TV, celebrities, and our own actions to determine what is good and important. Often that will be the same empty vision of happiness presented in our consumer culture focused on buying products and showing off our wealth. Quinones and Hughes would likely argue that this is only going to exacerbate our loneliness, emptiness, and the potential for drug use and despair.
Thoughts on Personal Responsibility

Complex and Conflicting Thoughts on Personal Responsibility

I’m really hesitant to criticize others for not taking sufficient personal responsibility for the ways they live and the outcomes of their lives. A lot of factors influence whether you are economically successful or whether you are fit and healthy. Some things we seem to have a lot of control over, but many things are matters of chance and circumstance. Placing too much blame on the individual doesn’t seem fair, yet at the same time, there is clearly an element of personal responsibility involved. I’m not sure where I land on how we should think about this division.

 

What is clear, however, is that there can be negative consequences when we take away people’s agency in their decision-making and life outcomes, and when we erode the authority of those who are reasonably critical of negative lifestyles and ways of thinking and being, we can put ourselves and societies in vulnerable positions.

 

Sam Quinones writes about these tensions in his book Dreamland and he highlights how patient responsibility and physician authority devolved between the 1980’s and twenty-teens as a quick fix, there’s-a-drug-for-that mindset took hold of the American healthcare system. He writes, “…patients were getting used to demanding drugs for treatment. They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist. As the defenestration of the physician’s authority and clinical experience was under way, patients didn’t have to take accountability for their own behavior.”

 

I’m usually hesitant to say that the problem is people’s lack of accountability, because how often do we really control how much exercise we can get when many of us live in places where walking is difficult because our streets are not safe, or are not well designed for pedestrian use, or because half the year it is dark early and we get lots of snowfall? How often do we not know what kinds of exercises we should do, and how often do we have people who are only critical of our current state rather than supportive and encouraging? How often have we had a bad break and poor advice on how to get back, only leading to a further defeat, deflating our sense of self worth? In addition to all this, how often have we seen people use the personal responsibility argument in bad faith? To justify not helping others or to rationalize their greed or excessive self-aggrandizement?

 

But at the same time, as Quinones shows, responsibility is important. We need to think about what we can and should be doing to help improve our own lives, without hoping for an easy fix in the form of a miracle pill. We can’t just throw out the opinions of experts and devalue their authority because they are willing to say things that are discomforting for us, but are likely correct in terms of how we can make our lives better. Somehow we need to work together to build a society that recognizes the barriers and challenges that we face toward becoming the successful and healthy people that we want to be, but encourages us to still work hard and overcome obstacles by taking responsibility for our actions and (at least some percentage of) our outcomes. I don’t know what this looks like exactly, and I’m not sure where the line falls between personal responsibility and outside factors, but I am willing to have an honest discussion about it and about what it all means for how we relate to each other.
Humans are Not Automobiles

Metaphors and Similes of the Human Body

Human beings think in metaphors and similes, especially when it comes to thinking about ourselves. We come to understand one thing by comparing it to another, and we describe something as being like something else, to help us understand how we should relate to it. A metaphorical way of thinking that Sam Quinones is critical of in his book Dreamland is the description of the human body as an automobile, or more generally as a machine.

 

We think of ourselves as if we were the most advanced technologies we have developed. We imagine that we could have parts swapped, that we just need little tune-ups here and there, that all we need is a mechanic to tinker with a few things and we will be back to running smoothly if we are ever out of whack. However, this metaphor, like all metaphors, is an incomplete way to understand the reality of what we are.

 

Our minds are only so good at holding lots of complex information. We use metaphor and simile to simplify our thought process. Metaphors and similes serve as heuristics to understand and conceptualize complex structures and relationships, but they don’t actually capture the full scope of reality. To say that the human body is an automobile, or operates as an automobile, misses key aspects of human dynamism, plasticity, adaptability, and function. We respond to the world and our environments, change and adapt to new settings and structures, and move in ways that no machine that we can create today can. We share some things in common with machines, but we are not machines.

 

In Dreamland, Quinones quotes a physician at the University of Washington Center for Pain Relief named John Loeser who explains why this type of thinking is dangerous, “Usually the patient says, ‘I come to you, the doctor. Fix me.’ They treat themselves like an automobile. People become believers in the philosophy that all I need is to go to my doctor and my doctor will tell me what the problem is. That attitude has been fostered by the medical community and Big Pharma. The population wants to be fixed overnight. This is the issue we addressed with chronic pain patients. They have to learn it’s their body, their pain, their health. The work is done by them.”

 

The automobile metaphor manifests falls apart when we project a quick scientific and technical fix for ourselves. The idea that all we need is a special additive to make our body work better is what fuels our desire to have a pill to solve all our medical problems, and it is emboldened by the idea that we are basically automobiles.

 

We always compare ourselves, our brains, and our bodies to the highest technology of the time. If we don’t consider ourselves automobiles anymore, we probably think of ourselves as technical space ships or precision fighter jets. Humans once thought of the brain as a complex system of pulleys and levers, and now we think of our brains as supercomputers.

 

What Quinones uses the quote from Loeser to show is that we are living systems. We are not machines that can be isolated from our environment, tinkered with, and tuned for optimal performance. We have to be responsible for how we live and the systems, structures, societies, and institutions that we all build and live within. If we don’t truly think of ourselves as more dynamic than machines, and if we don’t consider our interconnectedness, we will never understand ourselves properly, and we will never fix the problems we face, like chronic pain. We will turn to cheap tricks and remedies, and we will face the consequences of living in a way that praises quick fixes and pills to try to solve our problems.